Understanding workers’ compensation benefits can be a challenge. Take this quick quiz to test your knowledge and understanding.
1) Does an employee have to miss work to be entitled to workers’ compensation benefits?
No. There are four different types of workers’ compensation benefits (medical, income, death, and burial). If an employee suffers a work-related illness or injury, the insurance carrier may pay for treatment regardless of whether the employee is able to return to work or not. Temporary Income Benefits (TIBS), are only paid when the employee is unable to work for more than seven days up to a maximum of 401 weeks.
2) Is time spent for medical treatment of a work-related injury or illness compensable?
Maybe. Time spent for medical treatment of a work-related illness or injury, including time spent travelling to and from the appointment, is compensable if the employee is able to work or has returned to work following an absence and the employer or the employer’s agent (e.g., insurance carrier) requires the employee to attend. For example, when the employer directs an injured employee to go to a specific clinic during the workday. Time isn’t compensable if the employee isn’t able to work, an appointment is required at the discretion of a private physician, an appointment relates to a non-work illness or injury, or an appointment is required before an employee may access paid sick leave.
3) While receiving workers’ compensation benefits, is an employee responsible for the payment of health insurance premiums?
Maybe. Responsibility for payment of health insurance premiums while an employee is absent from work depends on the type of leave benefits being applied. The district is responsible for paying the regular contribution to an employee’s premiums during paid leave and family and medical leave (FML). If the leave is unpaid, and FML doesn’t apply, the employer has no obligation to pay the regular contribution to the employee’s premiums. During any period of unpaid leave that isn’t designated as FML, the employee is responsible for the entire health insurance premium. This includes an absence due to work-related illness or injury during which an employee is receiving TIBs.
4) Does the workers’ compensation statute include provisions for leave entitlement or job restoration?
No. The workers’ compensation statute doesn’t include provisions for leave entitlement or job restoration. Persons receiving workers’ compensation benefits may also be eligible for leave benefits under other federal and state laws that provide job protection or restoration and continuation of district contributions to group health care premiums (e.g., Family and Medical Leave Act). Other types of leave may run concurrently with workers’ compensation benefits including FML, state personal leave, state sick leave, assault leave, temporary disability leave, and local leave.
5) Must worker’s compensation wage benefits be coordinated with assault leave?
Yes. State law requires school districts to coordinate assault leave with workers’ compensation wage benefits. Districts must supplement TIBS to provide the employee with income equal to the pre-injury wage. Districts should contact their workers’ compensation carrier for the TIBS rate on claims where assault leave must be paid to ensure the assault leave offset is the correct amount. Additional information on calculating the offset payment is covered in the HRX post, “Calculating Assault Leave Payments.”
6) Can an employee elect to not use paid leave while receiving TIBs?
Yes. The choice to use paid leave during a workers’ comp absence belongs to the employee. An employee can decline the use of paid leave and only receive TIBs.
Keith McLemore joined HR Services in 2015 and assists districts with compensation planning and development. He has 17 years of experience traveling the state supporting public education employees.
McLemore received a bachelor’s degree from Southwestern University and a master’s degree from Texas Tech University, both with a focus on research analysis and design. He is a SHRM-CP.
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