Know Your Rights
Workers' Compensation Benefits and Information
What California law provides for injured workers — the benefits available to you, and what to do after a workplace injury.
Basic Workers' Compensation
What is workers' compensation?
If you get hurt on the job, your employer is required by law to pay for workers' compensation benefits. You could get hurt by:
- One event at work such as hurting your back in a fall, getting burned by a chemical that splashes on your skin, getting hurt in a car accident while making deliveries, or
- Repeated exposures at work such as hurting your hand, back, or other part of the body from doing the same motion over and over, or losing your hearing because of constant loud noise.
Workers' compensation covers some, but not all, stress-related (psychological) injuries caused by your job. Also, workers' compensation may not cover an injury that is reported to the employer after the worker is told he or she will be terminated or laid off.
What are the benefits?
- Medical Care: Paid for by your employer, to help you recover from an injury or illness caused by work. This includes doctor visits and other treatment services, tests, medicines, durable equipment, and travel costs reasonably necessary to treat your injury.
- Temporary Disability Benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering.
- Permanent Disability Benefits: Payments if you don't recover completely and your injury causes a permanent loss of physical or mental function that a doctor can measure.
- Supplemental Job Displacement Benefit: A voucher to help pay for retraining or skill enhancement if you are eligible to receive permanent disability benefits, your employer doesn't offer you work, and you don't return to work for your employer. You may also be eligible for an additional, one-time payment under the Return-to-Work Supplement Program.
- Death Benefits: Payments to your spouse, children, or other dependents if you die from a job injury or illness.
What should I do if I get hurt at work?
You should immediately report your injury to your employer. Make sure your supervisor or someone else in management knows as soon as possible. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If your employer does not learn about your injury within 30 days, you could lose your right to receive workers' compensation benefits.
What should I do after I report my injury to my employer?
After reporting your injury, you should:
- Fill out a claim form and give it to your employer. Your employer must give you a Workers' Compensation Claim Form (DWC 1) within one working day after you report your injury or illness. You use this form to request workers' compensation benefits. Fill out and sign the "employee" portion of the form. Give the form to your employer. Do this right away to avoid possible problems with your claim.
- Get medical care. You should be treated by a doctor who understands your particular type of injury or illness. The role of this doctor is to prescribe care for your job injury or illness and manage your overall care, help determine when you can return to work, help identify the kinds of work you can do safely while recovering, refer you to specialists if necessary, and write medical reports that will help determine the benefits you receive.
Can my employer fire me because of my injury?
It's illegal for your employer to punish or fire you for having a job injury, or for filing a workers' compensation claim when you believe your injury was caused by your job. It's also illegal for your employer to punish or fire co-workers who testify in your case.
Also, the federal Family and Medical Leave Act (FMLA) and the California Family Rights Act (CFRA) say that an employer with 50 or more employees usually must let you take unpaid leave for up to 12 weeks, without losing your job, if you need time off for a serious medical condition.
Did you know?
- Medical care must be paid for by your employer if you get hurt on the job — whether or not you miss time from work.
- You may be eligible to receive benefits even if you are a temporary or part-time worker.
- You may be covered by workers' compensation as an employee even if you are called an "independent contractor."
- You don't have to be a legal resident of the United States to receive most workers' compensation benefits.
- You receive benefits no matter who was at fault for your job injury.
Medical Treatment
Who pays for your medical care?
Your employer pays for medical care for your work-related injury or illness, either through a workers' compensation insurance policy or by being self-insured. The claims administrator pays the medical bills. You should never receive a medical bill, as long as you filed a claim form and your physician knows that the injury is work-related.
What kind of medical care is available to injured workers?
California workers' compensation law requires claims administrators to authorize and pay for medical care that is "reasonably required to cure or relieve" the effects of the injury. This means care that follows scientifically based medical treatment guidelines.
Medical treatment guidelines used in California
The medical treatment guidelines currently being used in California are in the medical treatment utilization schedule (MTUS) published by the Division of Workers' Compensation (DWC).
The medical treatment guidelines are designed to help physicians give appropriate treatment. This includes advising and guiding the injured worker on how to remain active while recovering, and informing the employer about the kinds of changes at work that are needed to promote recovery.
If your doctor recommends treatment that is not in the guidelines
Some injured workers have medical conditions requiring treatment that is not in the MTUS. If your doctor recommends treatment not in those guidelines, the claims administrator is required to pay for the treatment if it follows other scientifically based guidelines that are generally recognized by the national medical community.
Limits on chiropractic, physical therapy, and occupational therapy visits
You are limited to 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits for your injury (except for visits under the post-surgical treatment guidelines), unless the claims administrator authorizes additional visits in writing.
When does my medical care start?
If it's an emergency, your employer must make sure that you have access to emergency treatment right away. For non-emergency care, the claims administrator is required to authorize treatment within one working day after you file a claim form. While investigating your claim, he or she must authorize necessary treatment up to $10,000.
Who can treat me right after I am injured for non-emergency care?
It depends on whether your employer or the insurer has created a medical provider network (MPN) or has a contract with a health care organization (HCO) to treat injured workers, and whether you previously predesignated your personal physician or a medical group.
If you previously predesignated your personal physician or a medical group. Workers with health care coverage for conditions unrelated to work are allowed to predesignate their personal physician or a medical group before injury. If you predesignated, you may see your personal physician or the medical group right after you are injured.
If there is a medical provider network (MPN). An MPN is a group of physicians and other health care providers who treat injured workers. An employer or insurer that has an MPN must give you written information about the MPN. If your employer or the insurer has an MPN, in most cases you will first be treated in the MPN after you are injured, unless you predesignated.
If there is a health care organization (HCO). An HCO is an organization certified by the DWC that contracts with an employer or insurer to provide managed medical care for injured workers. If your employer or the insurer has a contract with an HCO, in most cases you will first be treated in the HCO after you are injured, unless you predesignated.
If there is no MPN or HCO. If your employer or the insurer does not have an MPN and does not have a contract with an HCO, in most cases the claims administrator can choose the doctor who first treats you after you are injured, unless you predesignated.
Did you know?
- Your employer is required to post information about your workers' compensation rights, including the right to predesignate your personal physician in case of job injury.
- If your employer or the insurer created a medical provider network (MPN), the employer or insurer is required to give you written information about rights, procedures, and services while being treated within the network.
- You have a right to request and receive copies of all medical reports that affect your benefits.
Temporary Disability Benefits
What are temporary disability benefits?
If your injury prevents you from doing your usual job while recovering, you may be eligible for temporary disability (TD) benefits. TD benefits are payments you receive if you lose wages because your treating doctor says you are unable to do your usual job for more than three days, or you are hospitalized overnight; and your employer does not offer you other work that pays your usual wages while you recover.
How much are temporary total disability payments?
Temporary total disability (TTD) payments are usually two-thirds of the wages you were earning before you were injured. Example: If the gross wages that you would be earning if you were not injured are $300 per week, your TTD payments are $200 per week.
You can't receive more than a maximum weekly amount set by law. Therefore, if you earned more than a certain amount of wages before you were injured, you could receive less than two-thirds of those wages.
What if I can do some work while I recover?
You may receive temporary partial disability benefits if your doctor says that you're able to go back to work on a limited basis. For instance, your doctor may recommend a schedule of only four hours a day or three days a week. In that case, you'll usually receive two-thirds of your lost income — the difference between what you were earning before the injury and what you're earning now.
If your injury is covered by workers' compensation, your first TD payment is due within 14 days after your employer learns that you have a job injury or illness, and your treating doctor says your injury prevents you from doing your job. You should receive this payment from the claims administrator.
How often do you get temporary disability benefits?
After the first payment, TD benefits must be paid every two weeks by the claims administrator, for as long as you are eligible.
How long do temporary disability payments last?
TD payments end when your treating doctor says you can return to your usual job; or you return to your usual job or to modified or alternate work at your regular wages; or you have reached a point where your condition is not improving and not getting worse; or you were injured on or after January 1, 2008, and received up to 104 weeks of TD benefits within five years from the date of injury.
Do I have to pay taxes on temporary disability benefits?
You don't pay federal, state, or local income taxes on TD benefits. Also, you don't pay Social Security taxes, union dues, or retirement fund contributions on these benefits.
Permanent Disability Benefits
What are permanent disability benefits?
If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability. This means that you may be eligible for permanent disability (PD) benefits.
What is a Permanent & Stationary (P&S) report?
When you reach a point where your medical condition is not improving and not getting worse, your condition is called "permanent and stationary" (P&S). This is referred to as the point in time when you have reached maximal medical improvement (MMI). When this happens, your primary treating physician writes a P&S report.
The P&S report should describe specific medical problems, limits on the work you can do, medical care that you may need in the future for your injury, whether you are able to return to your old job, and an estimate of how much your disability is caused by your job compared to how much it is caused by other factors.
How do you become eligible for a permanent disability award?
To be eligible for permanent disability benefits in California, your doctor must write a P&S report. If you've completely recovered and can go back to work without any limitations, you won't be eligible for PD benefits. However, you may be entitled to compensation if your injury or illness has left you with permanent physical or mental limitations on the work you can do. In workers' compensation, this is called "permanent disability."
What is a rating?
A "rating" is a percentage that estimates how much your disability limits the kinds of work you can do. It determines the amount of your PD benefits. A rating of 100 percent means that you have a permanent total disability. Ratings of 100 percent are very rare. A rating between 1 percent and 99 percent means you have a permanent partial disability. Most injured workers do not have a permanent disability, and those who do usually have ratings between 5 percent and 30 percent.
When a doctor writes a P&S report, he or she must rate your "impairment," or how much you have lost the normal use of injured parts of your body. The doctor's methods for rating your impairment must follow guidelines published by the American Medical Association (AMA).
How are permanent disability payments determined?
PD benefit amounts are set by law and based on several factors such as the rating of your disability, your date of injury, your age and your wages before you were injured.
When do I receive permanent disability (PD) payments?
You are eligible to receive the total amount of your PD benefits spread over a fixed number of weeks if you have a permanent partial disability, or over the rest of your life if you have a permanent total disability.
The first PD payment is due within 14 days after the final TD payment or within 14 days after the claims administrator learns that you have a permanent disability caused by your injury. After the first payment, PD benefits must be paid every 14 days.
If your employer offers you work that pays at least 85 percent of the wages and benefits that you were paid at the time of injury, or you are working in a job that pays at least 100 percent of the wages and benefits that you were paid at the time of injury, you will not receive PD payments until after a workers' compensation judge approves a settlement of your case or decides on the PD benefits you will receive.
PD payments end when you reach the maximum amount allowed by law or when you settle your case and receive a lump sum.
Supplemental Job Displacement Benefits
What is a supplemental job displacement benefit?
A supplemental job displacement benefit is a voucher that promises to help pay for educational retraining or skill enhancement, or both, at eligible schools. You can use the voucher to pay for tuition, fees, books, tools, or other expenses required by the school for retraining or skill enhancement, and for licensing or professional certification fees, related examination fees, and examination preparation course fees.
- Up to $600 of the voucher money may be used to pay for services of a licensed placement agency, a vocational or return-to-work counselor (a person who helps injured workers develop their goals and plans for returning to work), and resume preparation.
- Up to $1,000 may be used to purchase computer equipment.
- Up to $500 of the voucher money may be used upon request for miscellaneous expenses without receipts or other documentation.
What is the dollar amount of this benefit?
The voucher is redeemable up to $6,000, regardless of your permanent disability rating. You cannot redeem the voucher as part of a settlement of your case.
How can I obtain this benefit?
The claims administrator must offer you a supplemental job displacement benefit if the following are true:
- Your injury causes permanent partial disability.
- Your employer does not offer you regular, modified, or alternative work within 60 days after the claims administrator receives the "Physician's Return-to-Work & Voucher Report."
The claims administrator sends the voucher on a form called "Supplemental Job Displacement Nontransferable Voucher Form" (DWC-AD 10133.32).
When do I receive the voucher?
The claims administrator must offer you the voucher within 20 days after the end of the period when your employer may offer you regular, modified, or alternative work.
What schools can I attend?
The voucher helps pay for you to attend a California public school or receive training with a provider on the state's Eligible Training Provider List (ETPL).
What vocational or return-to-work counselors can I use?
The Division of Workers' Compensation (DWC) maintains a list of qualified vocational and return-to-work counselors. To see the list, you can go to the DWC website: www.dwc.ca.gov.
How do I use the voucher to pay for expenses?
If you present the voucher to the school and counselor you select, they can contact the claims administrator for direct payment. If you pay the expenses directly and submit receipts to the claims administrator, the claims administrator reimburses you. He or she must do this within 45 days after receiving the receipts along with your signed voucher.
Is there a deadline for using the voucher?
Yes. The voucher expires two years after the date the voucher is furnished to you. All expenses must be incurred and submitted with required receipts and other documentation before the expiration date.
What is the Return-to-Work Supplement Program (RTWSP)?
The RTWSP was created for the purpose of making a one-time supplemental payment to workers who experience a disproportionate loss of earnings. You may be eligible for a Return-to-Work Supplement if you have a date of injury on or after January 1, 2013, and have received a Supplemental Job Displacement Benefit (SJDB) voucher for that injury. The application for the supplemental benefit must be received by the RTWSP within one year of the date the SJDB voucher was served on the applicant. A one-time $5,000 Return-to-Work supplement is issued to an injured worker who meets the eligibility criteria.
Personal Injury Claims
Overview
The Law Offices of Victor H. Altamirano represents injured workers to obtain the compensation they deserve. However, we also help people with their personal injury claims. If you have been involved in an automobile accident or other personal injury accident such as slip and fall or dog bite, please call us and we will do our best to help you with your claim. We will fight to get you the maximum recovery when you are injured because of the negligence of others.
What is a personal injury claim?
A personal injury claim is any type of claim where a person has been injured because of the carelessness of someone else. The most common causes of personal injury are: automobile accidents, motorcycle accidents, bicycle accidents, slip and fall, and dog bites.
What must you prove to win your personal injury case?
Just because you were hurt does not mean that you are entitled to compensation. You must prove that someone else was negligent and that it was his negligence that caused your injury. If you fail to do this you lose. If you sue the wrong person, you lose. If you wait too long to sue, you lose.
What is the value of my personal injury case?
The value of a personal injury claim depends on a number of factors, including: the nature of your injuries, amount of your medical bills and lost wages, need for future medical treatment and the compensation for permanent injuries such as disfigurement, impairment and other disabilities.
What is the main difference between a personal injury and a workers' compensation claim?
The biggest and most important difference between a personal injury claim and a workers' compensation claim is that a personal injury claim is based on fault while a workers' compensation case is not.
In order to recover damages against someone in a personal injury claim, the other person must be negligent, meaning that the person must have done something wrong. For example, if you are in a car accident, you can only recover damages from the other driver if the other driver was at fault. Similarly, if you are in a slip and fall accident on someone else's property, you must prove that that other person negligently maintained the property to recover damages.
Can you recover damages for pain and suffering in a personal injury claim?
The biggest difference in damages between a personal injury lawsuit and a workers' compensation case is that you aren't entitled to benefits for pain and suffering in a workers' compensation case. In a personal injury case, you are entitled to recover all of the damages that you have suffered. Damages include lost earnings, loss of earning capacity, medical bills, future medical expenses, permanent impairment, pain and suffering, and loss of enjoyment of life, among other things.
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