How to Calculate Workers’ Compensation Benefits

The workers’ compensation system pays three primary benefits: the cost of medical care, temporary disability benefits, and permanent disability benefits. Since most medical expenses are paid as they are incurred, those benefits do not usually need to be calculated. However, injured workers may need help understanding how to calculate their disability benefits. A workers’ compensation lawyer at Santa Rosa’s Kneisler & Schondel can help calculate workers’ compensation disability benefits.

Calculating Temporary Disability Benefits

Temporary disability benefits are usually easy to calculate. As a general rule, injured workers who are unable to work due their injuries are entitled to a temporary disability benefit that equals two-thirds of their gross wages (that is, wages prior to deduction of taxes and other withholdings). These benefits are tax free.

Injured workers are entitled to temporary disability benefits after missing three days of work or spending the night in a hospital due to a work-related injury. The benefits are paid every two weeks, beginning 14 days after a physician determines that the injured worker will be unable to return to work due to the work-related injury or medical condition.

The general rule is subject to some exceptions, so not every worker will receive temporary disability benefits that equal two-thirds of their wages. Low-wage injured workers are entitled to a minimum weekly disability benefit and nobody may receive more than the maximum weekly disability benefit.

The minimum and maximum weekly disability benefits depend on the year in which the injury occurred. The minimum weekly temporary disability benefit for an injury that occurred in 2017 is $175.88 per week (up from $169.26 for injuries in 2016). The maximum weekly temporary disability benefit for an injury that occurred in 2017 is $1,172.57 (up from $1,128.43 for injuries in 2016).

Calculating Permanent Disability Benefits

Permanent disability benefits are more difficult to calculate and give rise to one of the most disputed issues in the workers’ compensation system. Generally, workers’ compensation claims adjusters will be motivated to interpret the evidence in a way that minimizes permanent disability benefits. To help resolve these issues, it is helpful to have an experienced Santa Rosa workers’ compensation lawyer calculate your permanent disability benefit.

Several steps must be followed to calculate workers’ compensation permanent disability benefits.

1. Review the QME Report

Permanent disability benefits are paid after an injured worker’s Qualified Medical Examiner (QME) determines that the injury is no longer improving and is not likely to get any better. The workers’ compensation system refers to that as reaching the point of maximum medical improvement (MMI).

In order to calculate permanent disability benefits, one must start with a report written by a QME. The report describes the injury, the functional impairment caused, and provides an opinion as to what future medical care may be needed to help the injured worker maintain her current level of disability.

The report will quantify the injured worker’s functional limitations (such as bending, lifting, or range of motion) that are caused by the injury. The report describes limitations which affect the injured worker’s Activities of Daily Living (ADL’s). Finally, the report will estimate how much of the employee’s disability is related to the work injury and how much, if any, was caused by other activities.

The value of permanent disability benefits depends heavily on the QME report. It is important to assure that the QME corrects any inaccuracies in the report. The injured worker’s Santa Rosa workers’ compensation attorney can help select a QME from a panel provided by the Division of Workers’ Compensation.

2. Obtain a Rating

The QME report is used to determine a disability rating. The rating will range from 0% disability (no functional impairment) up to 100% disability (permanently and totally disabled).

An experienced Santa Rosa workers’ compensation lawyer can help calculate the rating of a QME report, and may be able to use that rating to negotiate a fair settlement. When the injured worker’s lawyer and the claims adjuster disagree about the rating, they may turn to a disability rater or a Workers’ Compensation Judge (WCJ) to issue a rating.

Permanent Disability Ratings are based on a number of factors, including:

• The disability described in the QME report
• The injured workers’ age when injured
• The injured workers’ occupation
• The date of the injury
• How much of the disability is caused by the work injury
• An adjustment factor (which varies depending on the date of the injury)

Determining a permanent disability rating makes it possible to calculate the permanent disability benefits that are due.

3. Calculating the Permanent Disability Benefit

The permanent disability benefit is based on:

• The permanent disability rating
• The date of injury
• The injured workers’ wages at the time of the injury
• In certain cases, whether or not the employer invited the injured worker back to work after the injury

Those four factors are inserted into a mathematical formula that determines the permanent disability benefit.

Settling Workers’ Compensation Claims

If an injured workers’ attorney and the insurance adjuster can agree on the rating, the case can generally be settled. If not, permanent disability benefits may need to be determined by a workers’ compensation judge. Either way, injured workers benefit from having their permanent disability benefits calculated by an attorney at Santa Rosa’s Kneisler & Schondel. To get that process started, call us at (707) 542-5132 or submit our online contact form.