You have been injured at work and are being treated by a physician. The physician has said you can return to work or there is nothing more he or she can do for you. What happens now?
There are two phases to a Kentucky Workers´ Compensation Claim. The first is the temporary phase and is addressed in the TTD Benefits page. During this phase, the injured worker is entitled to both income and medical benefits. However, when any physician says you can return to work or you have reached maximum medical improvement (MMI), the income benefits are terminated. This brings us to the permanent phase of a workers´ compensation claim. In this phase, the injured worker is paid for the loss of ability to work (impairment) he or she has suffered as a result of the work injury, in addition to continuing medical benefits.
Special note: Once the TTD benefits are terminated, generally there will be no additional benefits paid to you until the Judge has approved a settlement or entered a judgment in your favor. This could be months from the time the TTD benefits are terminated and many clients have difficult financial times during this period, especially if they are unable to return to work. It is a good idea to set aside some of the TTD benefits to survive this period, especially if you do not have a working spouse who can pay the bills.
If the insurance company does not promptly offer a settlement that is reasonable, you will have to file a formal workers´ compensation claim using a Form 101 and the necessary attachments. The Department of Workers´ Claims will then assign your case a number, assign it to an Administrative Law Judge and set it for a hearing a few months away. During the time before your hearing, you will likely be evaluated by another insurance defense physician to minimize your injury. Most Plaintiff attorneys will have you evaluated as well to counter the efforts of the insurance company. You will also likely have to testify under oath (a deposition) to answer questions about your work history, medical history and this injury. Eventually, you will be ready for your Benefit Review Conference (BRC).
The BRC is an informal hearing held with the Administrative Law Judge in which the attorneys discuss your case. They will determine which issues they can agree on and decide what issues remain contested. If all of your medical treatment is complete and you are at Maximum Medical Improvement, the case will then be set for a final hearing within two to four (2-4) weeks.
The Final Hearing is similar to the deposition you have already given, but will be shorter. Both your attorney and the insurance company attorney will ask you questions about your injury. At the conclusion of the Final Hearing, the Judge will instruct the attorneys to file legal Briefs supporting their arguments. A decision will be made on your case within sixty (60) days following the final hearing.
While this background information is important, the main question our clients have is “how much money will I get?” The answer to this question is rarely satisfying. It is important to remember that the main benefit of a workers´ compensation claim is the medical benefit. If you win your case, the insurance carrier will have to pay for your medical bills related to the work injury for life. PPD Benefits, however, are not for life.
In 1996, Kentucky changed the system to pay injured workers for a total of 425 weeks. Thus, you will receive benefits for approximately 8 years. The period may be longer if you are totally disabled, but those cases are very rare. The benefits are based upon the level of impairment the physicians gave you.
For Example: If you are a worker earning $600.00 per week and the physician says you have a 5% impairment, the benefits calculation is $600.00 x 2/3 = $400.00 (TTD rate) x .05 x .65 = $13.00 per week for 425 weeks. A total settlement over time of $5,525.00.
There are factors that may increase the weekly amount, but the example shows that the PPD Benefit amount can be very small, depending on the impairment rating you are given by the physicians. It is important to remember that the insurance company is only paying you for what you lost due to this injury. They are not paying for your entire wages. This is why it is generally a good idea to see another physician who may determine that you have a higher impairment rating.
CAN I GET ONE LUMP SUM PAYMENT?
This is a question that comes up frequently as most clients do not want to receive $13.00 each week, but would rather have one large payment. This is an option if the case is settled, but not if the Judge decides the case. However, many insurance companies will want to also settle their obligation to pay for future medical treatment if they give you a lump sum payment. Depending on your injury, this may or may not be a good idea. Generally, the insurance company will offer an additional amount to get you to give up these benefits.
Permanent Partial Disability (PPD) Benefits are complicated and confusing and this information could not possibly cover all of the factors that go into determining the amount of PPD benefits you are due. If you have any future impairment at all from your work injury, it is strongly recommended that you consult with an experienced workers´ compensation attorney.
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