Permanent Total Disability in Workers Compensation
Workers’ compensation is generally the only compensation employees are allowed for on-the-job injuries. Under workers’ compensation, workers are guaranteed specified damages for on-the-job injuries, so they don’t have to prove negligence or other wrongdoing by their employer. The tradeoff is that workers’ compensation is the only recovery and the remedies it provides are limited. Workers’ compensation damages are limited to a percentage of an injured worker’s average weekly wages plus the cost of medical care. What workers’ compensation does not cover are special damages such as mental anguish or pain and suffering. Likewise, there are generally no punitive damages. But there are exceptions to the limitations that workers’ compensation imposes, which we discussed in a previous blog [link]. If a workers’ injuries prevent continued work, there are other benefits.
How is Permanent Total Disability Calculated?
In addition to medical care and vocational rehabilitation, a worker whose injuries result in Permanent Total Disability is entitled to 66 2/3% of their average weekly wage, not to exceed the prescribed maximum in effect at the time of injury, for the duration of their disability (lifetime benefits).
What is Permanent Total Disability Benefits?
Permanent Total Disability means the worker cannot:
Perform his trade
Obtain other reasonable gainful employment
Perform gainful employment with reasonable accommodations
Be retrained for reasonably gainful employment
If a worker is gainfully employed through vocational rehabilitation, then the Permanent Total Disability would no longer be payable.
What is SS Permanent Total Disability?
Permanent Total Disability may trigger other claims or benefits, as well. Depending on the amount, a worker may also be entitled to Social Security Disability Insurance benefits.
Social Security disability benefits are paid only to workers who have long-term impairments that preclude any gainful work, regardless of whether the disability arose on or off the job. By law, the benefits are paid only to workers who are unable to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment that is expected to last at least a year or result in death. The impairment must be of such severity that the worker is not only unable to do his or her previous work but is also unable to do any other type of substantially gainful work. Social Security disability benefits begin after a 5-month waiting period.
Permanent Total Disability may also trigger benefits under any disability insurance policy.
Many employers provide insurance through a third-party insurer which provides benefits for workers who are disabled. The terms and conditions for such benefits are prescribed by the policy. Most require that an insured be unable to perform any job while others may provide coverage if a worker cannot perform the job they were doing at the time of the disability. The policies often have very detailed and specific claims processes which must be followed to receive a claim. Those policies are most often covered by a federal statute known as ERISA and must be enforced through federal court action.