IF MY CLAIM IS ACCEPTED
What benefits am I entitled to?
Workers' compensation insurance provides five basic benefits:
- Medical care: Paid for by your employer to help you recover from an injury or illness caused by work.
- Temporary disability (TD) benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering.
- Permanent disability (PD) benefits: Payments if you don't recover completely.
- Supplemental job displacement (SJDB) benefits: If your date of injury is in 2004 or later, you may receive vouchers to help pay for retraining or skill enhancement if you don't recover completely and can't return to work for your employer.
- Death benefits: Payments to the spouse, children, or other dependents if a worker dies from a job injury or illness.
What if I have a disagreement about my benefits?
At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury or treatment. When there is a disagreement, you may be evaluated by a qualified medical evaluator (QME).
To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers' compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).