The first and most basic type of is workers’ compensation medical benefits. Under the law, an employer/insured must normally pay for all of an injured worker’s “reasonable and necessary” medical expenses. These types of “reasonable and necessary” medical expenses include compensation for doctor visits; hospital stays and treatment; physical therapy; prescription medication costs; chiropractic treatment; and, in some cases, psychological counseling. Compensation for these types of medical benefits normally continues until an injured worker is able to return to work or until the worker reaches a level of “maximum medical improvement,” which is discussed below.
Wage Replacement Benefits
An injured worker may also be entitled to wage replacement benefits under Vermont law. These benefits are also known as temporary disability benefits, of which there are two types: (1) temporary total disability benefits; and (2) temporary partial disability benefits.
Temporary total disability benefits are available when an employee is completely unable to work during the time he or she is recovering from a work-related injury. In Vermont, these benefits are calculated as two-thirds of the injured worker’s average weekly wage. The average weekly wage is subject to a state minimum amount and a state maximum amount, which are set by the Vermont Department of Labor each year. In addition to these temporary disability payments, an injured worker is entitled to receive a stipend of ten dollars ($10.00) per week for each of his or her minor dependent children.
Temporary partial disability payments are available when an injured worker returns to work on a part-time or “light duty” basis and/or when the employer places restrictions on the type of work an employee can do as a result of the injuries sustained in the work-related accident. Temporary partial disability payments are calculated as two-thirds of the difference between an injured worker’s full-time and part-time pay amounts.
Permanent Impairment Benefits
In addition to the disability benefits discussed above, when an injured worker is left with a permanent impairment to a specific part(s) of the body following the workplace injury, he or she may be entitled to permanent partial impairment benefits. The amount of these benefits depends upon the nature and severity of the injury obtained. In order to make that determination, the worker’s doctor must typically examine him or her and evaluate for permanency by establishing a percentage rating. This rating is usually reported as a percentage amount of impairment to the body as a whole. For example, an injured worker’s doctor may conclude that as a result of his permanent injury to the right arm, he sustained a thirty percent (30%) whole person impairment to his entire body. The permanency percentage is then multiplied by a corresponding number of weeks established by Vermont law (and depending upon the body part(s) injured), in order to determine the total number of weeks that the benefits will continue. That number is then multiplied by two-thirds of the employee’s average weekly wage (again, subject to the state minimum and maximum average weekly wages), to determine the total amount of the award.
Example: An injured worker sustains a 20% whole person impairment to his right arm resulting from the work-related injury, as determined by his physician, that percentage is then multiplied by the corresponding total number of weeks for that body part (e.g., 405 weeks) to arrive at a total of eighty one (81) weeks over which the benefits will be paid. If the injured worker’s average weekly wage is $600.00 per week, he or she will be entitled to two-thirds (2/3) of that amount, or $400.00 per week. That number is then multiplied by 81 weeks, for a total award of $32,400.00, payable over the 81-week period.
A worker may be entitled to permanent total disability benefits when he or she is not able to return to the job at all, as a result of the workplace injury. In that case, the injured worker will typically receive two-thirds of his or her average weekly wage, subject to the same state maximum and minimum requirements that apply to temporary total disability payments. After these benefits continue for an established number of weeks and the worker still cannot return to gainful employment, the benefits will then be continued.
As you can imagine, disputes as to the amounts of benefits and the nature and extent of treatment oftentimes arise. In those instances, an injured worker or his attorney may file issues with the Vermont Workers’ Compensation Commission, which is overseen by the Vermont Department of Labor.
Disputes typically arise after an injured worker sees his or her doctor, and the doctor establishes a permanency rating as to the injured part(s) of the worker’s body. The injured worker is then seen by a doctor for the employer/insured, who undertakes an independent medical examination (IME) of the worker, and sets a much lower permanency rating percentage. A dispute may also arise ifthe employer/insured believes that the injured worker IME report shows over-treatment, or that the worker was not injured to the extent he or she claimed.
When a dispute arises as to the nature/extent of the worker’s injury, or as to the amount of benefits paid, the Commission will first schedule an informal telephone conference, during which the parties will attempt to resolve the dispute. If the dispute does not resolve, a formal hearing may be requested and scheduled. If the injured worker is still dissatisfied with the outcome, he or she may appeal the hearing officer’s decision through the Vermont court system to obtain an ultimate resolution.
Vocational Rehabilitation Benefits
An injured worker may also be entitled to vocational rehabilitation benefits. This type of benefit is available when a work-related injury prevents the employee from returning to the type of employment he or she was previously trained in or experienced in. Vocational rehabilitation benefits may include job placement or on-the-job training to help the injured worker return to similar, gainful employment.
One last type of workers’ compensation benefit under Vermont law – death benefits – are available in the event an injured worker dies as a result of the workplace injury. In that instance, the deceased worker’s dependents may be entitled to receive death benefits.
Termination of Benefits
Each type of workers’ compensation benefit discussed above may be terminated under various situations. Typically, the employer/insured may discontinue benefits when the employee is able to return to work and/or reaches a level of maximum medical improvement. Under Vermont law, maximum medical improvement, also called an “end medical result” or a “medical end result,” occurs when an injured worker “has reached a substantial plateau in the medical recovery process, such that significant further improvement is not expected, regardless of treatment.” Maximum medical improvement may even apply if the injured worker does not recover from his or her injuries completely. Once maximum medical improvement is attained, disability payments are no longer paid, and a determination is made as to whether the injured worker has sustained a permanent impairment to a part of his or her body. If benefits are terminated, you or your attorney can elect to proceed forward via the appeal process outlined above.
In any case, it is essential that you have an attorney that is experienced in Workers’ Compensation benefits process in Vermont in your corner, representing you throughout the entire process – in particular, if you are disputing a denial of coverage or a discontinuance of benefits. Every case is different, and an experienced VT workers’ compensation attorney can help to streamline the process and ensure that you are awarded the maximum amount of benefits available in your unique situation.