When someone is out of work because of an injury, they depend on workers’ compensation benefits to get by. When the checks are inconsistent or late, it can create problems with paying the bills, transportation, and even buying food. Understanding the different payment schedules can help you prepare in advance and plan for potential problems.
First, until the Workers’ Compensation Board makes a direction for the insurance company to pay you – either by a “Proposed Decision” or at a hearing – all payments are voluntary. What this means is that the insurance company can pay whatever it thinks is appropriate based on the medical reports it has, or not pay you at all if it is not satisfied with the medical reports or has another reason to deny payment. If that is your situation, then we can call the insurance company to try to resolve the problem, but in most cases we have to file a request for a hearing in order to address benefit payments.
PAYMENTS DIRECTED BY THE BOARD
After a hearing is held or a decision is issued, there are two kinds of money awards – retroactive benefits (for periods of time before the hearing or the decision), and continuing payments (that go into the future after the hearing or decision). We’ll use this Notice of Decision Notice of Decision as an example.
You may receive a decision from the Board stating that you are owed a certain number of dollars per week for a certain period of time in the past. In our sample Decision, this would be the part of the award that is outlined in black.
The insurance company has to pay this award – after subtracting all of its previous payments and the attorney fee – within 10 days of the date the decision is filed. That date is the part of the sample Decision that is outlined in red. In the sample Decision, the filing date is February 5, 2019, so the insurance company has until February 15, 2019 to pay the benefits due through February 1, 2019. Be aware, though, that if the tenth day falls on a weekend or a legal holiday, the time to issue payment is extended to the next business day.
The sample Decision we are using here was issued after a formal hearing. If the decision is not from a hearing, but instead is a “Proposed Decision” or an “Administrative Decision”, then the date that is used to calculate the payment time is not the filing date, but instead is the date the decision becomes “FINAL.” That date usually appears in the block of text in the middle of the decision above the award.
SCHEDULE LOSS BENEFITS
One type of decision that involves a retroactive payment is a schedule loss award, which is an award for the percentage loss of use of a limb (arm, leg, hand, foot, fingers, toes, hearing loss or vision loss). These awards are calculated at a weekly rate for a certain number of weeks, which translates into the total value of the award. For instance, an award for 24.4 weeks of compensation at $400 per week is worth $9,760.
The insurance company is entitled to deduct all of its previous payments from a schedule loss award – both checks it issued and wages paid by the employer, as well as the attorney fee. The balance due after all of those deductions is the amount you should receive.
Another kind of award is a direction for the insurance company to make ongoing payments at a certain weekly benefit rate. This is called a direction for the Carrier to Continue Payment or “CCP.” On our sample Decision, the CCP is located in the blue box.
Many insurance companies will send you a check every two weeks. However, the law does not require them to do so. Instead it requires the insurer to mail an “installment payment” within 25 days after the last date it made payments through. That is often a date before or after the date the check was actually mailed, and as a result the payments may not come every two weeks.
For example, if the insurance company mails you a check on March 25 that pays you through April 1, it is not required to mail the next check until April 26. If that check pays you through April 15, the next check must then be mailed by May 10. But if it pays you through April 22, the next check would be timely as long as it was mailed by May 17.
There are exceptions to almost every rule, and that includes the rules for timely payment.
On exception is if the insurance company appeals the decision, which it can do within 30 days from the date decision was filed (again, the date in the red box on our sample Decision). If it files an appeal, it is not required to make payment of any part of the award it is objecting to in the appeal. Another is one we mentioned earlier – if the due date for a payment falls on a weekend or a holiday, it is not due until the next business day.
MY CHECK IS LATE – WHAT HAPPENS NOW?
If your check is late, we can contact the carrier to address the status of your payments. This is usually the fastest way to resolve any issues regarding your checks. We can also file for a hearing to address your payments. Usually, the Workers’ Compensation Board will schedule a hearing within 4 to 6 weeks after a request is made.
In addition to collecting any outstanding benefits you are owed, we may also be able to have a penalty imposed against the insurance company. Whether a penalty is due and the amount involved depends on the type of payment owed to you.
If the carrier does not pay a retroactive award or pays it late, then the penalty amount is 20% of the non-payment or late payment. If you think you were paid late, we recommend that you keep a copy of both the check and the envelope it was received in so we will have the proof we need to claim that a penalty is due.
If the carrier does not pay ongoing awards in a timely manner as outlined above, we can also ask for a penalty, but the Judge has discretion about whether or not to impose one.