Disability Benefits for Work Injuries
If you are injured on the job, you may be entitled to Workers' Compensation benefits, regardless of fault. Below, we've outlined the benefits that are potentially available. Please remember that each case is specific, and the benefits may differ depending on your date of injury. It's important to speak with an attorney regarding your own situation.
1. Medical Care
2. Temporary Disability payments
3. Permanent Disability payments
4. Supplemental Job Displacement Benefit (voucher if you are not offered to return to work by your employer)
5. 120 Million Dollar Return-to-Work Fund
6. Death Benefits for dependents of the deceased worker
Report your work-related injury or illness, regardless of the nature or severity, to your supervisor immediately. Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor. Click here for a copy of the claim form.
Legislation that went into effect during 2004 substantially changed Workers' Compensation benefits and procedures. Additional reform legislation was passed in late 2012, and will be going into effect over the course of 2013. References to "new law" describe these changes.
1. Medical Care
You are entitled to reasonable medical care needed to cure or relieve the effects of a work-related injury or illness. In appropriate cases, the Workers' Compensation Appeals Board (WCAB) can award lifetime medical care for a work-related medical condition. Medical care can include doctors, hospitals, chiropractors, nurses, medicine, braces, canes, hearing aids, as well as treatment found to be necessary and reasonable care ordered by a doctor. Under California's Workers' Compensation law, "doctor" includes physicians and surgeons, psychologists, optometrists, dentists, podiatrists, acupuncturists and chiropractic practitioners licensed by the state of California; although there are some rules regarding how long certain types of professionals can act as your primary doctor. Workers' Compensation also includes reimbursement for transportation to and from medical treatment and pharmacies.
If you file a claim on or after April 19, 2004, your employer must provide medical care within 24 hours of the filing of the claim and pay up to $10,000 in treatment for the alleged condition—even if they have not accepted the claim—until the claim is rejected. Beginning in 2005, the manner in which employers provide treatment to injured workers has changed. Beginning in 2013, further changes have been made to procedures regarding appeals of denials of medical treatment.
Medical Provider Networks
Under current law, if an employer sets up a Medical Provider Network (MPN) to treat injured employees, a worker may be treated only by a doctor in such a network unless he or she pre-designates a doctor. If no MPN is set up, an employee can still change treating doctors to a doctor of his or her choice after 30 days after giving notice of an injury, unless the employer has a Health Care Organization (see below). The employer must send out specific notices before requiring treatment within the MPN. If your employer advises that treatment within the MPN is required, you should consult with an attorney to see if such notices were sent and if the MPN is certified. The stated goal of the employer-controlled medical provider networks is to provide prompt and effective medical care. If you are not getting that kind of medical care, and wish to know your options to address this concern, you should consult with a workers’ compensation attorney to discuss your options.
Health Care Organizations
A Heath Care Organization (HCO) is like an HMO for treatment of industrial injuries. Although certain requirements must be met, if your employer contracts with an HCO, you may be required to be treated by the employer's HCO for up to six months before you can change treating doctors—un less you have pre-designated a treating doctor. If your employer claims you are covered by an HCO, you should consult an attorney to see if the proper requirements have been met.
Pre-designating your Doctor
You may advise your employer in writing before an injury that, if hurt on the job, you wish to be treated by your personal physician. The doctor must agree to be the treating physician, in writing. He or she must be the employee's regular physician, with an existing medical record and history of care. Employees are able to pre-designate a doctor if they have group medical coverage, either through their employer, through a spouse, or purchased on their own. Employees should complete a pre-designation form and make two copies (one for their records and one for their doctor's files) stamped with the date they file it with their supervisor. Pre-designated physicians may refer employees to appropriate specialists and therapists or for other treatment. A pre-designation form is available here.
Limits on Medical Treatment
The law caps chiropractic care and physical therapy to 24 visits each for injuries after Jan. 1, 2004, and occupational therapy is also limited to 24 visits for injuries after April 19, 2004. The Labor Code now defines "reasonable and necessary" treatment based on approved medical treatment guidelines. Understanding these treatment guidelines insures that care is properly being authorized. Doctors and lawyers specializing in workers’ compensation cases rely on this understanding to insure that injured workers get the necessary medical care for their injuries.
The Attorney's Role in your Medical Care
An attorney can give you experienced guidance on your choices and availability of medical treatment and evaluation. Laws concerning rights for treatment and disability benefits are quite complex. It is now more important than ever to seek skilled legal advice to ensure that your rights are protected. Employees represented by an attorney have different rights than unrepresented workers. It is in your best interest to see an attorney before choosing a doctor from a State Panel Qualified Medical Examiner list to evaluate your disability. If you choose a doctor from a State Panel, your future Workers' Compensation rights and benefits may be adversely affected.
2. Temporary Disability
You are entitled to Temporary Disability (T.D.) benefits if you are unable to perform your job duties while recovering from a work-related injury or illness. Benefits begin on the fourth day you are absent from the job due to a work-related injury or illness. There is no compensation for the first three days unless you miss 14 days of work or are hospitalized overnight.
T.D. benefit rates are two-thirds of your average weekly salary, up to the legal maximum. The first payment is to be paid no later than 14 days after your employer is made aware of the injury and accepts liability. Additional payments must be made at least twice a month. These benefits are non-taxable.
For injuries before 2004, T.D. payments are made until you return to work, or until your condition reaches a point of maximum recovery, or becomes "Permanent and Stationary”—with no time limit. T.D. benefits for injuries on or after Jan. 1, 2004 and before December 31, 2007, with very few exceptions, are no longer payable after two years from the date of the first payment. For injuries after January 1, 2008, T.D. benefits are payable up to two years within a five year period from the date of injury.
3. Permanent Disability
If you suffered a work-related injury or illness before 2005 that resulted in permanent symptoms, loss of function, work restrictions, or a decreased ability to compete in the labor market, you may qualify for Permanent Disability benefits. Under the old system, these weekly payments were based on a person's loss of ability to compete in the open labor market.
After 2005, California Labor Code prescribes new way for Permanent Disability (P.D.) benefits to be calculated. Benefits for claims are based in part on a book entitled the American Medical Association Guidelines, 5th Edition (AMA Guides). The book purports to provide an "objective basis" for evaluating loss of overall body function. Disability caused by subjective symptoms (pain) without objective findings may no longer be compensated. The new guidelines may also apply to injuries before 2005 if a doctor did not declare the injured worker "permanent and stationary" prior to that date, or if the employee has not returned to work after a period of Temporary Disability before 2005.
P.D. benefits for many disabilities have also been significantly altered by reforms passed in 2004 and 2012. Recent court decisions, particularly the Alamaraz/Guzman series of cases, have given injured workers an opportunity to be compensated more accurately by allowing a physician to use different charts and tables in the Guides in describing permanent disability.
The final P.D. rating, a percentage between 1% and 99%, establishes the amount of the award and the length of time benefits will be paid. Employees may still be eligible to receive this benefit even after returning to work. These benefits are non-taxable. Given the changes in the law, a capable attorney can help you navigate through these changes to insure that you are awarded an accurate permanent disability Award.
If an employer has more than 50 employees, the law allows for an increase in P.D. benefits by 15% if the injury happened on or after Jan. 1, 2005, but before January 1, 2013, and the injured worker was not offered a return to work. Conversely, benefits decrease by 15% for injured workers who are offered a return to work for 12 months. If terminated during those 12 months, the injured worker is entitled to his or her full P.D. award.
Employees must disclose previous disabilities upon request, and employers are liable only for the portion of Permanent Disability caused by the workplace injury. Any prior Permanent Disability award is now presumed to exist at the time of a subsequent injury. Successive awards may never exceed 100% for multiple injuries to any one region of the body.
4. Supplemental Job Displacement Benefit (Voucher)
If you are an injured worker with an injury occurring after January 1, 2005, and you are not offered a permanent or modified job with your employer within 85% of your pre-injury wages, you will qualify for a Supplemental Job Displacement Benefit (voucher). The amount of the voucher will vary depending on your date of injury and, in some cases, your level of permanent disability. There are detailed rules that describe how an injured worker may access and spend the voucher money to assist in returning to work. If your disability precludes you from going back to work, it is important to consult with an attorney about your right to this voucher.
5. 120 Million Dollar Return-to-Work Fund
The 2012 reforms provided for a $120 million fund for “injured workers whose permanent disability ratings are disproportionately low in comparison to their wage loss.” Eligibility for the benefits and the specifics of how the fund will be administered will be based on research to be performed by the State of California in consultation with the Commission on Health, Safety and Workers’ Compensation (CHSWC). Most likely these benefits will be available to workers who sustain injuries after January 1, 2013
6. Death Benefits
If an employee dies on the job from a job-related injury, or from a heart attack, cancer, stroke or other disease found to be caused or aggravated by work, the surviving spouse, minor children or other dependents may be entitled to receive benefits. Dependents who are good-faith members of the household also may be eligible for benefits, even if not legally married. For example, the family of an employee with three or more dependents may be entitled to benefits of $320,000.
If the job-related injury was not the main cause of the death, but contributed to the cause of death, a dependent spouse and children still may be entitled to full death benefits. Even survivors only partially dependent on support of the deceased worker may be eligible for this benefit. There is also an allowance for reimbursement of burial expenses.
A $250,000 benefit is now owed to the estate of safety officers without dependents who die from job-related injuries that occur on or after Jan. 1, 2003.
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