Wage loss benefits (time loss)

How will I be compensated if I miss time from work because of my work injury?

You should receive time-loss benefits from the insurer if your attending physician authorizes time off work or modified work (also called “light duty”) that results in lost wages. Your first check will usually be issued two weeks after you report the claim to your employer.

Is there a waiting period before I will be eligible for time-loss benefits?

Yes. The waiting period is three consecutive calendar days, beginning with the day you lost wages or did not complete your work shift as a result of your accidental injury or exposure. You will not receive time-loss benefits for the three-day waiting period if you are released to light duty within the first 14 days of disability, even if your employer does not have any work within your light-duty restrictions.

Time-loss benefits for the waiting period are only due when your attending physician takes you off work completely for 14 consecutive days or if you were admitted into the hospital as an inpatient within the first 14 days of disability.

How does the insurer calculate my time-loss benefits?

Your time-loss benefits are based on your wages on the date of injury or date of disability (occupational disease claims only). If you were working multiple jobs, only the wages from the job where you were injury will be considered. However, wages from concurrent employment may supplement (increase) your time-loss benefits. See supplemental disability benefits (SDB). If your wages or hours vary, the insurer may average your earnings for up to 52 weeks before your date of injury or disability. The insurer will refer to this amount as your average weekly wage (AWW).

The time-loss rate is 66.67 percent of your AWW. For example: If your AWW is $800, your weekly time-loss rate would be $533.36 ($800 x .6667).

Is there a maximum weekly time-loss rate?

Yes. Time-loss benefits are subjected to a maximum amount. Currently, for injuries occurring on or after July 1, 2012, the maximum time-loss rate is $1,118.88 per week.

If I return to modified work, but my post-injury earnings are less than my AWW, will I still receive time-loss benefits?

Yes. If your employer is able to provide modified work (light duty), you would still be eligible to receive time-loss benefits from your insurer. However, your time-loss benefits will be reduced based on the wages paid by your employer.

For example: If your AWW is $800 per week and you return to part-time modified work, but only earn $350 per week, your time-loss benefits would be:

1. $800.00 (AWW) subtracted by $350 (post-injury wages) = $450 (difference)

2. $450 (difference) divided by $800 (AWW) = .5625 or 56.25% (percentage of loss of wages)

3. $533.36 (weekly time-loss rate) multiplied by .5625 (percentage of loss wages) = $300.02 time-loss benefits due

Will I receive time-loss benefits when I miss work to receive medical treatment related to my work injury?

Generally, time-loss benefits are not payable unless you are required to be away from work for four or more hours to attend a medical appointment. Required to be away from work means the appointment and reasonable travel time equals four hours or more.

My workers’ compensation claim was re-opened for an aggravation. Will my time-loss benefits change?

Your average weekly wage (AWW) is still based on the wages you were earning when you were originally injured or date of disability (occupational disease claims only). However, your time-loss rate will be adjusted each July 1 based on changes to the state's average weekly wage.

For example: If your AWW was $800 when you were injured on June 1, 2010, your current time-loss rate would be $561.29:

       $800 x.6667 = $533.36

       $533.36 x 1.02346 (7/10 increase) x 1.02824 (7/11 increase) = $561.29

There was no time-loss rate increase for July 1, 2012.

Supplemental Disability Benefits (SDB)

I was working two (or more) jobs at the time I was injured. I can’t return to either job. Will I be paid time-loss benefits for both jobs?

Maybe. If you were working more than one job at the time of injury, you may be eligible to receive supplemental disability payments for lost wages from the secondary job. You must notify your insurer about the other jobs within 30 days of the insurer’s receipt of your initial claim. You must provide proof of wages (e.g., check stubs or payroll records) paid on the other jobs within 60 days of the insurer's request or you will be found ineligible for supplemental disability benefits.

I received a letter from my insurer indicating that my benefits have been overpaid. Am I required to pay back the overpayment?

No. If your insurer determines you were overpaid benefits, the insurer must notify you in writing of the reason and amount of the overpayment. However, the insurer may recover the overpayment from your future benefits (e.g., time-loss benefits, mileage reimbursement, permanent partial disability). The insurer cannot reduce an individual time-loss payment by more than 25 percent to recover an overpayment.