Weekly Worker’s Compensation Benefits
Temporary Weekly Benefits
If a doctor says you are completely unable to work due to your injury for 4 days or more, you are entitled to receive weekly Temporary Total Disability (TTD) benefits. The weekly TTD benefit is 2/3rds of your average gross weekly income (before taxes), called your Average Weekly Wage. TTD benefits are usually very close to your net wages (after taxes). You will also receive an additional $10 per week for each dependent child.
The workers compensation insurance company should complete a Form 32 which is an agreement about the amount of your weekly benefit. Do not sign the Form 32 unless you have reviewed the Form 25 (see explanation below, under Average Weekly Wage) and you are absolutely sure the Form 25 has the correct numbers.
If your doctor releases you to work, but because of your injury you can only work part-time or find a job where you earn less than your old job, you will receive Temporary Partial Disability (TPD). TPD is 2/3rds the difference between what your Average Weekly Wage (AWW) and what you are making in the new job. You must submit your pay stubs to the insurance company for it to determine the amount of TPD you are entitled to each week.
The weekly benefits will end automatically when you successfully return to work at full duty with the same pay. Otherwise, the insurance company cannot stop these benefits unless (A) doctor says you are at a “Medical End Point” or at “Maximum Medical Improvement” OR (B) A doctor releases you to return to work and you refuse to return to work or you refuse to comply with the insurance companies’ requirement for a “good faith job search”; AND for both (A) and (B) the insurance company must file a Form 27 with the Vermont Department of Labor explaining why it is terminating these benefits.
Average Weekly Wage (AWW)
Your Average Weekly Wage is calculated by averaging your gross wages (before taxes) over the 26 weeks prior to your injury. You should ask for a copy of the Form 25 which lists your 26 weeks of wages to ensure it is correct.
The Form 25 lists a lot of the rules for determining the AWW. Some of those rules are:
(1) Each week of work must be listed separately so you can see how many hours were worked each week.
(2) Any week where you worked less than half the week should not be included.
(3) The week that you were hurt should also not be included.
(4) Overtime and bonuses must be included.
The AWW is then used to determine your Weekly Compensation Rate ("WCR"). Your WCR is 2/3 of your AWW. The amount of the Weekly Benefit (TTD) is the WCR plus $10 for each dependent (dependent is defined in 21 VSA 601.) For most people, the WCR is equal to their after-tax wages.
Every year on July 1st your Weekly Benefit should be increased by a Cost of Living Adjustment which is published by the Vermont Department of Labor. The insurance company must file a Form 28 showing the increase as of July 1st every year.
Medical End Result
Medical End Result is also called Maximum Medical Improvement or Medical End Point. This means your condition is stable and there is no further treatment which will improve your condition. This is a determination that must be made by a doctor.
After you reach medical end you can still get treatment for pain, or to help you remain functional (called "palliative care"). Such palliative care includes: medications, chiropractic care, acupuncture, or physical therapy.
Once you are at medical end result the insurance company can file a Form 27 with the Vermont Department of Labor to terminate your Weekly Benefits.
This is also the point at which the assessment of permanency is done for Permanency Benefits.
If an insurance company doctor says you are at Medical End Point, and your treating doctor disagrees, you need to get something in writing from your treating doctor and file it with the VT Department of Labor.
Good Faith Job Search
If you have been cleared to return to work by a doctor, whether full duty with restrictions, or part-time, you will be required to perform a good-faith job search to remain entitled to Weekly Benefits (TTD).
When you are doing a job search, you must be able to prove that you are unable to get a job because of your injury. If you are unable to find a job for some other reason (like no one is hiring), you may not be entitled to continue the weekly wage replacement benefits. The insurance company must file a Form 27 with the Department of Labor to terminate your weekly benefits for failure to conduct a good faith job search. If your benefits have been terminated, you should call a lawyer.
The insurance company should provide you with forms to be filled out weekly documenting your job search activities. It is extremely important that you provide as much information as possible - the number you called, the name of the person you spoke to, the results of the contact, etc. These forms must be submitted to the insurance company weekly for you to continue to receive your weekly benefits.