How Is the Amount of Workers’ Compensation Benefits Determined?

How Is the Amount of Workers’ Compensation Benefits Determined?

Workers who suffer work-related injuries or illnesses may wonder, “how is the amount of workers’ compensation benefits determined?” Workers’ comp insurance in Illinois usually pays the medical costs resulting from your injury or illness. The wage replacement benefits entitled to you are, however, two-thirds (or 66.6%) of your average weekly wage (AWW). The state minimum and maximum benefit caps will apply to these benefits.

Workers compensation printed on wooden blocks held by a man in white shirt and blue tie with dollar symbols around. How is the amount of workers' compensation benefits determined?

The amount of your workers’ compensation benefits will depend on various factors, including your pre-injury wages, the severity of your injury or illness, and the impact on your ability to work. A detailed workers’ compensation claim checklist can help streamline the claims process by guiding you on eligibility requirements for workers’ comp benefits, factors impacting the compensation amount, and how to calculate workers’ compensation benefits.

Call Martay Law Office at 312-374-6403 to request a free consultation with seasoned workers’ compensation lawyers if you have suffered an injury or illness at work.

Eligibility for Workers’ Compensation Benefits in Illinois

You must meet requirements to be eligible for workers’ compensation benefits in Illinois. These include:

Employment Relationship

A valid employment relationship between you and your employer must have existed when you sustained a work-related injury or illness. Records of employment are essential in showing the existence of an authentic employment relationship. These records include employment offer letters, wage statements, and performance reviews.

Scope of Employment

The Illinois Workers’ Compensation Act covers injuries employees sustain while performing their duties. The Act also covers injuries sustained by employees who earn wages while traveling or those whose job duties involve traveling between locations. Employees injured outside the work zone while running errands for the employer are eligible for workers’ comp benefits as well.

Directly Related to the Job

Besides happening within the scope of your employment, your injury or illness must also stem from your job to qualify for coverage under Illinois workers’ comp insurance. An injury or health issue that starts showing symptoms while you are working, but is not work-related, is not eligible. Medical records and witness statements can help you prove your injury or illness was caused or worsened by a work accident or hazard.

The Injury Is Reported Before the State-Imposed Deadline

You must report your injury or condition to the employer within 45 days of the work-related accident to qualify for compensation. This report can be oral or written, but it is advisable to provide a written report. You should, however, ensure the report includes your identifying details and a comprehensive description of the accident. Read the report carefully to ensure it captures everything, sign it, and submit it to your employer or supervisor. Be sure to retain a copy of the report.

The Claim Is Filed Within the Statute of Limitations

Missing the state-imposed statute of limitations is one of the common mistakes to avoid when filing a workers’ comp claim. In Illinois, you must initiate a claim within three years of sustaining a work injury or within two years of the last compensation collected for that injury, whichever occurs later.

Submitting an injury report to your employer does not mean that you have filed a workers’ comp claim. You can only initiate a claim by completing and filing an Application for Adjustment of Claim form with the IWCC.

Factors That Impact the Amount of Workers’ Compensation Benefits

The amount of workers’ compensation benefits depends on various factors. Knowing how to identify and account for these factors can help increase the compensation amount you recover.

Your Pre-Injury Average Weekly Wages

Workers’ comp benefits partially replace your wages when you cannot work because of your injuries. As such, your average weekly wage before your injury is a fundamental factor in determining these benefits.

Your AWW will depend on your basic salary and supplemental employee compensation, like commission, bonuses, or overtime. The higher your pre-injury AWW, the higher the workers’ comp benefits. Your benefits will be subjected to the minimum and maximum statutory caps.

Severity of Your Injury or Illness

The more severe your occupational injury or illness, the higher the value of your workers’ compensation claim. Severe injuries, such as concussions, back injuries, spinal cord damage, and head and traumatic brain injuries, may keep injured workers from working for a long period.

Such injuries cause greater wage loss and result in higher workers’ comp payments. Workers with these injuries may continue to receive benefits until they recover completely or attain maximum medical recovery.

Disputed Workers’ Comp Claim

Your employer or workers’ comp insurer may contest your claim at any point in the process. Your claim value may drop if there is a dispute over your benefits. The insurance company may, for instance, agree that you have a valid claim, but contest an aspect of your case. A good example is how soon you return to work after a workers’ comp injury.

Your Ability to Work

Your workers’ comp benefits will be lower if you can work and earn an amount almost equivalent to your pre-injury wages. Injuries that allow you to work at a limited capacity and earn lower than your pre-injury wages will result in higher compensation. Your claim value will be much higher if your injuries prevent you from working completely.

The Lawyer You Hire

Skilled workers’ compensation lawyers know how to calculate workers’ comp benefits and steps to take to better your odds of receiving maximum compensation. So, ensure you hire a lawyer with a demonstrated history of helping injured workers recover adequate compensation before filing a claim.

What Is the Process for Calculating Workers’ Compensation Benefits in Illinois?

The process for calculating workers’ compensation benefits in Illinois starts by determining the average weekly wage (AWW). Determining AWW, generally, involves adding gross earnings for the last 52 weeks and dividing by 52.

Several factors may impact your AWW. You may include overtime earnings when determining your average weekly wages, especially if you worked overtime hours on a regular basis. You may also include earnings from other jobs if you worked for multiple employers when you got injured.

Temporary Total Disability (TTD) Benefits

You can calculate TTD benefits by multiplying your pre-injury AWW by two-thirds. These benefits are available if you cannot return to work for a specific duration or your employer cannot accommodate work restrictions recommended by your physician.

If you were making $900 a week before you got injured, your TTD benefits would be $600 – 2/3 of $900. Your TTD benefits must be within the state average weekly wage (SAWW).

Temporary Partial Disability (TPD) Benefits

TPD benefits amount to 2/3 of the difference between your AWW before and after the injury. These benefits usually replace your lost income if your injuries have forced you to hold a job or position that pays less than your pre-injury wages.

Let’s say your pre-injury earnings were $800 a week, but now you make $400 per week while performing light duties or working part-time. In this scenario, your TPD benefits will be $266.67 – 2/3 of the difference between $800 and $400.

Permanent Partial Disability (PPD) Benefits

There are four methods for calculating PPD benefits in Illinois. The wage differential method will determine your PPD benefits if you have to switch jobs and the new job pays less than what you were earning before the injury. It involves finding two-thirds of the wages lost.

The scheduled awards method will apply in your benefits calculation if you have sustained the loss of use of body parts listed on the schedule. It involves multiplying 60% of your AWW before the injury by the number of weeks provided in the schedule.

The nonscheduled awards method is used when the physical impairment you suffered is missing from the schedule. You can determine a nonscheduled award by multiplying your disability rating by 500 weeks and then multiplying that figure by 60% of your pre-injury AWW.

The Disfigurement benefits method applies when you have permanent disfigurement or marking on a noticeable body area. These benefits add up to 60% of your AWW before your injury, to a maximum of 162 weeks. The severity of the disfigurement will determine the number of weeks used to calculate your benefits.

Permanent Total Disability (PTD) Benefits

The amount of PTD benefits is two-thirds of your pre-injury AWW up to 133.3% of the SAWW for the period when your injury happened. You will qualify for these benefits if you have suffered a permanent workplace injury and cannot return to work.

Death Benefits

Illinois recorded 177 work-related deaths in 2022. Death benefits may be available to surviving dependents of an employee who dies because of a job-related injury or illness. These benefits amount to 2/3 of the deceased employee’s average weekly wages. Illinois offers these benefits for up to 25 years or up to $500,000, whichever is higher. Eligible surviving dependents may also receive up to $8,000 to pay funeral and burial expenses.

Workers’ compensation lawyers at Martay Law Office can secure workers’ compensation benefits that reflect your injury severity, medical needs, and lost wages. Contact us today. Initial consultations are free. 

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David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association