Workers’ Compensation Insurance

While you are unable to work, the workers’ compensation insurance company is responsible to pay two-thirds of your average weekly wage for every day you miss from work with a doctor’s excuse, except you do not get paid for the first three days until you have missed two weeks of work.
These payments are called temporary total benefits and are paid until the time when you have reached maximum medical improvement which means that they are paid until such time as the doctor says that your condition is now permanent and you will not get any better and no further treatment will help you.
Your average weekly wage is calculated by adding the last 14 weeks of gross pay together and then dividing by fourteen and this produces your average pay over that period. Workers compensation then pays you two thirds of that number. If you have missed time from work for other reasons during those previous weeks than this will affect the amount you are paid while you are off. If you worked more hours around the time of the accident but less hours for other weeks this will affect the average.
The workers’ compensation insurance company is responsible to pay for your medical treatment for the rest of your life, as long as the medical treatment is related to the work related accident. If you reach a full and final settlement agreement with the insurance company, then those medical expenses could be closed. Most workers’ compensation cases stay open and can only be closed at the request of the employee. Under the Maryland Workers’ Compensation law the employee has the right to choose whatever doctor he would like to see, as long as the doctor is willing to accept payments under the Maryland Workers’ Compensation fee schedule. see article regarding pain management issues
In addition the employer has the right to have the injured employee seen by one of their doctors in order to determine if the treatment that the injured worker is receiving is necessary and reasonable, however, they have no right to demand that you treat with the doctor chosen by the employer. It is not unusual for the insurance company to try and limit the amount of treatment you receive or refuse to authorize a visit to a doctor of your choice. Most doctors’ offices will not see you without a prior authorization from the insurance company.
Doctors fear they will not get paid unless there is an authorization. While this is not required by law, doctors do not want to have to go to court in order to be paid. If I handle your workers compensation case, I have a list of doctors that do not require a pre authorization before they will see you. Even after you receive a permanent injury award you still have a right to go back to the doctor for additional treatment unless the medicals are closed and a medicare set aside is set up.
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