How Is Workers’ Compensation Calculated?

How Is Workers' Compensation Calculated?

Question

How can I calculate the amount of my compensation if I got injured at work?

 

Answer

You can calculate your workers’ compensation by using the average weekly wage formula from the R.I. department of labor. 

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The Weekly Indemnity Formula

The amount you receive in your weekly workers’ compensation benefit check (sometimes referred to as “weekly indemnity”) is calculated using a statutory formula that is based on your average straight gross earnings during the 13 weeks immeadiately prior to your injury, plus an average of your overtime/bonuses for the 52 weeks prior to your injury, and your dependency status (i.e. single/married/children, etc.).  

How To Determine Your Spendable Base Wage?

This formula is used to arrive at your “average weekly wage” (AWW) for workers’ compensation purposes. Your average weekly wage amount (AWW) is then used to determine your “spendable base wage,” which can be ascertained by using the RI Department of Labor’s spendable base wage tables in effect as of the date of your injury. 

Find your average weekly wage on the left-most column on the applicable wage table, and then go across that row to find your status on the applicable table columns (i.e. single-2 or married-3, etc.), that number will be your “spendable base wage.”  Once you have that number, what you actually receive in your weekly workers’ compensation check will be 75% that number, i.e. you weekly check will amount to 75% of your spendable base wage.

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What’s workers’ compensation insurance?

What's workers' compensation insurance?

Question

What is the purpose of workers’ compensation insurance?

Answer

The purpose is to pay injured workers’ the benefits they are entitled to under the workers’ compensation laws of the jurisdiction that applies. 

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What's The Purpose of Workers' Compensation Insurance?​

Workers’ compensation insurance is a type of insurance that employers can and usually have to purchase by law and carry.  Failure to carry workers’ compensation insurance can subject employers to severe penalties.  

The purpose of workers’ compensation insurance is to pay injured workers’ the benefits they are entitled to under the workers’ compensation laws of the jurisdiction that applies (usually state law). 

The payments are typically handled by the workers’ compensation insurance company (or a company hired by the insurance company to administer workers’ compensation claims).

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What’s workers’ compensation?

What's workers' compensation?

Question

I was injured at work – What’s workers’ compensation?

Answer

Workers’ compensation are benefits paid by insurance that injured workers may receive and must be carried by their employer.

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Workers' Compensation Defined

Workers’ compensation is a system created by your state legislature to provide for injured workers. Prior to the creation of a workers’ compensation system, injured workers often had no remedy or benefits to sustain them when they were unable to work and earn.  In limited cases, prior to the creation of the workers’ compensation system, injured workers’ only remedy might be to sue their employer and prove that the employer was somehow negligent or at fault for the injuries.  

As a result of the workers’ compensation system, however, workers no longer have to sue their employers, or prove fault, on account of their injuries. Rather, injured workers may receive benefits paid by insurance that must be carried by their employer. These benefits can include partial weekly wage replacement while you are hurt and out of work, medical treatment, and other payments.

Prove You Were Hurt at Work

Therefore, instead of having to show that someone negligently caused their injuries as a prerequisite to recovery, injured workers need only show that they were hurt at work.  No fault need be shown. Each state has different rules and features of their workers’ compensation system, and how long you can collect, what you can collect, and what you are entitled to various on a state-to-state basis.  You are best served by consulting with a local workers’ compensation attorney to better understand your rights.

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What will workers’ compensation cover?​

What will workers' compensation cover?

Question

I have a workers’ comp case- what costs will it cover?

Answer

Worker’s compensation will pay you a weekly benefit during times you are unable to work due to your injury.

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General Workers' Comp Payments

Worker’s compensation will pay you a weekly benefit during times you are unable to work due to your injury.  The amount of this benefit is calculated using a statutory formula that is generally based on your earnings during the 13 weeks prior to your injury, your overtime/bonuses for the 52 weeks prior to your injury, and your dependency status (i.e. single/married/children, etc.).

This formula is used to arrive at your “average weekly wage” for workers’ compensation purposes. Your average weekly wage amount is then used to determine your “spendable base wage,” which can be ascertained by using the RI Department of Labor’s spendable base wage tables in effect as of the date of your injury.

What you actually receive in your weekly workers’ compensation check will typically be 75% of your spendable base wage. Although there are exceptions, generally, you may collect for up to 6 years, provided you remain partially disabled from your job as a result of the injury.

In Addition to your Check

In addition to your weekly benefit check, workers’ compensation will pay for all medical treatment, devices, and prescriptions which are reasonable and necessary to treat you.  This can include doctor’s visits, physical therapy, injections, MRI or other imaging studies/tests, surgery, etc.

There are also additional specific amounts of money that you may be entitled to under the Rhode Island Workers’ Compensation system for scarring/disfigurement related to the injury or surgery for the injury, as well as for “loss of use” or “permanency rating” if there are permanent injuries. You may also receive mileage reimbursement for certain trips to doctor’s/therapy appointments.

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How long will workers’ compensation last?​

How long will workers' compensation last?

Question

How long can I expect my workers’ comp payments to last?

Answer

Generally, you may collect weekly workers’ compensation for up to six (6) years, i.e., 312 weekly checks.

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The Workers' Comp Payment Period

Generally, you may collect weekly workers’ compensation for up to six (6) years, i.e., 312 weekly checks.  We say “generally” because most people out on workers’ compensation are considered “partially disabled,” and the maximum those who are “partial” can collect weekly benefits is 312 weeks.  This time limit, however, does not apply to your rights to have medical treatment for the injuries paid for.

That right continues beyond any 6-year time period. As long as medical treatment is “reasonable and necessary to cure, rehabilitate, or relieve the employee” from the effects of his/her work-related injuries, it shall be paid for under the Rhode Island workers’ compensation system.

The "Total" Exception

There are more exceptional cases where an employee may be deemed “total” in terms of their disability from working.  The significance of being “total” in terms of how long you may remain out on workers’ compensation is that there is no time limit for those who are totally disabled.  A better way of putting this is to say that the six (6) year (312 week) clock for collecting workers’ compensation is not ticking while the employee is “totally disabled” as a result of the work injury. 

“Total” cases are exceptional, difficult to prove, and fiercely contested, however, they tend to have significant settlement value, the reason being that the employer/insurer could theoretically have to pay weekly benefits for the rest of the employee’s natural life – which amounts to significant potential exposure.

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How will my workers’ compensation settlement be paid?​

How will my workers' compensation settlement be paid?

Question

I have a workers’ comp case- how will my settlement be paid?​

Answer

Once the judge approves the settlement and enters a court order, the company typically has fourteen (14) days to pay.

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How the Judge Approves a Settlement

If you settle your workers’ compensation case, you will have to go to court for a brief hearing for a judge to approve the settlement.  This will generally consist of your lawyer asking you questions about the settlement in front of the judge, so that the judge can listen and make sure you are voluntarily entering into the settlement (i..e that you understand you do not have to settle your case and that no one is forcing you to settle), that you understand the terms of the settlement (i.e. what you will receive as your net settlement amount after any attorney’s fees or costs), and most importantly, that you understand the consequences of the settlement (i.e. that your case is going to be over forever and all time).

When You Get Paid for Your Case

Once you do this, and the judge approves the settlement, the judge will typically enter a court order right then and there approving the settlement before you leave. It is from that point that the employer/insurance company has fourteen (14) days to pay you your settlement money. Typically, the insurer will send one check directly to you for your net settlement amount, and send a second check directly to your attorney for the attorney’s fee.

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When Can I Get My Scar Money?

When Can I Get My Scar Money?

Question

When Can I Get My Scar Money?

Answer

The point in time at which you are likely to receive this benefit is when a doctor has given an opinion that your disfigurement is at “end result,” meaning that further medical care is unlikely to enhance the appearance of it.
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When Scar Money Arrives

The Rhode Island Workers’ Compensation Act does provide for a separate benefit, i.e. a separate check and amount of money if you have disfigurement from the injury, whether that is a scar, a burn or some other deformity. Once you are at that point in time, your lawyer and the insurer will meet with you to view the deformity or disfigurement and try to agree on a number or a dollar amount that is fair.

How Much Scar Money is Worth

The value of your scarring or disfigurement is highly subjective. However, a lawyer who has done this many times will have a very good idea as to whether you are better off taking the offer that is on the table for the scarring or proceeding to workers’ compensation court and having a judge determine the amount of your scarring benefit. This usually occurs about six months after the date of the injury, but it could happen earlier or later.

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What Is The “Going and Coming” Defense To Workers’ Compensation?

What Is The “Going and Coming” Defense To Workers’ Compensation?

Question

What Is The “Going and Coming” Defense To Workers’ Compensation?

Answer

The going and coming rule is a rule that Rhode Island recognizes as a bar or a prohibition against receiving compensation.
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The Rule

Generally, the rule states that injuries sustained while going to or coming from the workplace are not compensable under the Rhode Island Workers’ Compensation Act and do not entitle the employee to any benefits. In reality, however, case law overtime has expanded the number of exceptions to that rule- so much so that it’s commonly considered that the exceptions have swallowed the rule.

You're Neither Entitled or Barred

So, that’s not to say that if you have a case where you get hurt going to or coming from the workplace that you will be entitled to benefits. The employers and insurers will aggressively pursue a going and coming defense the moment they smell one. This requires that your lawyer be very well-versed in handling that area of the law because the case could be hotly contested. At the end of the day, the mere fact that you were going to or coming from work when you got injured does not necessarily mean that you’ll be barred from compensation.

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Is There A Danger Of Getting Less Than What An Insurance Company Initially Offered At Trial?

Is There A Danger Of Getting Less Than What An Insurance Company Initially Offered At Trial?

Question

Is it possible to get less when my workers’ comp case goes to trial?

Answer

If you go to trial, it’s always possible to lose and therefore end up with less than what you were offered.
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The Compromise

The offer is a compromise on both sides, because the insurance company could wind up not owing you anything. On the other hand, you may prevail and they may owe you a lot more than what they initially offered.

Difficult Cases

These types of cases and situations require a great deal of judgment and experience on the part of your workers’ compensation lawyer. They also require a lot of thought from the employee, because everyone’s situation is different; what might be best for one person may not be the best for another person.

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What Can I Expect If My Claim Goes To A Hearing Or Trial?

What Can I Expect If My Claim Goes To A Hearing Or Trial?

Question

What happens when my claim goes to trial or a hearing?

Answer

Anytime you file a petition in the workers’ compensation court in Rhode Island, the matter comes on for a pretrial hearing.
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During the Pretrial Hearing

If there is a dispute about whether or not you’re entitled to benefits under the Rhode Island Workers’ Compensation Act, your lawyer may file what’s called an original petition, which essentially determines whether or not you should be on workers’ compensation at all. Once filed, that petition will trigger a “pretrial hearing,” which is a court date that you and your lawyer attend.

During that hearing, a judge will informally listen to arguments from both sides, review evidence available at the time, and make a preliminary determination without the benefit of a full hearing. In some cases, a judge might determine at the pretrial heraing that additional evidence or a full trial is necessary.

Why Pretrial is Important

In reality, the pretrial conference on your original petition is the most important day in the life of your workers’ compensation case in Rhode Island. The reason for that is if your original petition is granted at this first pretrial hearing court date, then you’ll immediately begin to receive everything you’re entitled to under the workers’ compensation act. For all intents and purposes, you would be in the driver’s seat in terms of your legal case.

If your case is denied at the pretrial level, then you will have to take a “claim for trial” (an appeal) and you would not receive benefits during that process. You will then be proceeding through a long and winding road known as claiming a trial, which can be very difficult, and take a very long time, all during which you’re not receiving income replacement.

Why Petitions Aren't Granted

There are many reasons why a petition may not be granted at the pretrial level. While lawyers try to avoid proceeding further than the pre-trial hearing, doing so can be necessary. There are also some cases in which the lawyer and the employee realistically know that the case has serious legal problems. In those cases, the lawyer should make his or her client very aware of the fact that a denial at the pretrial level is likely.

They should already be prepared for how they’re going to attack the case after that point, whether it’s to target some sort of settlement through a denial and dismissal, or to proceed through a full trial. If doing the latter, a strategy has to be determined and the cost to the employee of prosecuting the case in the absence of receiving any benefits must be considered.

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