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10:31:30 AM CDT
Sunday, December 21, 2014

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Types of Benefits

Medical Benefits:

On an accepted claim, WSI pays for reasonable and necessary work-related medical care and prescriptions in accordance with fee schedule limitations and administrative rule guidelines.

Wage Replacement Benefits:

If your doctor orders you not to work for five or more calendar days in a row because of your work-related injury or illness, you will be paid a wage replacement benefit. There are three types of wage replacement benefits:

  • Temporary Total Disability (TTD) - If your disability is total, but only temporary, and your doctor has taken you off work for five or more calendar days in a row, you will be paid a TTD wage replacement benefit. Additionally, you may receive up to $15 per week for each dependent child you support. A dependent child is defined as: 1) a child under the age of 18 residing in the injured worker's household or a child for whom the injured worker has a legal obligation to support; or 2) a child age 18 and older who is incapable of supporting himself because of a disability and who is dependent upon the injured worker for support; or 3) a child between the ages of 18 and 22 who is a full-time student and dependent upon the injured worker for support.

  • Temporary Partial Disability (TPD) - If your wages are reduced because of a physical limitation related to your injury, you will be paid a TPD wage replacement benefit. TPD benefits end when your wages return to at least 90% of your gross weekly preinjury wages. TPD benefits can only be paid up to 5 years for those suffering a loss of earnings capacity after July 1, 1991.

  • Permanent Total Disability (PTD) - This benefit is for workers who are totally disabled and unable to return to work of any kind. When deciding whether PTD has been sustained, WSI must consider the following factors: nature of injury, degree of physical impairment, education, work history, wage-earning capacity, and potential for vocational rehabilitation.

Permanent Partial Impairment (PPI) Benefits:

This benefit is for workers who suffer permanent physical loss of a body part or function because of a compensable work-related injury. You can receive both a PPI award and a wage-replacement benefit, assuming you meet the criteria used to determine PPI eligibility. You will be eligible for a PPI assessment once you reach maximum medical improvement. PPI benefits are awarded only if your full-body impairment meets or exceeds the statutory minimum impairment.

Return-to-Work Services:

The goal of return-to-work services is to return the injured worker to substantial gainful employment with a minimum of retraining as soon as possible after an injury occurs. The emphasis is placed on substantial employment with the preinjury employer in the injured worker's preinjury capacity by utilizing transitional (modified or alternate) work. Depending upon the needs of the injured worker, there are several types of return-to-work services to assist an injured worker in returning to work:

  • Services provided by an on-site return-to-work case manager (registered nurses at several of the larger medical facilities across North Dakota assist injured workers).
  • Services provided by a medical case manager (registered nurses on staff at WSI who assess options and services needed to support the injured worker in the recovery process and help them return to work).
  • Vocational rehabilitation services (staff of an independent contracted company will develop a return-to-work plan taking into account the injured worker's functional capabilities, education, employment history, work experience, and transferable skills).
  • Preferred Worker Program (this program assists injured workers in obtaining gainful employment after a work-related injury).
  • The Exceptional Circumstances Scholarship Program grants scholarships to injured workers when it is determined that a scholarship would be beneficial and appropriate because of exceptional circumstances. This scholarship consists of the payment of tuition, fees, and books not to exceed $10,000 per year for more than five years. Scholarships are payable to an accredited institution of higher education or an institution of technical education on behalf of the student attending that institution. A scholarship covers the academic year for which it was applied. To be eligible for this program, applicants must have completed the rehabilitation process with WSI, and there must be no outstanding litigation on any rehabilitation plan. Applicants must reapply each year and maintain a satisfactory grade point average. For more information on this program or to obtain an application form, call (701) 328-3826 or 1-800-440-3796 (83826#).
  • The Education Loan Fund provides a low-interest loan to an individual who has suffered a compensable injury and is working to enhance their employment. The loan must be used to pursue an education at an accredited institution of higher education or an institution of technical education. In order to be eligible for this type of loan, an individual must have obtained a high school diploma or its equivalent and either must be ineligible for retraining under Chapter 65-05.1 of the North Dakota Century Code or must have exhausted training and education benefits. Eligibility will be established by WSI’s Education Loan Fund Committee and application determinations will be based on established criteria. WSI will determine program eligibility in conjunction with vocational rehabilitation. The interest rate is one percent (1%) below the Bank of North Dakota’s prime interest rate. The interest rate is fixed and is based on the rate applicable on the date of first disbursement, the day immediately following withdrawal date, or last date of attendance, whichever is the lowest rate. For more information, contact Robin Halvorson at 1-800-777-5033.

Reimbursement for Personal Expenses:

If your injury claim is accepted, WSI will reimburse you (upon your request) for mileage, meals, and other out-of-pocket costs that are necessary for your medical care, within the limits of the law. Mileage payments are based on map mileage from city limit to city limit.

For personal expense reimbursement, you may print a Request for Personal Reimbursement form (C40a) or call our office and request a copy. Complete this form, attach your receipts, and submit them to WSI. You will need to provide original, itemized, dated receipts. Request for reimbursement must occur within one year of the date the expense was incurred. Some reimbursement exclusions do apply. Please refer to the booklet entitled Workers' Compensation and You: A Guide for Injured Workers for detailed information.

Death Benefits:

WSI pays death benefits to the survivors of workers killed in work-related accidents. Benefits are paid to the eligible spouse or the dependents of the deceased worker at a rate of 2/3 of a deceased worker's weekly wage, up to 125% of the state's average weekly wage. They may also be paid up to $15 each week for each dependent child.

Additionally, the surviving spouse receives a one-time death benefit of $2,500, plus $800 for each dependent child. There are also scholarships available for some dependents. Total benefits may not exceed $300,000 over the lifetime of a claim. WSI pays all medical bills directly related to the compensable injury and death of a worker, including up to $10,000 for funeral expenses.

If the deceased worker is not survived by a spouse or other dependents, WSI will pay a lump sum of $15,000 in equal parts to any surviving non-dependent children. If the worker is not survived by non-dependent children, the $15,000 will be paid in equal shares to the worker's surviving parents. If there are no surviving parents, this sum will be paid in equal shares to surviving brothers and sisters. If there are no living brothers or sisters, the $15,000 will be paid in equal shares to surviving grandparents.

Survivors of a worker killed on the job must file claims within 2 years of the worker's date of death. Please contact WSI at 1-800-777-5033 to request the appropriate forms for filing a claim for death benefits.

To further assist the spouses and dependent children of workers who lost their lives due to work-related injuries, WSI offers the Guardian Scholarship Program. This program awards academic scholarships to spouses and dependent children to help defray the costs of furthering their education. Upon scholarship approval, applicants may receive up to $10,000 a year, for a total of five years. Applicants must reapply each year and maintain a satisfactory grade point average. For more information on this program or to obtain an application form, call (701) 328-5936 or 1-800-440-3796 (85936#).

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