Workers' Compensation Benefits and Returning to Work

A workers’ compensation agreement is an insurance policy taken up by an employer to compensate an employee in the event the employee is injured during the discharge of their duties. It is expected that every employer should have this policy for its employees. All accidents covered in this policy are work-related. That means that employees can only access the full benefits stipulated in the policy if the injury is work-related.

The workers’ compensation coverage is a no-fault plan. This means that the employer’s responsibility for the accident is not pursued through a lawsuit. Therefore, by accepting to be compensated under the workers’ compensation agreement, you forfeit your right to address your employer’s culpability for the accident legally. Should you decide to sue your employer, you forgo the compensation sums in the workers’ compensation coverage.

Workers’ who are injured at their workplace need to file a claim, and they will access the benefits the coverage offers. Once the claim is filed, the insurance company assesses the information provided to determine if the injury is work-related. If accepted, you stand to be paid any of the following benefits as per your injury.

Medical Treatment

Initial treatment of the injury should be handled by a doctor within the medical provider network, MPN. Doctors in this network are approved by workers’ compensation insurance companies to provide medical care to injured employees. The doctors follow a set of guidelines, the Utilization Review (UR), which dictates the process that they need to follow in assessing the medical condition of the injured party.

An independent physician is later on brought in to offer medical treatment for the injury. The physician treats the patient to a point where they are satisfied that they no longer need to provide further medical treatment to the patient. This is a situation referred to as the maximum medical improvement. It is at this point that it is the doctor’s view that the employee will require no further treatment in the short-run. This determination is detailed in the medical assessment report that they provide to the insurance company.

Treatment costs and all other expenses that were incurred in pursuit of seeking treatment should be accounted for and billed to the insurance provider. All evidence of the costs incurred should be attached with your claim request.

Temporary Disability Benefits

TDBs are payable to workers who lose their ability to carry on with their work duties because of their injury. Temporary disability sums are paid to compensate the employee of wages lost due to the work injury. Insurance firms can only pay for the sums stated in this package if the insurance company is satisfied that the injury was work-related. Furthermore, the insurance company will expect a doctor’s report to state that as an employee, you are in no position to work. Furthermore, you are limited in the amount of work you can do because of the injury.

It is expected that the examining doctor will carry out their assessment on the injured employee every 45 days. They are expected to offer recommendations as to the progress of the patient during their recovery period. Similarly, during the same period, the insurance company is expected to make payments every two weeks. Its first payment to the injured employee is within 14 days of receipt of the medical assessment report.

An injured party seizes to enjoy temporary disability benefits when;

• They return to work,

• It is the doctor’s opinion that the injured employee can return to work,

• The worker’s condition is stable.

If the above conditions are not met, the employee will enjoy the benefits for a period not lasting 104 weeks within five years since the injury was first reported. During this period, you will receive two-thirds of your weekly average wage. The sum will, however, be subjected to change further to ensure that it does not go below the minimum set level or exceeding the maximum cap as directed by the state. The rate may change depending on the going market pay employers are offering their employees.

There are situations that the doctor’s assessment contradicts what you feel. If you are not in a position to work yet the doctor’s assessment says otherwise, you can seek an alternative assessment. Be sure to communicate the new assessment to the insurance company.

Permanent Disability Benefits

Certain injuries may hinder an employee’s ability to work and earn income in the future. If this happens, they are entitled to permanent disability benefits. A determination of permanent disability has a significant cost implication to the insurance company. As such, they, the insurance company, determine the level of disability through percentiles. Any injury rated as below 100 percent is considered a temporary disability. The insurance provider will pay fortnight payments to the employee for a specified period. If the injury has a rating of between 70 and 99 percent, you are entitled to a life pension. Once the fortnight payments seize, you get a guaranteed sum over the rest of your life.

Once the doctor’s report states that you have reached a permanent and stationary status, you are considered by the insurance company to have reached a permanent disability level. The doctor’s give the permanent disability rating, and it is converted to a permanent disability value.

The disability rate is determined by having two-thirds of the average weekly wage. However, the rate is capped at $290 per week. Therefore, the computed value should not exceed $290 per week.

If you are not satisfied with the medical assessment of your permanent disability, you can have a different medical assessment done by a different doctor. If the reports conflict, the trial becomes an option you can opt for to resolve the matter. You will offer your account of your injury to a court. The judge will then use your testimony and the medical records to determine your disability level.

Supplemental Job Displacement Benefits

Some injuries may be severe and may affect your return to work. If so, your employer should offer you $6,000 as a supplemental job voucher. However, should your employer avoid paying this voucher, they should offer a job alternative. The work should give;

• No less than 85 percent in income when compared to your previous salary,

• A reasonable commute from your home, and

• Should last 12 months.

The sums offered to go to catering for tuition fees, rehabilitation and counseling services, as well as other related services. Such a voucher is only payable to you sixty days after the end of the temporary disability period.

Death Benefits

These are sums owed to dependents and/or spouses of the worker if the employee passes on due to a work-related injury. The sums take care of all funeral expenses as well as offer some form of reprieve for the family because of the changes in their economic status.

Late Payment of the Workers’ Compensation Benefits

The law safeguards the interests of injured workers. It is illegal for the insurance company to delay the sums owed to the injured worker. As such, they risk punitive charges for the delay. The sums are then forwarded to the injured worker.

These charges are enforced to ensure that the insurance company pays for delaying the sums owed to the injured worker. Further, the sums also ensure that the injured employee is protected against economic hardships that may result from delayed payments. It is critical to analyze the legal provisions set to protect the needs of the worker.

1. Penalties under Labor Code 4650

   Labor Code 4650 protects the injured employee against late payments under temporary disability benefits as well as permanent disability benefits. Failure on the part of the insurance company to make timely payments ensures that the sum payable to the injured party is increased by 10 percent. Payment under the code is considered late if they are not effected within 14 days from the day the claim was filed or if they are not paid two weeks after that.

   Temporary and permanent disability sums are both paid out every two weeks. Injured parties receive two-thirds of the weekly earnings. However, permanent disability is paid out when the temporary disability payments end.

2. Labor Code 5814’ Penalties

   In the event sums due to the injured have been delayed or denied, the sums due shall be increased by 25 percent. Alternatively, according to code 5814, the employee should be paid $10,000, whichever is less. The law allows for the insurance company to correct the fault. If the company discovers that the delayed payment before the worker makes a penalty claim, the company should honor the payments within 90 days with a 10 percent interest. Any claim for a penalty under this section must be made within two years of the due date of the original payment.

Certainty is vital when recovering from your injuries. Knowing that you have a job to go to and that your income is not lost reinforces on the surety you are looking for during the recovery period. The question many injured workers have is whether they will be able to resume their duties after an injury, a question that is well addressed under the labor laws.

Technically your return to work is based on a decision that is made by your physician’s input, attorney, and employer. Your physician tells of your medical condition and if you are fit to resume duties in your previous employment position or you should get lighter duties. Your employer decides on whether they are comfortable having you in the same job or there is another that will be available should the doctor’s recommend a change. Your attorney guides you on which direction you should take, one that safeguards your rights throughout the process. Let us break what each party does and their roles in determining what duties you should handle.

1. The Physician

   Their report is what all other parties including your employer and attorney rely on to determine compensation. They determine your fitness and if you will be in a position to handle your previous responsibilities or if you need a change to lighter duties. This determination is based on your injuries. The doctor, in their report to the employer, will determine your working limits or work restrictions. This will help reduce the stress on your recovery process as well as protect you from further injury. If your physician recommends that you return to work without any restrictions, you should take on the tasks you were working on before the injury.

2. Your Employer

   The steps your employer takes are informed by the recommendations from your physician. They are required to be fair in their dealings with you; that is they should not withdraw your duties simply because you were injured at work. Further, they should provide any reasonable work if a change is so recommended by the physician. It is also expected that your employer will adjust your earning packages based on the legal recommendations.

3. Your Attorney

   In ensuring that your rights are not infringed in the entire process, your attorney will engage your employer in all changes they make with regards to your responsibilities at work after your injury. This will ensure that your job, as well as your income, is secured.

It is expected that your employer follows the restrictions offered by the physician. Should they decide to go against the recommendations, they are deemed to have violated your rights. If your employer offers duties that violate the restrictions, you are within your rights to decline the new tasks. Should they take action or threaten you because of declining the new role, they are deemed to have violated labor code 132 (a).

The code prohibits any discrimination on injured workers. If your employer cannot assign tasks that are within the work restrictions, they are required to pay you temporary total disability benefits.

It may be your physician’s determination that you are not in a position to resume your previous working capacity due to your injury. All details regarding your working restrictions in light of your injury should be factored in the report. If you do not agree with the report, you have the option of seeking an alternative opinion from a certified physician. The determination will help your employer determine when they should pay you the permanent disability benefits. Further, your employer may decide to offer you another role in the company, one that you will be capable of handling. Such decisions are a discretionary exercise of your employer.

Should your employer not offer you a job, you are entitled to a supplemental job displacement benefit. If they decide to offer you work, the claims administrator will send you a notice of alternative or offer of modified work. This notice should be sent to you within thirty days upon receipt of your final temporary disability payments. It is worth noting that you may not receive a job that you desire based on your new reality after the injury. The employer is not obligated to offer you the position of your choice. Their decision may be because of business dynamics. Therefore, for as long as they do not violate the conditions set in Labor Code Section 132 (a), their decisions are deemed fair.

No employer should terminate an employee engagement, or discriminate an employee for filing a workers’ compensation plan. However, some employers carry on such activities, which is against the spirit of the labor code.

The law provides that any employer who discriminates or terminates an employment engagement against an injured employee is guilty of a misdemeanor. An employee is free to file for increased compensation, back wages, wrongful termination, or job reinstatement. Such a violation is punishable to the advantage of the injured employee. The employee is entitled to a compensation benefit of up to $10,000. Further, the law requires their reinstating to their previous role if their employee engagement was wrongfully terminated with all lost wages fully reimbursed.

It is expected that the injured worker should make a 132(a) claim. The filling of this claim should be within a year since the termination or discrimination date. The 132 (a) claim is different since it results from an injured worker filling for a workers’ compensation against the employer. A 132(a) claim can only be filed with a petition. Further, a 132(a) claim can only be filled if you have filled for a workers’ compensation benefits’ claim.

An injured worker may have a filed FEHA, Fair Employment, and Housing Act claim as well as a wrongful discharge claim at the time of filling a 132(a) claim. All the mentioned are tailored to safeguard the injured employee from employment discrimination. Therefore, all three can be filled by one individual. A Workers’ Compensation Appeals Board hears the 132(a) claim. The bard is also tasked with hearing and determining workers’’ compensation cases. However, the injured worker is required to file the FEHA claim as well as the wrongful discharge as separate matters in a civil court. It, therefore, follows that all claims are heard and determined separately. All material facts and evidence are presented as directed by the courts and the guidelines of each claim.

The damages paid out in FEHA, and wrongful termination far exceed those paid for in a 132(a) claim. The punitive damages could go as high as $10,000 with an additional backdate of wages. They sums include past lost earnings, reinstatement, future lost earnings, emotional distress, and attorney fees. Any successful determination of a 132(a) claim does not mean that the injured worker wins a FEHA claim. Neither does it mean that they too win a wrongful discharge claim. On the other hand, any reward gained in a 132(a) claim will be factored in against a FEHA claim.

Ideally, accessing benefit packages offered in the workers’ compensation coverage should not be hard. However, the battle to access your benefits sometimes requires a fight, especially when denied coverage. It is best to get yourself an attorney who will ensure you receive what is owed to you according to the circumstances of your case. Hiring qualified legal representation means you have access to the best legal services and attention that is required for getting your benefits. Our team at The Workers Compensation Attorney Group in Long Beach can handle these matters and ensure you are rightly compensated for your injuries. Give our Long Beach workers compensation lawyer a call today at 714-716-5933 and let us handle your case as you recover from your injuries.