Workers Compensation Benefit Overview - Travelers Insurance

Customer Workers Compensation Benefit OverviewWYOMINGINDEMNITY ISSUESTemporary Total BenefitsTemporary Partial BenefitsPermanent Partial BenefitsPermanent Total BenefitsFatality BenefitsVocational RehabilitationSettlement AllowedDisfigurementTTD rate is based on 2/3 of the gross average monthly wage not to exceed thestatewide average monthly wage (SAMW) of $3,683.33 for the current quarter(4th quarter 2012). The SAMW changes quarterly.Due at 80% of the difference between light duty wages and actual monthlyearnings at the time of the injury as long as the total earnings from employmentdo not exceed 95% of the actual monthly earnings at the time of the injury. TPDcannot exceed the SAMW from date of injury.Two different permanent partial awards:1. Permanent physical impairment (PPI) benefit is established whenmedical authority has determined the injured worker is at ascertainableloss. All physical impairments are measured according to the mostrecent edition of the AMA Guides. The award is calculated at the rate of2/3 of the SAMW for the 12 month period immediately preceding thequarterly period in which the injury occurred for the number of monthsdetermined by multiplying the percentage of impairment by 44 months.2. Permanent partial disability (PPD) is available when the injured workeris unable to work at any occupation at a comparable or higher wage forwhich they are suited by experience and/or training. Benefits arecalculated according to a statutory formula which takes intoconsideration the worker's remaining work-life, experience in otheroccupations, education, career plans and age. Impairments are basedon a whole person.Award is calculated on earnings at time of injury multiplied by 80 months lessany previous award.Calculations:1. if the actual monthly earnings are less than 73% of the SAMW, theaward shall be 92% of the injured employee's actual monthly earnings;2. if the actual monthly earnings are equal to or greater than 73% of theSAMW, but less than the SAMW, the award shall be 2/3 of the SAMW;and3. if the monthly earnings are greater than or equal to the SAMW, theaward shall be 2/3 of the employee's actual monthly earnings, but theaward shall be capped at and shall not exceed the SAMW.In the case of death due to work related causes, and if the award computed isless than 80% of the SAMW, the award shall be adjusted to an amount not lessthan 80% of the SAMW.Yes, with a $30,000 maximum in benefits. Injured Worker waives right to PPDYes, of all issues (medical and indemnity) as a result of legal action.Maximum: not to exceed six months of compensation based on a rate that isequal to 2/3 of the gross average monthly wage. Previous disfigurement isapportionable.Claim Services 1 of 2 CE- 10173 Rev. 10/12© 2012 The Travelers Indemnity Company

MEDICAL ISSUESInitial Choice of ProviderChange of ProviderMedical Fee ScheduleManaged CareUtilization ReviewTreatment GuidelinesGeneric Drug SubstitutionMedical Mileage Reimbursement RateAbility to Terminate Medical TreatmentSettlement AllowedCap on benefits, exceptionsInjured worker has choice of medical provider.Yes, with written approval of the Division.YesNot permitted.None.Yes, Knee, shoulder, spine, carpal tunnel, IDET, Impairment Rating, PainManagement, Narcotic Management, Joint Revision, CT scan, Chiropractic,Physical TherapyThe state mandates generic substitution.55.5 cents/mile-must be provided within one year of travel and distance must begreater than 10 miles.Yes, with an IME, which is binding. Injured worker can challenge IME findings athearing.Yes, see above.None.OTHER ISSUESStaff CounselHearings require attorney or claimhandler participationOccupational DiseasesSecond Injury Fund availabilityOther Offset OpportunitiesEDIIn-State Adjusting RequiredLicense or Certification RequiredSTATE WC WEBSITE LINKNone.Yes, attorneys are required. Claim handlers do not have to be present. Disputesare handled in civil court.Yes.NoApportionment is permitted.NoNo, but if adjusted out-of-state, a license (by exam) is required. Reciprocitygranted if adjuster is licensed in another state (other than OH & NV)See above.http://wydoe.state.wy.usThe Travelers Indemnity Companyand its property casualty affiliatesOne Tower SquareHartford, CT 06183This material does not amend, or otherwise affect, the provisions or coverages of any insurance policy or bond issued by Travelers. It is not arepresentation that coverage does or does not exist for any particular claim or loss under any such policy or bond. Coverage depends on the factsand circumstances involved in the claim or loss, all applicable policy or bond provisions, and any applicable law. Availability of coveragereferenced in this document can depend on underwriting qualifications and state regulations.Claim Services 2 of 2 CE- 10173 Rev. 10/12© 2012 The Travelers Indemnity Company