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When does the workers compensation insurance company have to pay my work comp benefits?

Workers’ compensation insurers are required, under the law, to issue workers’ compensation checks in a timely fashion. What does this mean? Well this depends on the type of benefits you are receiving.

Temporary Total Disability Benefits

If you are off of work because of your injury you may be entitled to temporary total or TTD benefits. TTD would be owed within 14 days of notice to the employer that you were off due to the injury.

If you are receiving temporary total disability benefits, the checks are required to be paid at the same interval which you would be receiving checks normally from your employer. In other words, if you get your check on a weekly basis then, temporary total disability benefits are to be paid to you on weekly basis.

Temporary Partial Disability Benefits

If you are receiving temporary partial disability benefits, the checks are to be issued ten days after you have sent your paystubs to the insurance company. If you are relying on the employer to send the checks, then it would be ten days from which the employer is sending the check to the insurance company. You may want to send the paystub on your own and not rely on the employer to send it to make sure that they are sent in a timely fashion.

Permanent Partial Disability

PPD benefits are not payable until you are no longer receiving TTD benefits and one of the following has occurred:

  1. A PPD rating from a doctor or IME;
  2. A medical report where an insurer can determine a “minimum ascertainable amount” for PPD.

Often times an insurer will want to wait to pay PPD until you are at MMI. However, in some situations PPD may still be owed before then. 

PPD is owed within 14 days after 1st medical report with a PPD rating. If there are multiple ratings a “minimum permanency” is to be paid within 30 days. 

Medical Bills

An insurance company is required to make payment within 30 days after receipt of a medical bill unless denied in writing. If denied, your private health insurer is required to pay for the treatment. 

If a workers’ compensation insurer is waiting to approve treatment, they have seven days to admit, deny, request additional information or request an adverse examination.

Medical Mileage

Medical mileage is typically issued 30 days after it has been sent to the insurance company. The reason that it is 30 days is that the insurance typically handle it like medical bills for which under the statute they have 30 days to issue payment.

If checks have been sent to you untimely or late, a penalty may be assessed against the insurer. A penalty can be brought, at your request, by the Special Compensation Fund with the Department of Labor and Industry. A complaint can be made and an investigation with be undertaken to determine what, if any, checks have been issued late. The Department of Labor and Industry may then issue a penalty which would then be payable to you. In other circumstances, an attorney can also bring a claim for penalties based on the employer and insurer’s failure to issue checks in a timely fashion.

If you are having issues with workers’ compensation providing benefits in a timely fashion, please feel free to contact the experienced and knowledgeable attorneys at our office.