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Orange County Workers Compensation Benefits Explained

Nov 19, 2018| Posted by myadmin

It is common for a worker to be injured on the job. Some jobs present more potential risks than others. If such an occurrence does arise, a worker can face even more troubles when it comes to medical costs and the loss of a paycheck. However, it is important to know that if you have been injured, left incapable, or unable to properly work due to an accident or another danger at work, you are entitled to workers’ compensation in the state of California.

Under California Labor Code 3700, employers are required by law to carry workers’ compensation insurance for their employees. This means that businesses that have one or more employees must have insurance. Think of this as a safety net for employees should any injury, minor or serious, occur that limits their ability to do their job. If an employee has been rendered unfit to continue with his job due to an accident, or any other disability, then that employee may be able to benefit from workers’ compensation. No employee should stress over the issues than can arises if he or she becomes physically unfit to continue working. With a workers’ compensation insurance carried by their employer, an employee can receive help in their period of recovery.

It is important to know that different laws apply to different types of workers, and that there are certain injuries or illnesses that are and are not covered by workers’ compensation. At Orange County Workers’ Compensation Attorney, we have the knowledge to assist you when it comes to cases in involving workers compensation. With our highly-skilled attorneys, we are ready to make sure you are receiving the proper benefits and that your rights as a worker are protected.

What Injuries Are Covered by Workers’ Compensation?

There are many different types of injuries or illnesses that can occur on a job. It can be as small as a cut, or as serious as an accident that causes a permanent disability. However, most of these injuries are covered by workers’ compensation if they impede your ability to continue working. These injuries need to have been caused on the job. For example: a slip or fall while working, an injury sustained by repetitive movement, or exposure to harmful toxins. Workers’ compensation can also help towards psychiatric injuries if caused by your job.

A quick, but limited, list of injuries covered by workers’ compensation includes:

  • Back and neck injury
  • Head injury
  • Carpal Tunnel Syndrome
  • Hearing Loss
  • Psychiatric injury

These types of injuries, and more, can be covered by workers’ compensation if they were caused by or sustained by your job. If so, you can receive help in paying for related medical costs despite being unable to work.

What to Do if You Have an Injury on the Job?

In order to receive the benefits from workers’ compensation, you must report your injury. After you have been injured, you must let your employer, or supervisor, know about your condition. They should provide you with a claim form to fill out the details of your injury or illness. On this form, you should provide details such as how the incident occurred, when and where it took place, and the degree of injury. This is crucial in determining what benefits you may receive. It is also important that you report your injury as soon as possible.

Under California law, your employer must authorize medical care within one (1) business day of receiving your claim. Also, they may be liable for up to $10,000 in medical costs and treatment costs if they delay in authorizing medical care.

Your employer, or supervisor, should also fill out the form with the proper information and return a dated copy to you. They will, then, send a copy of the claim form to a claims administrator at the insurance company. From this point on, it is the administrator at the insurance company who will handle your claim and keep you informed about the benefits you can receive if eligible for workers’ compensation.

Remember, you must file a claim for your injury within 12 months from either the date of the injury, from when you learned the injury was related to your job, or from which you last received your benefits.

If you fail to report your injury within this time period, you may lose out on workers’ compensation benefits and may be faced with expensive medical costs on your own. Try to always report your injury or illness as soon as you possibly can so as to not delay any compensation you may receive.

What are the Benefits Assured by Workers’ Compensation?

If you have sustained an injury or became ill due to your job, then you can receive benefits under workers’ compensation. Benefits can vary from job to job considering that they may carry different types of workers’ compensation insurances, and it can also vary depending on the type and severity of the injury or illness. However, a basic outline of workers’ compensation benefits should include: compensation for medical costs, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits, and death benefits. Remember, a workers’ compensation benefit can only be applied to injuries or illnesses sustained while on the job. If not, you cannot receive these benefits.

Compensation for Medical Costs

As defined by workers’ compensation laws in California, medical costs and care must be authorized and paid so as to cover what is reasonably required to relieve or cure a work-related injury or illness. Treatment can only be covered by compensation if it follows the guidelines set out in the medical treatment utilization schedule (MTUS). If any sort of treatment for a work-related injury or illness does not follow this guideline, it cannot be approved. Your employer and/or claims administrator will help you figure out what treatments can and cannot be approved under a workers’ compensation insurance.

When it comes to what doctors and specialists you may see if you are injured, it depends on the employer. If you have already designated a personal doctor, you can still see him or her.

Sometimes your employer may have an MPN. This is a group of doctors, physicians, and specialists that your employer or insurer has already selected to treat work-related injuries and illnesses. If this is the case, a claims administrator will provide you a list of care providers and you may select within the MPN.

An employer may also have a health care organization (HCO) to provide health care to injured workers. If this the case and you choose the HCO, the organization will coordinate your medical treatments and care for you and plan out your return-to-work alongside your employer.

If you have none of the above in terms of health care, then your claims administrator may select a doctor for you within the 30 days after your injury. After 30 days, you may select a doctor or health care provider of your choice, but within reasonable means.

Temporary Disability Benefits

If you have developed an injury or an illness that prevents you from doing your job you may receive temporary disability (TD) benefits to cover your lost wages during your period of recovery.

Compensation under temporary disability covers two-thirds of the pre-taxed wages and benefits you would have received. The cannot receive more than the maximum weekly wage determined by the state. The maximum amount you can receive is determined by the state average weekly wage (SAWW). Every year this amount can shift, so make sure to check for an up-to-date rate during your recovery period.

When reporting your income, you should include all forms of income, including: food, lodging, tips, commission, overtime, bonuses, and any other form of income from another job.

You may receive TD benefits if your doctor has determined that you cannot work for three or more days, or if you get hospitalized. These payments are made every two weeks, and can stop after you return to your job, your doctor allows you to work, or if your injury has healed enough.

Permanent Disability Benefits

In the case of permanent disability due to a work injury or illness, benefits are paid out for life. The payments, at the temporary disability rate, are adjusted on a yearly basis should there be an increase in the state average weekly wage (SAWW).

The total amount of compensation shifts from year to year. Please always check the current rates to make sure you are receiving the correct amount. You can check out state sites, like the Department of Industrial Relations for more detailed information.

Supplemental Job Displacement Benefits (SJDB)

Under California workers’ compensation law, if you have sustained a permanent partial disability and your employer does not provide suitable regular, modified, or alternative work within 60 days, you may receive supplemental job displacement benefits (SJDB). This benefit is meant to provide the worker with the means to properly gain skills and certification to find other employment.

This is received as a type of non-transferable voucher which equals the amount of $6,000, regardless the severity of the permanent injury. With this voucher, you may pay for training, pay licensing or certification and testing fees, purchase computer equipment up to $1,000, and be reimbursed for extra expenses up to $500. Also, up to $600 may be used to pay for a licensed placement agency or vocational counseling.

This voucher is due within 20 days from 60 days the employer has to provide a suitable amount of work. The job must pay a minimum of 85% of the workers’ earnings at the time of the injury and must be expected to last at least one (1) year. This voucher can expire after two (2) years or in five (5) years following the injury (whichever date may come later).

Benefits in Case of Death

If a work-related injury or illness has led to death, then under workers’ compensation, benefits must be paid out to the worker’s spouse, children, or another type of dependent. This type of benefit will be made to cover the costs of burial, not exceeding the cost of $10,000, and more will be paid out to dependents.

Furthermore, the total amount of benefit to be received depends on the total amount of dependents or partial-dependents that the worker leaves behind. If there is a single total dependent, he or she may receive up to $240,000. If there are 2 or more total dependents, they may receive up to $290,000. With 3 or more total dependents, they may receive up to $320,000. In cases of one total dependent and one or more partial-dependents, they may receive $250,000 plus four times annual support for partial dependent for a maximum of $290,000. If there is just one or more partial-dependents, they may receive eight times annual support for a maximum of $250,000. If any total dependents are minors, they continue to receive payments until they turn 18 years-old.

Benefit payments in this case commence at one (1) year from the date of death if the death occurs within one (1) year from injury; one (1) year from the last receipt of benefits, or one (1) year from death if occurs more than one (1) year after injury. Benefits in this case are paid out at the total temporary disability rate, a minimum of $244.00/week.

Death benefits include:

  • Maximum $10,000 for burial costs
  • Maximum $240,000 for a single, total dependent
  • Maximum $290,000 for two or more total dependents
  • Maximum $320,000 for three or more total dependents
  • Maximum $290,000 for one total and one or more partial-dependents
  • Maximum $250,000 for one or more partial-dependents

Note: these amounts are subject to change and reflect the benefits to be received if the injury or illness related to the death occurred after January, 1, 2013.

Mileage Rates

Having an injury or illness sometimes means you have to visit doctors and pharmacies for treatment. If you have to travel to places like doctors, pharmacies, therapy, and the hospital, you can be reimbursed for travel mileage. The mileage rate shifts from year to year. Make sure to check for an up-to-date rate. 

In total, these are some of the basic benefits you may receive under workers’ compensation law in California. Once you fill out a claim form after you have sustained a work-related injury, your claims administrator will inform you of the benefits you may receive. If you need up-to-date information about benefits and going rates, you can ask your claims administrator or refer to the Department of Industrial Relations website.

Can I Be Penalized for Taking Workers’ Compensation?

In short, no. The Workers’ Compensation Act of California prohibits a company or employer from penalizing its workers for sustaining an injury while on the job and making a workers’ compensation claim. This act is meant to protect a worker’s right to compensation and to further ensure a worker’s well-being. An employer cannot retaliate against an employee with a work-related injury by treating them differently. Also, an employer cannot strip the injured worker of their seniority. If the employer acts in a way to violate this act, then they can be penalized.

If an employer has refused to let an injured employee to be reinstated back into their former job, then can be penalized. This can be viewed as a form of laying off the employee due to their work-related injury despite the employee being healthy enough to return.

If your employer has committed an action similar to one of these, they can be penalized. More than this, they are liable to reimbursement your lost wages. The employer may also be forced to pay a penalty including a 50% increase of the worker’s compensation award—a possible penalty of up to $10,000.

What to Remember When Claiming Workers’ Comp Benefits

There are some keys things to remember if you have sustained a work-related injury or illness and you want to receive workers’ compensation benefits. These include:

  1. Your injury or illness must have been sustained while working
  2. Report your injury or illness as soon as possible to your employer
  3. Fill out a claim with proper information
  4. Keep in contact with your claims administrator about your benefits
  5. Once you have recovered, plan your return to work alongside your employer and doctor

Finding a Workers Compensation Attorney Near Me for Help

Becoming injured or ill on the job can be overwhelming and can make the process of receiving the proper workers’ compensation benefits burdensome. However, Orange County Workers’ Compensation Attorney is here to help you. With our team of highly skilled and professional attorneys and staff members, we want to assist with any involving workers compensation. Sometimes, the process can be a bit confusing and tedious and we know this.

Furthermore, if you are having a difficult time dealing with your employer or if you feel that you are not receiving the correct workers’ compensation benefits, do not wait to find assistance. Please contact our work injury attorney at 949-423-3212 if you need help with a case involving workers’ compensation. We want to make sure your rights as a worker in California are protected and ensured. We are willing and ready to fight for your rights.

We have other offices to serve you in Southern California: Los Angeles workers comp attorney & Long Beach workers comp attorney


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