As attorneys who have represented thousands of injured workers in Delaware, we often get asked how long someone can stay on workers’ compensation and receive benefits. The duration of benefits will depend on the facts of each specific case.
In Delaware, an injured worker has two years from the date of the claimed work accident to get workers’ compensation to formally accept the claim (i.e. file an Agreement as to Compensation) or file a Petition to Determine Compensation Due (DCD) with the Industrial Accident Board (IAB). If the workers’ compensation insurance company has not accepted the claim, and the injured worker has not filed a DCD petition with the IAB within two years of the work accident, then workers’ compensation benefits will not be afforded to the injured worker. However, once the workers’ compensation carrier has accepted the work injury, the statute of limitations changes from two years to five years from the date of the last payment. In other words, the injured worker has a right to pursue workers’ compensation benefits for five years from the last date that the workers’ compensation carrier makes a payment on his or her claim. The statute of limitations is extended an additional five years each time the workers’ compensation insurance carrier makes a payment on the claim.
Permanent Total Disability (PTD)
If an employee has suffered a catastrophic injury, such as a severe spinal cord injury, traumatic brain injury, or loss of limbs, they may qualify for permanent total disability (PTD). This means that they are unable to perform any type of work due to the injury, and as a result, they may be eligible for lifetime benefits. However, the insurance company may require yearly or bi-yearly medical evaluations to review the employee's condition.
Permanent Partial Disability (PPD)
If a worker has suffered an injury that results in a permanent loss of function, the injured worker may be eligible for permanent partial disability (PPD). This is where an individual has some degree of permanent impairment, which is determined by having a doctor rate a specific body part and opine a percentage of impairment for that specific body part (usually based on the AMA Guides to Permanent Impairment). A calculation is used, based on 1) the percentage of impairment, 2) the body part injured, and 3) the injured workers’ compensation rate, to come up with a monetary value.
Temporary Total Disability (TTD) and Temporary Partial Disability (TPD)
If an employee has suffered an injury that is temporary and can recover back to their pre-injury condition, they may be eligible for temporary total or temporary partial disability benefits. This means that the injured worker can receive benefits while they are unable to work due to the work injury. There is no maximum for the amount of temporary total disability benefits (injured worker is unable to work), but there is a 300 week lifetime maximum on temporary partial disability benefits (the injured worker can work, but with restrictions that limit the amount of wages earned).
The workers’ compensation carrier must pay medical bills that are reasonable, necessary and causally related to the work accident. If they refuse, a petition to DCD must be filed with the IAB within 2 years to preserve the statute of limitations. As stated above, every time that a medical bill is paid by the workers’ compensation carrier (as long as it is paid with prejudice), the claim remains open for an additional 5 years. Medical bills are paid based on the workers’ compensation fee schedule and treatment is covered under the workers’ compensation practice guidelines. Workers’ compensation also covers mileage, at the rate of $0.40/mile, when traveling to and from medical providers.
In conclusion, the duration of workers’ compensation benefits differs in each case depending on whether the claim is accepted and when payments are made by the workers’ compensation carrier. It is essential to retain the services of an experienced attorney who can help you navigate the complex workers’ compensation system.
If you have been injured on the job in Delaware and are unsure about your workers’ compensation benefits, the experienced attorneys at Kimmel Carter are here to help. Call (302) 565-6100 for a free legal consultation.