Do You Qualify for Lost Wages
Through Workers' Compensation?
May 30, 2022
You’ve been injured or fallen ill at work due to exposure to toxic substances or another source, and you apply for workers’ compensation coverage. Soon, your condition prevents you from even showing up at work and performing your assigned duties. Can you get compensated for time lost due to your injury or illness?
The answer, generally, is “yes” if your medical provider certifies that you are unable to work. Lost-wage benefits are then dependent upon the length and scope of the condition that prevents you from working.
If you’re out on workers’ compensation in or around Billings, Montana, and you have questions or concerns about recovering for lost wages, or other benefits afforded under Montana’s workers’ compensation laws, contact Gerstner Adam Law.
Our attorneys are dedicated to helping employees throughout the state receive the full benefits due them under the workers’ compensation system. In addition to Billings, we also proudly serve clients in Glendive, Miles City, and Sidney.
Montana’s Workers’ Compensation Law – Filing Requirements
As in all states, workers’ compensation is a no-fault program in which neither employee nor employer can be held liable – sued – if an accident at work results in an injury, or if a worker falls ill due to conditions at work, generally from chemicals or toxic substances being used.
Employers with one or more employees are required to carry workers’ compensation insurance or to self-insure. If your employer does not carry coverage, which would put them in violation of the law, you can still apply for benefits from the Montana Uninsured Employers’ Fund.
The requirements for filing a claim under workers’ compensation in Montana are that you first must report your injury or illness to your employer within 30 days. Your employer then has six days to report your injury or illness to the Montana Department of Labor & Industry.
You then have one year to file for workers’ compensation from the date of your injury or of your diagnosis. The diagnosis standard covers injuries or illnesses that develop over time and not from a specific accident or incident.
Benefits Available Under
Benefits available under workers’ compensation fall into two categories: medical treatment and wage-loss compensation. Medical treatment covers the full range of services needed for your recovery, including physical and hospital visits, medications, diagnostics, therapies, adaptive equipment, and other related expenses.
Wage-loss replacement commences on the fifth day you are unable to work because of your condition, but once you miss 21 days of work, you will be paid retroactively from the first day of missed work.
Qualifying for Lost-Wage Benefits
If your treating physician does not release you to return to work, you may be eligible for lost-wage benefits. As mentioned above, the first 32 hours or four days of lost wages are not initially covered until the days missed from work total 21.
It should be noted that “treating physician” is not necessarily the one of your choice. When you are first injured or fall ill, you can seek evaluation and treatment from a physician of your choice, but once your claim is filed, the insurer can specify a different physician or medical group.
Generally speaking, if you are eligible for lost-wage benefits, you will receive two-thirds of your gross wages at the time of injury or illness (or diagnosis), up to a cap of $793 per week. If you seek Social Security Disability Insurance (SSDI) in addition to workers’ compensation, your workers’ compensation benefits can be reduced by up to half.
What If I Can Never Return
to Full Working Status?
Lost-wage benefits fall into four categories:
Temporary total disability: Your disability is total and prevents you from returning to work for a specific period of time. Benefits may cover the time you cannot work.
Temporary partial disability: You can return to work to perform lesser duties, in which case workers’ compensation will pay any difference between the pay for your new job and your old one.
Permanent partial disability: Similar to temporary partial disability, you may receive benefits to cover lost wages according to a physician’s impairment rating – the percentage representing your lost function.
Permanent total disability: If you can never return to do any work, you may be eligible for benefits until you reach Social Security retirement age. You can receive two-thirds of your normal wages up to the cap of $793. After 104 weeks of benefits, you can be eligible for a cost-of-living increase of 3.25 percent.
Let Our Experience Guide You
Workers’ compensation is generally managed by private insurance companies, and they are all for-profit entities. This means that it is in their best interest to challenge any submitted claim to either lower the benefits or, if possible, deny the claim. They have armies of attorneys and medical specialists at their disposal to safeguard their liability.
If you need to file a workers’ compensation claim – or an appeal – contact us at Gerstner Adam Law. We can help you assemble the documentation and supporting medical evidence needed to navigate the system and obtain the just benefits you deserve. We are located in Billings but are happy and proud to serve employees throughout Montana who are seeking workers’ compensation benefits.