Catastrophic Injury Benefits – How Does It Work?

In workers’ compensation law, catastrophic injury benefits are generally the same as total permanent disability benefits. Victims will usually have their medical care covered and will receive a portion of their wages, up to a certain amount. The details will depend on the law of the specific state. Some states may have laws that treat catastrophic injuries differently than other workplace injuries.

What are the workers’ comp benefits for a catastrophic injury?

Generally, the workers’ compensation benefits for a catastrophic injury are the same as for a workplace injury that has left a worker totally and permanently disabled. However, some states have workers’ compensation systems that may treat catastrophic injuries differently.

This means that workers who have suffered a catastrophic injury while on the job will generally receive workers’ compensation for:

• medical treatment and other attendant care, and
• lost wages due to the injury.

Typically, when a worker is hurt on the job, he or she will recover from the injury to the point where he or she can work again. During this time, they will receive the following 2 types of workers’ compensation for their lost wages:

1. total temporary disability benefits while they are held out of work completely from the injury, and
2. partial temporary disability benefits while they work in a lesser capacity.

Workers who have suffered a catastrophic injury, however, do not progress to the second part. Their injuries are so severe that they are unable to work again. They are totally disabled, and their disability will likely be permanent.

In these cases, the worker can continue to receive total disability benefits for their lost wages from the employer’s workers’ compensation insurance company. The precise amount varies by the state. Generally, though, it is a percentage of the worker’s wages or salary, capped at a specific amount. For example, under Georgia law, injured workers receive disability benefits of two-thirds, or 66 percent, of their weekly income up to a maximum amount of $675 per week.¹

Many states limit how long workers can recover total disability benefits, though. In Georgia, for example, total disability benefits stop after 400 weeks, or about 7 years and 8 months.² However, if the Georgia worker’s injury falls under the definition of a “catastrophic injury,” then the disability benefits continue until the worker gets better.³

In states that differentiate between non-catastrophic workplace injuries and catastrophic ones, it is essential to get the legal advice of a catastrophic injury lawyer from a reputable law firm to help with your workers’ compensation claim. Having legal representation can ensure that you get the compensation and disability benefits that you need and deserve.

What is a catastrophic injury?

A catastrophic injury is a severe and extremely debilitating medical condition. Federal law defines a catastrophic injury as one that “permanently prevents an individual from performing any gainful work.”⁴ Some examples can include:

• traumatic brain injuries (TBIs) and other head injuries,
• limb dismemberment or amputation,
• paralysis,
• paraplegia,
• quadriplegia,
• spinal cord injuries,
• blindness, and
• severe burns, like second- or third-degree burns covering a significant amount of the victim’s body.

However, each state’s workers’ compensation laws may set out specific medical conditions that amount to a catastrophic injury.⁵ In states that have such a legal definition, that definition determines whether an injury is catastrophic or not. Even when a victim has been defined as disabled for the purposes of receiving Social Security Disability Income (SSDI) benefits, that may not suffice for his or her state workers’ compensation case.

Note that the key factor is how much the injury impacts the worker’s ability to hold a job. Some injuries that seem severe enough to be considered catastrophic may not be if they do not impact the victim’s professional life. Additionally, the same injury may be the grounds for a catastrophic injury claim for one person but not another based on their profession.

For example: Claudia and Andy both have a leg amputated after an accident. Andy is a furniture mover. His condition will likely be considered a catastrophic injury. Claudia is an accountant. Because her amputation will probably not affect her job, it will probably not be considered a catastrophic injury.

These job injuries can happen in a wide variety of workplace accidents, including:

• falls,
• car accidents,
• crush incidents,
• vehicle rollovers, and
• saw accidents.

Victims in these injury cases should strongly consider hiring a personal injury lawyer or catastrophic workers’ compensation lawyer. Hiring an attorney can help recover accident benefits for medical bills, anticipated future medical expenses, and lost wages.

How are these injuries different from others in the workplace?

Catastrophic injuries are different from other workplace injuries – even very serious ones – in that some states provide more generous workers’ compensation benefits for them. Not all do, though. Some states, like California, do not differentiate between catastrophic and other workplace injuries.

What is the law in California?

In California, catastrophic injuries are treated the same as other severe workplace injuries: Victims can recover permanent total disability benefits for as long as they are disabled by the injury.

Victims of workplace injuries are assigned an impairment rating by their treating physician for each injured body part. These ratings are then used to provide a “whole person impairment.” The whole person impairment is then converted into a permanent disability rating using the Permanent Disability Rating Schedule. If the permanent disability rating is 100 percent, the worker has suffered a permanent total disability. If the number is less than 100 percent, the worker has a permanent partial disability.

Some personal injuries are presumed to cause permanent total disabilities, though. These serious injuries are:

• loss of both eyes or total blindness,
• loss of both hands or the use of them,
• any injury that causes a practically total paralysis, and
• severe brain injuries leading to permanent mental incapacity.⁶

These types of injuries are the closest that California comes to having a definition for catastrophic injuries. Victims who have suffered one of these injuries do not have the burden of proving that they are permanently and totally disabled.

Workers who have a permanent total disability receive workers’ compensation income benefits equal to two-thirds, or 66 percent, of their weekly wage. They receive these benefits once a week for the rest of their life or until they are no longer totally disabled.⁷

Workers with a permanent partial disability receive two-thirds of their weekly wage loss.⁸ However, these benefits only last a specific number of weeks, as set down by California Labor Code 4658 LAB.

---