What Are Workers’ Compensation Lost Wage Benefits?

Workers compensation lost wage benefits might confuse some people. Think of this benefit as a partial replacement for lost wages due to a work-related injury or occupational disease. In simplest terms, this benefit – lost wages – is money that replaces some of your earning capacity while you’re unable to work. It also provides some income while you receive medical treatment until you can work again.

Whether or not you qualify to receive money, how long you have to wait, and how much you’re entitled to depends on:

• Which state you live and work in
• The type of work that you do
• Whether your employer classifies you as full time, part time, seasonal, temporary, or an independent contractor

We’ll explain what types of workers’ compensation lost wage benefits an injured worker might qualify for and when below.

What Type of Wage-Loss Benefits Exist?

In most cases, if you’re unable to work at all for more than three days, you may qualify for wage-loss payments. While the amount, waiting period, and duration of these wage-loss benefits varies by state, they’re called temporary total disability benefits.

If you can work reduced hours or with limitations and therefore make less money, you may be eligible for partial temporary disability benefits.

When Does Workers’ Comp Start Paying for Lost Wages?

Which state you live in determines the laws that govern when workers’ compensation benefits begin for eligible injured workers. Each state has its own statutory waiting period, and the law that decides that can change at any time. For example, the following states each have a three-day waiting period for workers’ compensation lost wage benefits:

• Alabama
• Alaska
• California
• Connecticut
• Colorado
• Delaware
• Hawaii
• Iowa
• Illinois
• Maryland
• Minnesota
• Missouri
• New Hampshire
• Oregon
• Oklahoma
• Rhode Island
• Utah
• Vermont
• Washington
• West Virginia
• Wisconsin
• Wyoming

That means the first three days injured workers must miss work in these states will always count as unpaid time off.

If you have a work injury in Montana, you must miss at least four work shifts to qualify for lost wages.

Workers’ compensation only covers lost wages when you need at least five days off for a work-related injury in:

• Idaho
• Massachusetts
• Mississippi
• Nevada
• North Dakota

Finally, you must miss more than seven days of work to get workers’ compensation lost wage benefits in the following states:

• Arizona
• Arkansas
• Florida
• Georgia
• Indiana
• Kansas
• Kentucky
• Louisiana
• Maine
• Michigan
• Nebraska
• New Jersey
• New Mexico
• New York
• North Carolina
• Ohio
• Pennsylvania
• South Carolina
• South Dakota
• Tennessee
• Texas
• Virginia

What if the Doctor Says I Don’t Need Any Time Off After My Work-Related Injury?

If you can work again before your state’s waiting period ends, then workers’ compensation only covers your medical care. That means your employer’s insurance carrier should pay your workers’ comp doctor directly for any ongoing medical treatment you need.

However, if your employer puts you on light duty work, then you may qualify for temporary partial disability benefits. These temporary disability benefits usually pay part of the difference between your pre-injury and post-injury weekly wages.

How Much Money Can I Get in Workers’ Compensation Lost Wage Benefits?

While amounts can vary, generally, this benefit pays about two-thirds of your average weekly wage. It covers about two-thirds of the pay you miss while you’re unable to work, provided you meet all requirements set by your state. In addition, your wage-loss benefits are subject to your state’s maximum and minimum amounts, set by law.

However, not every state follows this “two-thirds rule” in calculating lost wage benefits. Here are a few examples of states that use different percentages to calculate workers’ compensation lost wage amounts:

• Alaska – 80% of your spendable weekly wage
• Connecticut – 75% of your average weekly wage (AWW)
• Idaho – 67% of the state’s gross average weekly wage for the first 52 weeks
• Massachusetts – 60% of your gross AWW
• Michigan – 80% of your after-tax AWW
• New Hampshire – 60% of your AWW
• New Jersey – no more than 75% of the state’s AWW
• Ohio – 72% of your full weekly wage (FWW) for the first 12 weeks
• Oklahoma – up to 70% of the state’s AWW
• Rhode Island – 62% of your gross AWW + $15 per week per eligible dependent
• Texas – up to 100% of the state’s AWW, or 70%-75% of the difference in your pre-injury and post-injury earnings, depending on your hourly pay rate
• Washington – 60%-75% of your AWW, depending on how many eligible dependents you support

What Happens if I Reach Maximum Medical Improvement but Still Can’t Work?

Maximum medical improvement means you reached a point at which continued medical treatment is unlikely to help you improve.

The point at which your workers’ comp doctor determines MMI is usually based on a certain amount of time:

• 6-24 months for fractures, severe soft tissue injuries, and conditions that require surgery
• 2 years or longer for catastrophic injuries

Depending on where you live, once you reach MMI, your payments could change to permanent total disability benefits. If you are still unable to work full time after reaching MMI, then your doctor will assign you a disability rating. This rating can range from 0 to 100, depending on what percentage of your body counts as disabled. The higher your rating, the better chance you have for a larger disability settlement or lump-sum payment. A total disability rating of 0 means you fully recovered from your work-related injury. A 100 disability rating means you cannot work at all in any job again for life.

Because every case is different – and because it varies by state law – it’s impossible to give a dollar amount that applies to everyone. There are, however, 2023 insurance statistics that show that the highest average claim value set at $93,942.

How and when you receive payment after you reach maximum medical improvement also varies by injury type and state. California, for example, must make payments within two weeks, while payments in Illinois generally start within two years.

When Does My Employer Not Owe Me Workers’ Compensation Lost Wage Benefits?

There are circumstances under which your employer is not required to pay workers’ compensation lost wages benefits. For example, if you can return to work before your state’s required waiting period ends, you’ll only qualify for medical benefits. That means your employer’s insurance company only pays directly for your medical treatment.

For a very minor injury where you didn’t seek medical attention and kept working, you also won’t receive wage-loss payments.

Another reason you might not be entitled to lost-wage benefits is if your injury isn’t work-related. This includes things like an injury that happens at work while you’re clocked out. Or an illness that starts while at work (like food poisoning from dinner the night before) that your job did not directly cause.

Some employees are also automatically exempt from coverage under your state’s workers’ compensation laws. Contractors are sometimes exempt as are some undocumented workers.

Finally, in some states, if you fail an on-the-spot drug test, you can be denied wage-loss benefits. The same is true when your injury is self-inflicted.

How to Get Free Help Qualifying for Workers’ Compensation Benefits

If you believe your employer wrongly denied you workers’ compensation payments, always consult an experienced attorney. Not sure where to find one near you who offers free case reviews? We can connect you with a nearby lawyer who understands how to navigate the workers’ compensation laws in your state. This way, you can get a free case evaluation to learn whether you may have an eligible claim. Most states recommend securing attorney representation before appealing denied workers’ compensation claims.

Want to talk to an attorney for free about your claim and get private answers that apply to your situation? We can connect you with someone for a free phone call during normal weekday business hours. If an attorney cannot help you secure workers’ compensation benefits after denial or increase your pay amount, you owe $0. But if you’re successful, then you only pay one small fee after you receive your settlement award.

Ready for your free workers’ compensation case evaluation? Click the button below to start your free online benefits quiz to see if you may qualify:

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