How to Calculate Workers Comp Settlement for Telehealth Only Treatment (No In-Person Doctor Visits)

Introduction: Workers Comp Settlements for Telehealth-Only Treatment

If your workers' compensation treatment has been conducted entirely through telehealth—video calls, phone consultations, and virtual appointments—you may wonder whether this affects your settlement value. The short answer: the delivery method of your medical care does not change how your settlement is calculated.

Telehealth has become a standard component of workers' compensation care. As of 2023, approximately 76% of U.S. employers offered telehealth benefits, a dramatic increase from just 24% in 2015, according to the U.S. Department of Health and Human Services. Between March 2020 and December 2021, 41 states expanded telehealth coverage for workers' compensation claims in response to the COVID-19 pandemic.

Your settlement calculation depends on specific factors: your injury severity, disability rating, lost wages, and total medical costs. Whether those medical costs came from telehealth visits or in-person appointments does not alter the calculation methodology, according to the U.S. Department of Labor.

However, there's a critical consideration you need to understand: while telehealth can handle ongoing treatment, most states require in-person physical examinations for the disability ratings that drive settlement values. This article explains exactly how to calculate your settlement when your treatment has been telehealth-only, and what steps you may need to take to protect your full benefit amount.

How Telehealth Treatment Affects Workers Comp Settlement Calculations

Workers' compensation settlements are built on three primary components, none of which penalize you for receiving telehealth care:

Medical Benefits (Approximately 50% of Total Workers' Comp Costs)

Your medical expenses are reimbursable regardless of delivery method. According to National Council on Compensation Insurance 2022 data, medical benefits constitute approximately 50% of total workers' compensation costs nationally. Telehealth visit reimbursement rates under workers' comp typically range from $50 to $200 per session, and approximately 40 states require workers' compensation insurers to reimburse telehealth at the same rate as in-person visits.

Wage Replacement Benefits

Temporary total disability (TTD) benefits replace a portion of your lost wages while you recover. These benefits range from $400 to $1,200 per week depending on your state and pre-injury wage. Your treatment method—telehealth or in-person—has no bearing on this calculation. What matters is your documented inability to work and your average weekly wage.

Permanent Disability Awards

This is where telehealth-only treatment requires careful attention. Permanent partial disability (PPD) awards account for approximately 30% of all workers' compensation benefits paid annually, according to the National Academy of Social Insurance. These awards depend on impairment ratings, which typically require physical examination.

Most states require in-person evaluations for Independent Medical Examinations (IMEs) to determine maximum medical improvement (MMI) and impairment ratings. The AMA Guides to the Evaluation of Permanent Impairment, 5th and 6th editions, require physical examination findings that cannot be fully assessed via telehealth. If you've only had telehealth treatment, you'll likely need at least one in-person examination before settlement to establish your disability rating.

Step-by-Step: Calculating Your Settlement with Telehealth Treatment Only

Follow this process to calculate your potential settlement value:

Step 1: Document All Medical Expenses

Gather records of every telehealth appointment, including:

• Video consultation fees
• Phone appointment charges
• Prescription costs ordered through telehealth
• Any medical equipment or supplies prescribed virtually
• Digital physical therapy sessions

These costs are part of your settlement calculation at the same rate as in-person visits.

Step 2: Calculate Your Lost Wages

Determine your average weekly wage (AWW) by reviewing your earnings for the 52 weeks before your injury. Most states pay TTD benefits at approximately two-thirds of your AWW, subject to state minimums and maximums. Multiply your weekly benefit rate by the number of weeks you've been unable to work.

Step 3: Obtain Your Disability Rating

This step typically requires an in-person examination, even if all your treatment was telehealth-only. Your treating physician or an IME doctor will assign a permanent impairment rating as a percentage. This rating directly impacts your settlement value.

State calculation methods vary significantly:

• California: Uses Labor Code formulas combining impairment rating with age, occupation, and future earning capacity
• Texas: Multiplies impairment ratings by statutory amounts per percentage point
• Florida: Applies permanent impairment guidelines with specific dollar values per rating percentage

Step 4: Apply Your State's Settlement Formula

Using your disability rating, calculate your PPD award based on your state's method. Permanent partial disability settlements range from $2,000 to $175,000 or more depending on impairment rating and state, according to the Workers Compensation Research Institute.

Step 5: Add Future Medical Costs

If your injury requires ongoing care, estimate future medical expenses. These may include continued telehealth monitoring, medications, or potential surgical interventions. Future medical costs can be negotiated as part of a lump-sum settlement or kept open for ongoing coverage.

Step 6: Calculate Total Settlement Range

Combine your figures:

• Past medical expenses (telehealth and any other care)
• Past lost wages
• Permanent disability award
• Future medical costs
• Future wage loss (if applicable)

Average workers' compensation settlements range from $20,000 to $40,000 nationally according to National Safety Council and NCCI data, though values vary widely based on injury severity and state law.

Telehealth vs In-Person Treatment: Settlement Value Comparison

The key takeaway: settlement formulas do not distinguish between telehealth and in-person care. Your settlement value depends on your documented injury severity, disability rating, and wage loss—not where your doctor was located during your appointments.

Common Questions About Telehealth Workers Comp Settlements

Will my settlement be lower because I only had telehealth treatment?

No. Settlement calculations are based on injury severity, disability rating, wage loss, and medical costs—not the delivery method of treatment. Telehealth visits are generally reimbursed at parity with in-person visits under workers' compensation in most states. Your settlement formula remains identical whether you received care virtually or in an exam room.

Can I get my disability rating through telehealth?

In most cases, no. State workers' compensation systems and the AMA Guides to the Evaluation of Permanent Impairment require physical examination for determining impairment ratings. You will likely need at least one in-person evaluation to establish the disability rating that factors into your settlement calculation.

Is telehealth treatment covered under workers' compensation?

Yes, the majority of states explicitly cover telehealth services under workers' compensation. Following COVID-19 policy changes, coverage expanded significantly across 41 states. While specific coverage rules vary by jurisdiction, telehealth has become a standard and accepted form of workers' comp medical care.

Do I need to convert to in-person care before settling my claim?

You don't need to change your ongoing treatment approach. However, you will likely need an in-person Independent Medical Examination to determine maximum medical improvement and obtain a disability rating. This single in-person evaluation is typically required regardless of how your regular treatment was delivered.

Get Help Calculating Your Telehealth Workers Comp Settlement

Understanding your settlement value requires accurate calculations based on your state's specific formulas and your documented medical condition. Use our free workers' compensation calculator to estimate your potential settlement based on your injury type, state, wages, and disability rating.

If you've received telehealth-only treatment, make sure you understand the disability rating requirements in your state before accepting any settlement offer. You have the right to fair compensation for your workplace injury—regardless of how you received your medical care.