Sickness and Injury Benefits

Sickness and Injury Benefits

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Sickness and injury benefits provide financial support if you can’t work because of an illness or injury that you suffered at work. Depending on your coverage, you may be able to receive cash payments for a period of time, medical treatment, and prescription medication. Your family members may also be eligible for payment of death benefits.

You’re able to claim sickness benefit when you are not able to work because of an illness or injury that is not the result of a work-related cause, and it is expected to last at least three consecutive days. This includes recurring illnesses, such as chronic bronchitis, asthma or dermatitis. It can also include conditions that are the result of repeated activities, such as carpal tunnel syndrome or repetitive strain injuries (RSI).

If your injury or illness is so severe that you cannot perform any type of work, you can apply for disability benefits under your FECA coverage. Generally, you will be paid two-thirds of your average weekly wage up to a maximum of your SAWW plus annual cost-of-living adjustments (COLA). Your spouse or other dependent children can also receive payments when they are living with you and you’re unable to care for them because of your condition.

In addition to the two-thirds of your SAWW, you can also claim a one-time payment for any permanent loss or impairment of specific functions, scarring or disfigurement caused by your work-related injury or illness. This can help pay for things like cosmetic surgery or a wheelchair.

Unlike workers’ compensation, there is no 30-day rule for reporting these kinds of injuries or illnesses to your 傷病手当金 employer. However, there are still requirements that you must meet in order to qualify for disability benefits under FECA. These include providing a doctor’s report, keeping all records and documents related to your injury or illness, and attending periodic physician’s meetings.

Your insurance coverage under the FECA covers not only your medical expenses but also the replacement value of any equipment or clothing you lost because of a work-related injury or illness. It also provides you with a death benefit for the loss of life that occurred as a result of your injury or illness.

During the first three months of disability, you can maintain your and your covered dependents’ eligibility under the FECA health plan by paying $20 per month for “S Coverage”—which provides only for medical, mental health, prescription coverage, and death benefits. You can also maintain this FECA coverage if you switch to another job that doesn’t offer a health plan, but only for the duration of your disability. Check with the person responsible at your establishment for more information.

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