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I'm injured and cannot work. What next?

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Q:

I'm injured and cannot work. What next?

A:

Thousands of workers are injured each year: on the job, through recreational activities or in car accidents. If you have been injured, you may qualify for disability benefits through benefits programs offered through workers' compensation and/or Social Security Disability Insurance (SSDI). Before applying for benefits, however, it’s important to review your options.

Step 1: Determine if you qualify for SSDI benefits

Social Security Disability Insurance (SSDI) is offered to injured or disabled workers who have a severe condition that is expected to last 12 continuous months and that does not allow the worker to perform substantial gainful activity (SGA).

Workers must also be insured for SSDI benefits, which means that they must have paid payroll taxes and earned sufficient work credits.

Workers who qualify for SSDI benefits will be paid a monthly benefits payment and medical coverage. Payments will vary based on the amount that the worker has paid into the disability system and their average wages over the calculation period. The average payment for SSDI benefits is currently $1,100 per month.

Not only must a worker’s condition be expected to last at least 12 continuous months to qualify for SSDI, but a worker’s wages must also be below a specific threshold. For instance, non-blind individuals must make less than $1,090 per month.

If you do not meet the requirements outlined above (i.e. you not insured, you do not have a long-term condition, or your wages are too high) you will be denied SSDI benefits, regardless of the severity of your current injury.

Step 2: Determine if you qualify for workers' compensation benefits

Workers' compensation insurance offers what is considered “exclusive remedy” for compensating workers who have been injured while performing their normal job duties. Currently, every individual state has its own workers' compensation insurance program. Talk to a workers' compensation lawyer in your state if you have questions about your state’s laws.

The benefit of workers' compensation is that it offers compensation to workers injured on the job. Assuming that the worker meets the requirements of coverage, the injured worker automatically receives compensation for lost wages, medical benefits and death benefits.

Under workers' compensation, the employee receives the benefit of avoiding a protracted legal battle in court to prove that their work injuries were caused by their employer’s negligence, and the employer avoids the costs and hassle of defending their actions.

Step 3: Decide if you should apply for SSDI benefits

Assuming that you were not injured at work (which we will discuss below), you may apply for SSDI benefits (if you are insured) as soon as you are certain that your injury will last at least 12 continuous months and your income is below the wage threshold ($1,090 per month).

There is a five-month waiting period to qualify for SSDI benefits, but due to the lengthy approval process, it’s important to apply as soon as you meet the requirements outlined above.

Some claimants also seem to be confused about whether they have to wait 12 months to apply. You do not have to wait 12 months to apply for SSDI; your condition must only be expected to last 12 continuous months.

Step 4: SSDI vs. workers' compensation benefits

So how do you know if you will receive workers' compensation or Social Security Disability Insurance? First, determine how you were injured. If you were injured on the job, your first course of action is to notify your employer and determine if your work injury is covered through workers' compensation.

If workers' compensation is offered, you may receive wage payments and medical care benefits even if your condition will not last 12 months. Additionally, most workers' compensation claims are approved (assuming that the worker did nothing to negate coverage).

If your injury is not expected to last 12 continuous months, you will not qualify for SSDI benefits. In this case, you will receive only workers' compensation for the allotted time and return to work.

However, if your injury is long-term and you are not expected to return to work, it is time to determine whether you may also qualify for SSDI benefits. Before applying for SSDI benefits, though, you should consult with the human resource contact who administers your workers' compensation plan to find out whether your workers' compensation benefits will be reduced by your SSDI benefits.

Can I go back to work after a work injury?

If you are only receiving workers' compensation, you will return to work when the doctor says you are able to. Workers' compensation payments will vary based on whether you are able to return to your full-time employment or a modified work assignment.

If you are receiving SSDI benefits and want to return to work, however, you will need to first contact the Social Security Administration. The Social Security Administration encourages workers, who are able, to return to work. In fact, there are several programs that may allow you to test your ability to work without immediately jeopardizing your SSDI benefits.


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