What Benefits Are Available To Me After a Work Injury?

This is one of the questions that we get asked the most: “What benefits are available to me other than workers’ compensation benefits after a work injury? Let us start with the obvious. An injured worker is entitled to wage loss and medical benefits under the PA WC Act until they return to work at the same or greater pay, or they recover from their work injury. Wage loss benefits are typically paid at 66 2/3% of the injured workers’ gross wages at the time of their injury, and it includes lost wages from other employment, like a second or part-time job, as well as lost overtime. Workers’ compensation benefits are tax free, which usually equates to the injured worker receiving about what they would have received after taxes when they were working. The exception is with high wage earners. The law has a maximum rate which is referred to as the ‘statewide average weekly wage’. This rate is determined annually by the PA Department of Labor & Industry. It varies from year to year depending on what the average earnings are across Pennsylvania; it usually goes up from year to year. The statewide average weekly wage, or maximum compensation rate, for an injury occurring in 2014  is $932.00 a week. This means that no injured worker can receive more than $932.00 a week in wage loss benefits, no matter what their wages were before the injury. For example, let’s say that a union carpenter who worked a lot of overtime before his injury in 2014 had an average weekly wage of $2,500.00 Using the typical calculation of 66 2/3% of their gross pay would give this individual a compensation rate of $1,666.65 a week, BUT, because of the maximum compensation rate, this worker is limited to $932.00 a week in wage loss benefits.

In addition to workers’ compensation benefits, an injured worker might also be eligible for unemployment compensations following a work injury. At first, this doesn’t seem possible because as we all know, in order to receive unemployment compensation a person has to be ready, willing, and able to work but cannot find work. This potential availability for work seems to run opposite to someone who is claiming a disability, or an inability to work, because of a work injury. An injured worker might be eligible for both workers’ compensation and unemployment compensation if they are disabled from their regular job because of a work injury, however can still do some kind of light duty or a sit down job that they cannot find, even though they are potentially available for it. The kicker is, that the law allows the time of injury employer to offset or reduce an injured workers’ wage loss benefits by any unemployment compensation that they receive. This coupled with the fact that unemployment compensation is taxed usually results in the injured worker receiving less that they would be entitled to in workers’ compensation wage loss benefits. It is understandable that in some situations the injured worker has no choice but to apply for unemployment compensation despite the offset against their workers’ compensation benefits. This is particularly when the claim is denied at the outset and their right to receive workers’ compensation has to be litigated. In this circumstance, unemployment compensation is all the injured worker has to live off of until their workers’ compensation claim is decided.

What other benefits might an injured worker be entitled to? For injured workers who have suffered a serious injury that is expected to disable them from substantial, gainful employment for a year or more, they may also be eligible for social security disability benefits (SSD). This benefit usually isn’t available right after a work injury because typically some time must pass in order to determine whether the work injury will disable the injured worker for at least a year. The amount of social security disability that the injured worker is entitled to depends on their wages and their contribution to the social security system during 20 out of the last 40 quarters, or 5 out of the last 10 years before their disability began. In other words, it depends on whether they paid social security taxes during his period. Social security disability benefits are also subject to a maximum monthly rate which is set by the federal government on a yearly  basis. Social Security disability benefits can be taxed, though there is typically a yearly increase called a ‘cost of living adjustment’- or COLA. Social Security disability benefits do not offset or reduce workers’ compensation benefits, but social security disability benefits may be reduced by the amount of workers’ compensation benefits that an injured worker receives. This reduction in social security disability because of workers’ compensation isn’t applicable to everyone, so you should consult with an experienced social security disability lawyer to find out if the reduction applies to you.

An injured worker might also be entitled to social security supplemental income benefits, or SSI. This is a federal form of welfare given to those with serious injuries who can’t work but who fail to meet the eligibility requirements of SSD benefits due to their work history. These benefits are much less than SSD benefits and the injured worker must have little or no assets in order to qualify. The asset requirement usually eliminates anyone who is receiving workers’ compensation benefits because they make too much money to be eligible for both. Though in a situation where the injured worker’s claim was denied, the injury is serious and it involves lengthy litigation, the injured worker may be eligible for SSI benefits, at least until their workers’ compensation claim is decided.

An older, injured worker can be eligible for social security retirement (SSR) benefits in addition to workers’ compensation benefits, however anyone who is considering applying for SSR benefits while they’re receiving workers’ compensation benefits needs to speak with an experienced workers’ compensation lawyer before applying for any retirement or pension benefit, including SSR. Applying for retirement benefits or a pension while on workers’ compensation could jeopardize your right to receive workers’ compensation wage loss benefits in the future. Generally speaking, the employer is entitled to reduce or offset your workers’ compensation benefits by 50% of your SSR benefit, if you started receiving SSR benefits AFTER your work injury. If you were receiving SSR benefits before your wok injury, the offset isn’t applicable.

Some other benefits that an injured worker might be entitled to other than workers’ compensation benefits are short-term or long-term disability (STD/LTD) benefits. These are typically offered by the time of the injury employer and are paid for by the employer, although the injured worker might contribute a small portion to the premiums for these benefits through payroll deductions. Here, as with many of the other benefits mentioned, the employer is entitled to offset or reduce the injured worker’s wage loss benefits dollar for dollar based on the employer’s contribution to the premiums paid for these benefits.

Pension benefits are another benefit that an injured worker might be eligible for after a work injury, in addition to workers’ compensation benefits. However, as previously indicated, receiving a pension while on workers’ compensation could adversely affect your right to receive future compensation. Generally, the employer who pays the pension is entitled to a dollar for dollar offset against your workers’ compensation benefits.

An injured worker might also be entitled to salary continuation or injured on duty (IOD) benefits after a work injury, but these benefits are usually viewed as payments in lieu of workers’ compensation, therefore receiving these benefits is a waste because they aren’t payments in addition to, but rather in place of workers’ compensation.

If you’re a member of a union you could be entitled to union health and welfare benefits in addition to workers’ compensation benefits. These benefits are typically small and depending on the union contract, must be repaid once the injured worker begins receiving workers’ compensation.

The other benefit worth mentioning is welfare benefits. Cash assistance or medical coverage through the state’s Medicaid plan might be available to an injured worker following a work injury, at least until their workers’ compensation claim is accepted. But, these benefits will create a DPW (Department of Welfare or Health and Human Services) lien against your workers’ compensation award that must be repaid before the compensation award or settlement can be distributed.

These are just some of the other benefits that might be available to an injured worker after a work injury, including workers’ compensation benefits. Before accepting any other benefit other than workers’ compensation, you should speak with an experienced workers’ compensation lawyer to fully understand the impact that receiving these other benefits might have on your entitlement to workers’ compensation.