A Santa Rosa workers’ compensation lawyer explains the kind of benefits that are available to employees who are injured at work.
In California, five different workers’ compensation benefits are available when an employee is injured in a work-related accident. In some cases, a workers’ compensation insurance administrator will approve the benefits without argument. In other cases, the administrator might contest whether any benefit should be paid or will disagree with the injured worker about the amount of the benefit that should be paid. When disputes arise, a Santa Rosa workers’ compensation lawyer can help injured workers obtain the benefits to which they are entitled.
Every California employee who is injured at work or who develops a health condition caused by work is entitled to medical treatment. That treatment is provided at the employer’s expense. Most employers meet that obligation by having workers’ compensation insurance. The workers’ compensation insurance company generally maintains a medical provider network, or MPN. Employers must give information about medical care for a work-related injury to new employees and must post a notice at work explaining how to obtain medical treatment after a work injury.
Medical treatment may include first aid, surgery, chiropractic, acupuncture, and hospital treatment, including nursing care, medicine, medical and surgical supplies, crutches, and medical devices such as prosthetic and orthotic devices. Workers’ compensation insurance companies must provide as much treatment for work-related injuries as is “reasonably required” to cure the injury or to relieve the injured worker from its effects.
The state has adopted guidelines to determine whether recommended treatment is “reasonably required.” However, injured workers are entitled to present evidence that departing from the guidelines is necessary to cure or relieve the symptoms of the injury. Unfortunately, for any single work-related injury, chiropractic treatment and physical therapy are limited to 24 treatment sessions.
Temporary Disability Benefits
When an injured worker is unable to work because of a work-related injury, he is entitled to temporary total disability (TTD) benefits. Those benefits equal two-thirds of the injured worker’s average weekly wages, subject to a minimum and maximum weekly benefit payment. In 2018, the maximum weekly payment is $1,215.27 per week.
TTD benefits are not taxed, so the benefit can sometimes be similar in amount to the injured worker’s take-home pay. TTD benefits are based on overtime pay and all other wages, including pay the injured worker may have earned at a second job.
When an injured worker is able to perform some work but cannot earn full wages (for example, if he is only able to work part-time), the injured worker is entitled to TTD benefits called “wage loss benefits.” These wage loss benefits generally amount to two-thirds of the difference between earnings at the time of the injury and the earnings after the injury.
TTD benefits continue for a maximum period of two years. The workers’ compensation insurance company may also terminate TTD benefits when the injured worker’s condition is cured, or when the condition has reached the point where it will no longer heal. When the injury will never completely heal, the injured worker should receive permanent disability (PD) benefits after the TTD benefits end.
Permanent Disability Benefits
Permanent disabilities occur when an injured worker has suffered permanent functional limitations in a body part or system as a result of the work injury.
Permanent disability benefits compensate injured workers according to a formula that is specified by California law.
The legislature has occasionally changed how benefits are calculated, so benefits may depend on the date on which the injury occurred. Other factors also affect the calculation of permanent disability benefits, including:
- the injured worker’s age on the date of the injury,
- the injured worker’s occupation,
- the extent of the permanent impairment, and
- the percentage of the impairment which was caused directly by the work injury.
The extent of the impairment is determined by a Qualified Medical Examiner (QME). The treating physician will prepare a “permanent and stationary” or “P&S” report when the injury reaches a stage where it is no longer healing. Thereafter, the injured worker will be evaluated by a QME.
Based on the QME report, the injured worker will be assigned a disability rating. The value of permanent disability benefits are based on that rating. While the rating is based on an objective medical assessment of the injured worker, the rating itself is necessarily subjective. Disagreements about the rating are usually resolved by negotiating a settlement with the workers’ compensation claims administrator.
Workers’ compensation settlements might provide for a final lump sum payment that resolves the claim entirely, or might provide for periodic payments of benefits along with ongoing medical care for life. A Santa Rosa workers’ compensation lawyer can help injured workers decide which kind of settlement is best for them.
Supplemental Job Displacement Benefits
For work injuries occurring in 2013 or later, an injured worker who has a permanent partial disability and who does not return to work may be entitled to receive a supplemental job displacement benefit. The benefit consists of a voucher that can be used to pay for job training at a California public school or at certain state-approved training facilities. It can also be used for certain other purposes, including:
- paying for licensing or certification and testing fees,
- purchasing tools required by a training course,
- purchasing computer equipment of up to $1,000,
- reimbursing up to $500 in miscellaneous expenses, and
- paying up to $600 for the services of a licensed placement agency or vocational counselor.
The total value of the benefit cannot exceed $6,000, regardless of the level of permanent disability.
The supplemental job displacement benefit is only available to employees who are not offered a return to work by their employer in a job that will last at least 12 months and that pays at least 85% of the employee’s earnings at the time of the injury.
When a work accident causes an employee’s death, the employee’s spouse, children, and certain other dependents are entitled to a death benefit. The benefit includes reasonable burial expenses of up to $10,000 and a payment of at least $224.00 per week. The amount and duration of the payment depends on the number of dependents who will receive the death benefit.
When an injured worker suffers permanent disability as a result of a work injury, or when an insurance administrator disputes a workers’ compensation claim, it is time to obtain legal advice. To get advice in Santa Rosa about receiving benefits for a work-related injury, call Kneisler & Schondel at (707) 542-5132. You can also ask us a question by submitting our online contact form.