How Workers Comp Weekly Rate Is Calculated – Temporary Total Disability

April 1, 2021 By Erica Libo 11 Comments

Workers Comp Weekly Rate for TTD – The Basics

Workers Comp weekly rates for TTD in all states are calculated differently. Workers are all deserving of the benefits beyond their efforts to work on time.

They need financial help from their employers while they are suffering from injuries that they may have during their working period. TTD or Temporary Total Disability is a disability wherein a worker who is injured or got ill can’t perform or unable to do any job temporarily.

Signage of Disability Workers Comp Weekly Rate outside the house

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TTD usually involves a waiting period. This has two categories: these are (1) TTD and (2) TD. Both of those explain if an employee is injured or ill for let’s say a week or longer than that they will be receiving payments.

You’ll be receiving TTD if you can’t work during your recovery stage. The amount of payment that an employee will be going to receive depends on their wage rate.

The payment that they might receive will be tax-free. For instance, if an employee earns $ 8 per hour and works 5 hours per week for an employer their Average Weekly Wage equals $40.00 per week.

In most states, the Workers Compensation weekly benefit is 2/3 of the Average Weekly Wage. Two-thirds of $40 equals $26.67 which is the workers’ comp benefits rate. In most states, the minimum compensation is $30, so the employee would receive $30 per week. This is just an example. Because not all the states have the same wage rate and policy about the TTD.

You’ll get your TTD according to the state where you are working. Each state has its special form. Most wage statements cover a period of 13, 26, or 52 weeks before the employee’s date of injury. North Carolina always seems to calculate a different wage than what the adjuster has deciphered as the Workers Compensation TTD rate. Employees can’t receive more than the maximum weekly amount.

While an injured employee was declared as TTD, FMLA notice should follow the same time of employee’s leave. If an injured employee is not formally notified while they are in TTD, there is what you called FMLA or Family Medical Leave Act that is not going to expire automatically.

Man is sick Worker Comp Weekly Rate laying at bed with meds on table

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Employers are the one who is responsible for sending that. Because if not, there may be the instance that employee will be entitled to 12 more weeks on leave even though their TTD ends already and they are being offered for the return to work.

Workers’ employees will not be paid after 7 to 21 days of being injured, but if it is extended by 22 days they will surely receiving payments. There is one from the previous articles that talks about TTD and PTD being a lifetime benefit.

Because there are some chances that unexpected things that might happen. Rates are always depending on the state where you are located. As an employer, you should always prioritize health more than anything. After that, make sure that you have been expecting something from the company if any incident might come on an unexpected day.

Always remember that even though there are such things as TTD, employees should take good care of themselves to not get sick or injured.

Workers Comp Bad Faith – Adjusters Look Back Over Their Shoulders?

January 24, 2019 By JL Risk Management Consultants

Workers Comp Bad Faith – The Rarely Discussed Possibility

For many years, Workers Comp bad faith remains one of those rarely-discussed topics due to many factors. The subject rears its ugly head for what seems approximately twice per year. The worn-out catchphrase is “sent a chill over the industry.”

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The reason I published this article originated with me reading an article this week containing that very phrase. My good friend Kevin Quinley was interviewed for the article. The article covered an automobile adjuster’s handling of a claim in Washington. See the Keodalah Decision

The workers compensation claimant bar has been pursuing bad claims handling as a tort for over 50 years. Yes, there have been some successes in this area.

Workers Comp Board Jurisdiction

The Workers Comp Board or Industrial Commission usually retains the authority over claims handling issues. If one looks at the current Appellate Court cases, the judge usually remands the case back to the lower court – usually the Appeals level within the respective workers compensation board or commission.

Approximately 20 years ago, an adjuster was found to have altered claims forms after obtaining signatures from the employer and employee. The changes to the forms occurred due to the adjuster wanting the claims agreement forms to be approved by the workers compensation commission. The adjuster even admitted altering the agreement forms. What happened to the case? The Court of Appeals remanded the case back to the Full Commission as they were deemed to have jurisdiction.

Exclusive Remedy

Exclusive remedy has always kept most claims issues within the board or commission’s authority. If one cannot sue their employer can they also not sue their adjuster?

Exclusive remedy is one of the underpinnings of how Workers Compensation insurance survives to this day. Exclusive remedy means that an injured claimant cannot sue his employer as a liability matter. Likewise, the employer cannot sue the employee for contributory negligence.

Structured Environment Element In Avoiding Workers Comp Bad Faith

Workers comp, overall, operates in a very structured environment. For example, making an offer to settle on a property or auto liability claim has many unknowns as to value. Offering too low (low balling) can be a path to a bad faith claim.

Workers comp bad faith remains a very structured environment. All the variables are pre-calculated from the Average Weekly Wage to a fee-schedule medical bill.

The great unknown of Workers Compensation barely exists from the way a First Report of Injury is filed to the settlement approval process.

Starve Them Out

The iciest my veins had ever felt reviewing a claim that I had taken over from a terminated adjuster was this phrase:

I am going to sit on this one and starve them out to get a quick, cheap settlement. Oh, yes that was documented in the file and could not be removed by anyone.

The file was not yet settled – back TTD and medical bill payments were inked that day along with a fine for late payment. That, to me, remains my crowning example of going down the path towards a massive bad faith claim.

Bottom Line

Even though the above passages point to a safe harbor while handling workers comp claims, no adjuster should ever think they are immune to a workers comp bad faith action against them.

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What Is A Workers Compensation Permanency Rating?

May 2, 2018 By JL Risk Management Consultants

Question From One Of Our Devout Readers on Workers Compensation Permanency Rating

A Workers Compensation Permanency rating can also be called a PPD Rating or Permanent Partial Disability Rating.

picture of circular slide workers compensation permanency rating rule

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Each state is very distinct on how they handle permanency ratings. PPD ratings by physicians differ in some states. For example, – are the AMA guidelines used or not.

Some states even set the ratings themselves using the doctor’s rating as a basis.

So, this article will cover just the generic basics of a Workers Compensation permanency rating. If you are an adjuster or anyone that handles Workers Comp benefits that is reading this article, most renowned law firms have a “cheat sheet” on Workers Compensation law including PPD rating benefits.

If your online claims system does not provide you with the associated number of weeks for each injury, you should contact the law firms you use for a “cheat sheet” for each state in which your employer has workers compensation interests.

Signing Workers Compensation Permanency Rating Disability

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They are called cheat sheets as no other term fits. The cheat sheets are not illegal or wrong to use. That name is just the name that they are given in the WC community.

For example, we will use our HQ state, North Carolina for a list of the applicable permanency. As mentioned before, most states, but not all have permanency rating.

If you want to dig into workers compensation permanency rating, then try looking here. This coverage is very in-depth. For just the benefits per part of body loss, you would want to use the chart below.

Let us use the thumb for example –

The injured employed severely fractured his/her left them. The rating formula would be:

workers compensation benefits rate x maximum number of weeks x physician rating

(As an important side note the benefits rate usually equals 2/3 of the injured employees total average before tax wages)

If the injured employee had a 30% rating to the right thumb, then the formula would be:

$400 * 30% * 75 = $9,000.00

The formula such as the one above generates so much debate. Is $9,000 worth using 30% of the use of one’s thumb? I will leave that to the debaters.

97-31. Schedule of injuries; rate and period of compensation.

woman athlete long jump workers compensation permanency rating disability

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In cases included by the following schedule the compensation in each case shall be paid for disability during the healing period and in addition the disability shall be deemed to continue for the period specified, and shall be in lieu of all other compensation, including disfigurement, to wit:

For the loss of a thumb, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 75 weeks.
For the loss of a first finger, commonly called the index finger, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 45 weeks.
For the loss of a second finger, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 40 weeks.
For the loss of a third finger, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 25 weeks.
For the loss of a fourth finger, commonly called the little finger, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 20 weeks
The loss of the first phalange of the thumb or any finger shall be considered to be equal to the loss of one half of such thumb or finger, and the compensation shall be for one half of the periods of time above specified.
The loss of more than one phalange shall be considered the loss of the entire finger or thumb: Provided, however, that in no case shall the amount received for more than one finger exceed the amount provided in this schedule for the loss of a hand.
For the loss of a great toe, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 35 weeks.
For the loss of one of the toes other than a great toe, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 10 weeks.
The loss of the first phalange of any toe shall be considered to be equal to the loss of one half of such toe, and the compensation shall be for one half of the periods of time above specified.
The loss of more than one phalange shall be considered as the loss of the entire toe.
For the loss of a hand, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 200 weeks.
For the loss of an arm, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 240 weeks.
For the loss of a foot, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 144 weeks.
For the loss of a leg, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 200 weeks.
For the loss of an eye, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 120 weeks.
The loss of both hands, or both arms, or both feet, or both legs, or both eyes, or any two thereof, shall constitute total and permanent disability, to be compensated according to the provisions of G.S. 97-29. The employee shall have a vested right in a minimum amount of compensation for the total number of weeks of benefits provided under this section for each member involved. When an employee dies from any cause other than the injury for which he is entitled to compensation, payment of the minimum amount of compensation shall be payable as provided in G.S. 97-37.
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For the complete loss of hearing in one ear, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 70 weeks; for the complete loss of hearing in both ears, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 150 weeks.
Total loss of use of a member or loss of vision of an eye shall be considered as equivalent to the loss of such member or eye. The compensation for partial loss of or for partial loss of use of a member or for partial loss of vision of an eye or for partial loss of hearing shall be such proportion of the periods of payment above provided for total loss as such partial loss bears to total loss, except that in cases where there is eighty-five per centum (85%), or more, loss of vision in any eye, this shall be deemed “industrial blindness” and compensated as for total loss of vision of such eye.
The weekly compensation payments referred to in this section shall all be subject to the same limitations as to maximum and minimum as set out in G.S. 97-29.
In case of serious facial or head disfigurement, the Industrial Commission shall award proper and equitable compensation not to exceed twenty thousand dollars ($20,000). In case of enucleation where an artificial eye cannot be fitted and used, the Industrial Commission may award compensation as for serious facial disfigurement.
In case of serious bodily disfigurement for which no compensation is payable under any other subdivision of this section, but excluding the disfigurement resulting from permanent loss or permanent partial loss of use of any member of the body for which compensation is fixed in the schedule contained in this section, the Industrial Commission may award proper and equitable compensation not to exceed ten thousand dollars ($10,000).
For the total loss of use of the back, sixty-six and two-thirds percent (66 2/3%) of the average weekly wages during 300 weeks. The compensation for partial loss of use of the back shall be such proportion of the periods of payment herein provided for total loss as such partial loss bears to total loss, except that in cases where there is seventy-five per centum (75%) or more loss of use of the back, in which event the injured employee shall be deemed to have suffered “total industrial disability” and compensated as for total loss of use of the back.
In case of the loss of or permanent injury to any important external or internal organ or part of the body for which no compensation is payable under any other subdivision of this section, the Industrial Commission may award proper and equitable compensation not to exceed twenty thousand dollars ($20,000). (1929, c. 120, s. 31; 1931, c. 164; 1943, c. 502, s. 2; 1955, c. 1026, s. 7; 1957, c. 1221; c. 1396, ss. 2, 3; 1963, c. 424, ss. 1, 2; 1967, c. 84, s. 3; 1969, c. 143, s. 3; 1973, c. 515, s. 3; c. 759, s. 3; c. 761, ss. 1, 2; 1975, c. 164, s. 1; 1977, c. 892, s. 1; 1979, c. 250; 1987, c. 729, ss. 7, 8.)

You may wish to look at this reference to find more info on any workers compensation permanency rating.

Permanent Partial Disability – Is It A Workers Comp Benefit?

August 12, 2010 By JL Risk Management Consultants

Permanent Partial Disability (PPD) – Important Benefit

Picture of Man On Wheel chair Permanent Partial Disability Workers Comp Benefits

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The permanent partial disability is completely separate from any reduced wage loss benefits such as TTD or TPD. PPD is the partial or total loss, or loss of use of a part of the body. It is also used in the case of occupational disease. It denotes the date the employee becomes unable to complete the same tasks at the same wage as before the disability began.

PPD ratings can range from 1 to 100%. In most states when the PPD reaches 51%, the state will likely deem the injured worker will be considered at 100% or Permanent Total Disability (PTD).

In most states, the treating physician – usually an orthopedist – assigns a Permanent Partial Disability rating using the American Medical Association (AMA) guidelines. Recently, some states have ruled against the AMA guidelines as the “last say” in a PPD rating.

The insurance carrier or Third Party Administrator (TPA) may send the injured employee for a second opinion on the PPD rating. The injured employee (in most states) asks for a second opinion appointment if they think the rating is too low.

The rating may be paid in a lump sum or weekly for a number of weeks.

The PPD rating formula consists of:

PPD Benefit (in weeks) = Average Weekly Wage * 2/3 * PPD Rating * Body Part Maximum Weeks

For example:

An injured worker John Q Smith receives a rating of 20% Permanent Partial Disability to his arm from the treating orthopedic surgeon. This means John has lost the permanent use of his arm by 20%. The state deemed his Average Weekly Wage to be $400.00. The $400 per week AWW comes from some type of wage statement

Using the formula above:

PPD Benefit = $400 * 2/3 * 20% * 240 weeks

PPD Benefit = $266.67 * 48 weeks

Lump sum benefit = $12,800.00

Permanent Partial Disability and its calculation varies among the states. This calculation should be looked at as a generic and not state specific. There are many other benefits besides Permanent Partial disability.