What Workers' Comp Pays You If You Get Hurt

Why this matters

Techs get hurt: a ladder that kicks out, a hand opened on a coil fin, a shoulder torn pulling a water heater up basement stairs, a back that goes in a crawlspace. What happens to your money next depends heavily on what you do in the first 48 hours, and on numbers most techs never see until they are already off work. A late report can cost you benefits outright in some states. A wage figure calculated on base pay alone can quietly cut every check for the whole claim. This card is the tech's view: what comp pays, how the check is figured, and how to protect it.

First, the injury. Get medical care before anything else: call 911 for anything serious, and do not drive yourself if you are lightheaded or bleeding heavily. Then come back to the paperwork.

This is general information, not legal or personal financial advice.

The layer: almost entirely state law

There is no federal workers' comp system for private-sector employees. (Federal employees, longshore workers and a few other groups have federal programs run by the U.S. Department of Labor; a residential service tech is not one of them.) Every rule below is state law, which is why each one comes with a range, not a number. Your state's workers' compensation agency publishes the exact figures, and most publish a plain-language worker guide.

Is your shop covered? Nearly every state requires employers to carry comp. Texas is the one state where most private employers can opt out entirely; a Texas employer that does is called a non-subscriber, and you would sue it in court for a work injury rather than claim comp. Several states exempt the smallest employers, with thresholds of three to five employees common and construction trades often covered from the first employee. Ask the office or look for the required coverage notice posted at the shop.

Are you covered? Comp covers employees. A tech paid on a 1099 is generally not covered, unless the facts make them an employee anyway. See related: Going 1099: The Tax Math a Tech Misses.

What comp pays: four kinds of benefit

1. Medical care. All reasonable and necessary treatment for the work injury, usually with no deductible or copay: the ER, surgery, physical therapy, prescriptions, and in many states mileage to appointments. Tell every provider it is a work injury and give them the shop's comp insurer. Your own health plan may deny a work injury claim, and a bill sent to it can get tangled for months.

2. Temporary total disability (TTD). Wage replacement while your doctor says you cannot work at all. Most states pay two-thirds of your average weekly wage (AWW), subject to a weekly maximum and minimum the state sets, usually tied to the statewide average wage and adjusted yearly. A few states use a different formula, such as 80 percent of after-tax wages. Comp wage benefits are not subject to federal income tax (IRS Publication 525 lists them as nontaxable income).

3. Temporary partial disability (TPD). When you return to light duty at reduced hours or pay, many states pay two-thirds of the difference between your AWW and what you now earn. Refusing suitable light duty your doctor has approved can suspend your wage benefits in many states.

4. Permanent disability. If you do not fully recover, a doctor assigns an impairment rating once you reach maximum medical improvement (the point where further treatment will not make you better). That rating drives a permanent partial disability payment on a state schedule; permanent total disability, where you can never work again, pays longer. Some states add vocational rehabilitation to retrain you for other work.

The waiting period

Most states do not pay wage benefits for the first few days off, commonly three to seven days. If you are still out after a longer period, commonly two to four weeks, the waiting days are paid back retroactively. Medical care is covered from day one. Some shops let you use PTO for the waiting days; ask, since rules about combining PTO and comp vary.

Reporting fast: the deadline that can cost you everything

Two deadlines run from the injury, and they are different.

Notice to your employer. You must tell the shop. States set the deadline, and it ranges from a few days to about a month: Colorado requires written notice within four working days, while California and Texas give 30 days. Missing it can reduce or bar your claim, and even inside the deadline, late reporting gives the insurer an argument that you were hurt somewhere else. Report the day it happens, in writing, even if you think it is minor. A "tweaked" back on Tuesday that cannot get out of bed on Thursday is exactly the claim that gets disputed.

The claim itself. A separate, longer deadline to file a claim with the state agency, commonly one to two years. Usually the employer's report starts the process, but if the claim is denied or stalls, this is the deadline that protects you.

Here is what the first two weeks look like in a state with a seven-day waiting period, paid back after 14 days out:

DAY 0    Hurt. Care first. Tell the supervisor now.
DAY 0    Written report to the shop, with date, time,
         place, what you were doing. Keep a copy.
DAY 1    Clinic: "This is a work injury," plus the
         shop's comp insurer. Get the work-status
         note in writing.
DAY 1-3  Shop files its first report of injury with
         the insurer, on a deadline its state sets.
DAY 1-7  Waiting period. No wage benefit yet.
DAY 8+   Wage benefit begins accruing.
DAY 14   Still off: days 1-7 now paid back.
WEEKLY   Each new work-status note goes to the
         adjuster the day you get it.

Many states require the insurer to start payment or explain a delay within about two weeks of learning of the claim. If nothing has arrived by then, call the adjuster and write down the date and what they said.

How your average weekly wage is figured, and why to check it

Every wage benefit is a percentage of your AWW, so an error in the AWW cuts every check for the life of the claim. States compute it over a lookback, commonly the 13 or 52 weeks before the injury, and define what counts. In most states that includes overtime, commission and flat-rate production pay, and some include the value of benefits such as a take-home vehicle, meals or lodging. Special rules apply to seasonal and part-time work.

The common error for a tech is an AWW figured from base hourly pay alone, because base is the figure sitting in the HR file.

The worked example: a 10-week shoulder injury

A residential HVAC tech tears his shoulder lifting a condenser onto a pad. His doctor takes him off work for 10 weeks. Call his hourly base rate "r." Over the 13 weeks before the injury he averaged:

• 40 base hours: 40r a week
• 6 overtime hours at time and a half: 6 times 1.5r, which is 9r
• spiffs and production pay averaging 4r a week

Correct AWW: 40r plus 9r plus 4r equals 53r. Two-thirds of that is about 35.33r a week. His state's weekly maximum is well above that, so the cap does not bind.

What the adjuster first used: base pay only, 40r, so two-thirds is about 26.67r a week.

The gap: 35.33r minus 26.67r is 8.67r a week. Over 10 weeks, that is 86.7r, a little more than two full weeks of his base pay (86.7r divided by 40r is about 2.17 weeks), lost to a data-entry choice.

How he caught it. He compared the first check to two-thirds of his own average gross from his pay stubs, saw it was low, and sent the adjuster 13 weeks of stubs with a short written request to recalculate including overtime and production pay. See related: Reading Your Pay Stub as a Technician, and Tracking Your Own Hours and Pay.

How the check feels against a paycheck. His usual take-home after payroll and income tax withholding was about 78 percent of gross, or 0.78 times 53r, about 41.34r. Because comp is not taxed federally, the correct benefit of 35.33r is about 85 percent of his normal take-home (35.33 divided by 41.34). "Two-thirds" sounds like a third gone; in take-home terms it was about 15 percent gone. The wrong AWW would have been about 65 percent of take-home (26.67 divided by 41.34).

Waiting period. He was out more than 14 days, so the seven unpaid days were paid back with a later check.

What changes the answer. If his overtime had been seasonal (heavy in July, none in March) and he was hurt in spring, a 13-week lookback would capture little of it, while a 52-week lookback would average it in. Which one applies is state law, and some states allow an alternative calculation when the standard one is unfair to a seasonal worker. If he earned enough to hit the state's weekly maximum, the cap, not two-thirds, would set the check, and the AWW correction might be worth nothing; the reverse holds in a state with a low cap, where a high earner's benefit can be far below two-thirds.

Your doctor, your job, and other people's fault

• Choice of doctor varies. Some states let the employer or insurer direct initial care or require you to choose from a posted panel (Pennsylvania and Georgia use panels), others let you choose among authorized providers (New York), and California lets you predesignate your own doctor before any injury happens.
• Your job is not guaranteed by comp itself. Most states prohibit firing you for filing a claim. FMLA may protect your position for up to 12 weeks if your shop has 50 or more employees within 75 miles and you have worked 12 months and 1,250 hours, and it commonly runs at the same time as comp.
• You generally cannot sue your employer. Comp is the exclusive remedy for a work injury in exchange for no-fault benefits. You can usually sue a third party whose fault caused it: the driver who hit your van, or the maker of a defective ladder. Comp may claim part of that recovery to repay what it paid you.

When to get help

Most claims run without a lawyer. Call a workers' comp attorney, many of whom work on a contingency fee capped by state law, if the claim is denied, payments stop, the insurer disputes your doctor, you are offered a settlement, or your injury is permanent. Bring your written report, every work-status note, your pay stubs for the lookback period and every letter from the insurer. Your state agency's ombudsman or information line is free and can explain your rights before then.

References

• Your state workers' compensation agency, worker guide and benefit rate tables
• U.S. Department of Labor, Office of Workers' Compensation Programs (overview of state versus federal programs)
• IRS Publication 525, Taxable and Nontaxable Income (workers' compensation)
• U.S. Department of Labor, Family and Medical Leave Act eligibility
• See related: What Workers Comp Actually Covers and What It Doesn't, Disability Insurance for People Who Work With Their Hands, Reading Your Pay Stub as a Technician