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Workers' Comp Benefits Explained

Know your rights under California’s compensation laws

In some occupations, workers face daily risks of slip-and-fall accidents, cuts, falls, and more. Oftentimes, these are freak accidents that are simply a risk one faces in the day-to-day of their jobs. But that does not have to mean they should carry the financial burden of paying their own medical costs and suffer through a loss of earnings while the injury renders them unable to work. Workers compensation law provides a fair and fast way for companies to take care of injured workers. No lengthy court battles are required to prove fault in order for workers to claim for lost wages and medical expenses.

In California, employers are required by law to carry workers compensation insurance, which the state administrates and supervises. If you are unable to work because of a workplace injury or illness, the insurance will provide workers' compensation, which covers your medical expenses and helps to cover some of your lost wages until you are able to return to work.

Different laws apply to different types of employees, although self-employed people, commission earners, and unpaid volunteers are typically not covered. Federal employees and Maritime workers are covered by similar laws.

Types of Injuries Covered by Workers' Compensation Benefits

Workers' compensation covers almost any illness or injury that is caused by your job, including repetitive motion over time, repeated exposure and events such as slips and falls. The scope ranges from first-aid injuries such as small cuts to serious accidents that lead to temporary or permanent damage. Additionally, it covers psychiatric injuries that result from workplace stress are covered.

What to Do In Case of an Injury

Naturally, the first thing to do when you suffer a workplace injury in the workplace, is to call 911, if need be. If possible, note the time and date, and take pictures or video of the place where the incident occured.

The next step is to notify your employer representative of supervisor. They should provide you with a claim form on which you can describe the incident and injury, explaining how it occured. You must complete the appropriate sections of the form in full, as most claims are denied for providing insufficient information.

Your employer will complete their part of the form and return a dated and signed copy to you, which you should file for safe keeping. They will also send another copy of the form to a claims administrator at their insurance company. The claims administrator will handle your claim and inform you as to your eligibility for workers' compensation benefits.

Acting fast is the key to receiving timely benefits. It's therefore important to report the injury to your employer and file the claim form as soon as possible. According to California state laws, employers must authorize medical care within one business day of receiving your claim form. They may also be liable for up to $10,000 in treatment until you have an answer regarding your claim. If the process is delayed, it will delay your benefits. You must file your claim within 12 months of:

  • the date of the injury
  • the date on which you knew that the injury was work related
  • or the date on which benefits were last provided.

The best way to maintain your right to benefits, is to report every injury, even if it seems insignificant. If anything more than a minor injury requires first aid, be sure to request a claim form.

Workers' Comp Benefits Explained

California's workers' compensation law guarantees:

All the reasonable, necessary medical care you require for your illness or injury and no deductibles. Medical care may include hospital services, treatment by a medical doctor, laboratory tests, medicines and physical therapy. There may be limits on some medical services, and non-emergency medical services are typically subject to preauthorization.

Benefits in the form of tax-free payments aimed at helping you replace lost wages during temporary disablement. If an injury causes death or permanent disability, additional payments will be made.

Supplemental job displacement benefits are available if your illness or injury causes permanent disability and your employer fails to offer appropriate alternative work and renders you unable to return to work within 60 days of the end of your temporary disability. This benefit takes the form of a non transferable voucher with a value ranging from $4,000-$10,000 (depending on the level and severity of your disability) for skill enhancement or education-related retraining at state-approved schools.

Payment of Workers' Compensation Benefits

Benefits are typically not paid directly to the injured worker. Instead, it is distributed as follows:

  • The claims administrator typically pays the medical expenses for necessary and reasonable treatment directly, which means that you should never receive bills.
  • Temporary disability is payable when you are unable to work for three days or more, including on weekends. The temporary disability benefit payments are aimed at helping you replace lost wages, and you should start receiving temporary disability checks approximately two weeks after the date on which you reported your injury. It should continue every two weeks until your doctor clears you to return to work, or when your condition is permanent and stationary. You will not receive payments for the first three days, unless you are admitted to hospital as an inpatient, or if you are unable to work for more than fourteen days. Temporary disability checks amount to two-thirds of your average wage, but it is subject to the maximums and minimums set by state legislature. Temporary disability rare equal the full regular paycheck but payments are tax free and there are no deductions. State law deems that temporary disability payments may not continue beyond 104 compensable weeks within two years for a single injury, or for more than 240 weeks out of five years of the date of injury for a long-term injury, such as chronic lung disease or severe burns. If you reach the end of the payment period and you are not yet able to return to work, or if you medical condition is stationary and permanent, you may apply for State Disability benefits that are available from the California Employment Development Department. This may also be available to you if your temporary disability benefits are denied or delayed. However, it is important to be cognizant of the time restrictions and to apply as soon as possible.

If your injuries leave you permanently disabled or limited in your ability to work, you may qualify for permanent disability benefits. Several factors will determine the amount, including:

  • your doctor's report
  • to what extend your work caused the permanent disability or injury,
  • your age,
  • your occupation,
  • the type of injury sustained,
  • and the date on which you were injured.

Additionally, the benefit may be affected by your employer's return-to-work offer, or lack thereof. California law determines the minimum and maximum benefit amounts, which will be laid out in a letter and calculation provided by your claims administrator. It will typically consist of a weekly amount which is spread over a fixed number of weeks. Your first permanent disability payment will be due within 14 days of your final temporary disability payment. However, if you never received temporary disability benefits, it will be due 14 days after your medical team declares your condition permanent and stationary. The benefit will be payable every two weeks until you reach the maximum, or until your case is settled and you receive a lump sum payment.

When a workplace injury causes death, members of your household or relatives who depended on you financially, will receive death benefits. State law set the amounts, depending on the date of the injury and the number of dependents. Workers' compensation will provide a burial allowance and death benefit payments will be made at a similar rate as temporary disability payments, except payments will be no less than $244 a week.

Your claims administrator will send you a letter within 30 days of the end of your temporary disability payment to advise you on whether the employer can offer you a modified or alternative job. The letter should outline your potential rights to supplemental job displacement benefits. In the absence of alternative of modified work, you may not be able to return to your job within 60 days of the end of your temporary disability, it may be determined that you have a permanent disability. In this case, you may opt for a non transferable voucher for education-related skill enhancement or retraining at a state accredited school. If you qualify for this, the claims administrator will provide the voucher. State law determines the maximum values that are as follows:

  • Up to $4,000 for permanent disability awards of between 0-15%
  • Up to $6,000 for permanent disability awards of 15%-25%.
  • Up to $8,000 for permanent disability awards between 26%-49%
  • Up to $10,000 for permanent disability awards between 50%-99%.

Additional Workers' Comp Benefits

Worker's compensation should not be confused with State Disability Insurance, although the two seem quite similar. While worker's compensation covers workplace injuries and disease, State Disability Insurance is for off-the-job illnesses and injuries. Worker's compensation is paid for by your employer, while SDI is paid out of deductions on your paycheck. If you are not covered by workers' compensation, you may be able to obtain State Disability benefits.

Retaliation Against Workers Comp Benefits Claims

The Workers' Compensation Act of California prohibits companies from penalizing workers for being injured in the workplace and making claims for workers' compensation. Employers may not unlawfully discriminate or retaliate against an injured employee as the result of the injury. If an employee takes a leave of absence in order to convalesce from the workplace injury, and returns to find that they have been stripped of seniority due to their absence from work, the employer can be penalized.

The courts may view detrimental treatment as retaliatory if the worker with the workplace injury is treated differently to other employees. Refusing to reinstate an employee in a former job for which the individual is fit, is seen as the functional equivalent to laying a person off, unless the job has been filled. Employers cannot keep a job vacancy available indefinitely.

Employees are entitled to a reimbursement for any loss of wages or work benefits that the employer caused through retaliatory acts. Additionally, employers who engage in retaliation may be obliged to pay a penalty to the employee, totalling a 50% increase in his or her workers' compensation award, up to $10,000, even if the retaliation caused no financial losses for the employee.

How to Successfully Claim Workers' Compensation Benefits

Most often, claims are denied because of late, incomplete, or incorrect documentation. It is important to obtain the disability benefits to which you are entitled as soon as possible, as temporary disability benefits equal two-thirds of all you wages from one or more jobs. Specific maximums do apply, which is why it is important to speak to a lawyer about the best way to go about filing your claim and to discuss the benefits and caps applicable to your situation. A specialist workers' compensation lawyer can provide you with time frames and explain what you can expect.

If your employer has denied benefits, or if you are having problems after you have reported your injury and filed your claim, it may be an idea to speak to a specialist workers' compensation lawyer who can guide you through the process. An experienced workers' compensation lawyer will do a thorough assessment of your case, and proactively explain your right to benefits. Your lawyer will be your voice in the complex negotiations for your rights to compensation. It can be detrimental to your case to file a claim without the help of an expert.

Call Orange County Workers Compensation Attorney today for an initial case review with one of our expert workers' comp lawyers. We will gladly discuss your situation and see how we can assist you in claiming the compensation you deserve.


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