The Duration of Lost Wage (Indemnity) Benefits in Louisiana Workers Compensation
How long indemnity benefits can typically last is based on the type of benefits received.
Though the calculations and exceptions can be complicated, the short answer is that, for most employees, their indemnity benefits will be limited to ten years.
Specifically though, the following types of indemnity last for the following periods:
- Temporary Total Disability (TTD): Lost wage (indemnity) benefits continue until the employee is able to work again.
- Supplemental Earning Benefits (SEB): Lost wage (indemnity) benefits continue for up to 520 weeks (or 10 years). But this includes the indemnity benefits paid for TTD (see below).
- Permanent Partial Disability (PPD): Lost wage (indemnity) benefits are defined and limited to a specific number of weeks, based on the body part injured and the anatomical loss found by the doctor.
- Permanent Total Disability (PTD): Lost wage (indemnity) benefits continue indefinitely for the injured employee. But the employee's injury must be so severe that that he or she can never work again.
So as to total disability — whether temporary or permanent — there is no limit to the number of weeks in which indemnity benefits can be paid. So long as an employee remains totally disabled, the employee will continue to receive weekly indemnity benefits for lost wages.
Since there is no limit on total disability indemnity benefits, these claims are often re-opened or re-examined.
But in order to have a re-examination in these cases, it must be shown that “a change in conditions” has occurred.
This change could either be a change in the physical condition of the worker, or a change in the labor market (since disability is defined as the ability to return to work).
The Typical Progression of Lost Wage (Indemnity) Benefits in Louisiana Workers Compensation
At the onset of a workers' compensation claim, the most common type of indemnity benefits paid is temporary total disability indemnity benefits. These benefits are paid only while the worker remains totally disabled from his or her pre-injury job because of his or her work injury or illness.
Eventually, the typical injured worker at some point either recovers from a job injury or reaches a point of "maximum medical improvement" (which is when the employee gets as recovered or healthy as he or she is going to get).
Then, when the injured worker's injuries or illnesses permit, the treating physician will release the employee to work.
This release and return to employment will be either with restrictions or without restrictions:
- If the injured worker is released by the treating physician to return to work without any physical work restrictions, then the employee's weekly lost wage (indemnity) benefits will end.
- But if the injured worker is released by the treating physician to return to work with physical work restrictions, and can prove a wage loss because of those restrictions, then the employee is entitled to supplemental earnings benefits (SEBs).
To receive supplemental earnings benefits (SEBs), then the injured employee who cannot return to work and earn at least ninety percent of his pre-injury wage, will receive 2/3 of the difference of what the employee was previously earning.
Again, the name of the benefit - supplemental earnings benefits - explains the purpose of these SEB benefits, which is to supplement an injured employee's income.
The employee has the burden of proving that, as result of a work-related injury, he or she is unable to earn 90% of his or her pre-accident wages.
But once the worker proves a wage loss, then the employer and its insurer have the burden of proving the employee's post-accident wage earning capacity.
The Duration of Supplemental Earnings Benefits in Louisiana Workers Compensation
There is no limit on the number of weeks of temporary total disability benefits (TTD) that can be paid.
But, for supplemental earnings benefits (SEBs), the injured worker can only be paid for a total of 520 weeks (or 10 years) where the employee remains disabled because of work injury.
So the employee can receive up to 520 weeks of supplemental earnings benefits (SEBs). But if in any given week the employee is able to earn 90% or more of his or her pre-injury wage, then no indemnity benefits will be paid at all for that week. But of course, the employer or carrier receives no credit for that week toward the maximum of 520 weeks.
And for any week in which indemnity benefits are payable (where the employees earns less than 90% of his or her pre-injury wage), the employer or insurer receives credit toward the maximum 520-week period.
Thus, the actual number of weeks that a claim might be in existence could extend well beyond 520 calendar weeks, though the actual number of weeks of payments should not exceed that figure.
Also, supplemental earnings benefits (SEBs) will terminate:
- At the end of any two-year period following the end of TTD, unless during that two-year period, SEB payments have been payable during at least thirteen consecutive weeks; or
- When the employee retires, but subject to a minimum of 104 weeks of SEBs.
Otherwise, supplemental earnings benefits (SEBs) continue until the wage loss ends or after 520 weeks, whichever comes first.
However, the total obligation to pay 520 weeks of supplemental earnings benefits (SEBs) is subject to a credit for the number of weeks of Temporary Total Disability (TTD) benefits or other benefits paid.
Credit of Temporary Total Disability Benefits on the 520 Week Limit of Supplemental Earnings Benefits in Louisiana Workers Compensation
Again, for supplemental earnings benefits (SEBs), the injured worker can only be paid for a total of 520 weeks (or 10 years) where the employee remains disabled because of work injury.
But, when calculating this 520 week limit, the employer and its workers compensation insurer will receive a credit for the number of weeks of Temporary Total Disability (TTD) benefits paid.
Therefore, if an employee receives six years of temporary total disability (TTD) benefits, and then switches over to supplemental earnings benefits (SEBs), then the employee would be limited to only 4 years of supplemental earnings benefits (SEBs), not 10 years.
This is a week-for-week credit off of those 520 weeks for any week in which the employee already received any amount of any other type of income benefits (but usually Temporary Total Disability (TTD) benefits).
Again, for example, if the employee received Temporary Total Disability (TTD) benefits for 100 weeks, but then was released to light duty and becomes eligible to receive supplemental earnings benefits (SEBs), then the maximum number of weeks which the employee could receive supplemental earnings benefits would be 420 weeks - not 520 weeks.