Workers’ Compensation Benefits Explained

Under California Workers compensation law, if you suffer injuries at your workplace, there are benefits you are entitled to get workers’ comp benefits. However, not all on-job injuries are compensated. There is a criterion you have to meet to get payment for these damages from your employer’s worker compensation insurance coverage.

First, you must be an employee of the individual from whom you are filing claims. When it comes to getting these benefits, not all workers are treated as employees. Individuals who are working on a freelance or temping in a company are not entitled to the worker's compensation benefits. If your employer claims that you are not eligible for the benefits, you need to contact a worker’s compensation attorney to help you contest the disqualification.

Second, your employer must have a worker’s compensation insurance coverage. Most employers are expected to have this coverage, and the amount of coverage is dependent on the number of employees they have.

Third, you must have been at work or on a work mission for your employer when you were injured. However, if you were at work and were not doing anything work-related, there is a chance that your employer may be reluctant to pay for your benefits. In the case where you suffer an injury at your workplace, it is crucial to take pictures or ensure there are individuals who witnessed the accident. This will help rule out the doubt of where your accident occurred since these witnesses may testify for you in court.

If you are a domestic worker, you will not get the worker’s compensation benefits after an injury. This is because the law does not require employers to have coverage for private workers who are not involved in the daily business or career of their employers. It is important to understand that when you collect the worker’s compensation benefits, you cannot sue your employer. That is, the workers’ comp law covers employees by ensuring they get benefits while protecting employers against personal injury lawsuits.

If you suffer an injury at your workplace, you are entitled to the following benefits from the worker's compensation insurance coverage.

If you suffer a work-related injury, you are entitled to get compensation for the medical care till you recover from your injuries. Medical payments are often unlimited and non-deductible. For these benefits, you will not get the money, but it will be directed to the medical service provider. After an injury, it is crucial to seek medical care with immediate effect and within the deadline stated by the law.

In the case where your employer has a privately recruited medical provider, either an MPN or is registered with a health care organization, you are required to get treatment from that practitioner. However, these MPN should be accepted by the state Division of Workers Compensation. They should also effectively understand occupational health care according to the worker's compensation law. If after thirty days from the day you reported your injury, the employer has not provided someone to treat your injuries, you can seek treatment from a physician of your choice. However, the recommendations of the physician are subject to review from another physician. This will help ensure there is no exaggeration or overestimation of the medical benefits to be received.

California Workers compensation laws require that your consultation fees, medical costs, nursing, and surgical fees, as well as the cost of medical supplies and equipment, are covered by your employer's insurance coverage. Also, your employer is required to cover for the cost you incur while traveling to seek medical attention. However, to get reimbursed for these expenses, you have to fill out the medical mileage expenses form. Other than the medical benefits you get for the injury at your workplace, you are entitled to compensation for other injuries that may occur as a result of that condition.

For example, if you are working and you injure your foot, it may result in walking difficulty, which might make you more vulnerable to other injuries. You may get treatment and recover, but the injury causes a complication later on. If this happens, your employer will be required to pay for additional medical expenses as well. Sometimes, your employer may deny that your injuries are work-related and, thus, refuse to compensate you. In this case, they are not responsible for giving you the benefits until the case is resolved in court. It is wise to contact a worker’s compensation attorney if your employer is not willing to pay for medical care.

Before your claim is finalized, the claim administrator may possibly disagree with the medical reports from your treating physician. In this situation, you will get an evaluation from a qualified medical evaluator depending on the type of injury for which you are getting treated. The physician is required to meet the licensing and educational requirements to qualify as a medical evaluator. The worker's compensation will also set an evaluation test which the practitioner must pass.

Even when state laws don’t allow you or your family to sue your employer after a work-related injury, you can sue them if your job category is excluded from the worker’s compensation benefits. You are also allowed to file a suit for subsequent injuries caused by the initial work injury.

An injury suffered at your workplace can render you either permanently or temporally disabled. According to the worker's compensation law, disability is defined as the inability to retain your employment status as a result of an injury. If you end up disabled, you are entitled to workers compensation disability benefits from your employer’s insurance coverage.

• Temporary Disability

  In the case where an injury requires you to miss a few days of work or causes hospitalization, you are entitled to temporary disability benefits. The doctor’s report must prove that you cannot continue with your routine work for a given period to receive California temporary disability benefits. However, your employer can decide to assign you different tasks which are in compliance with the doctor’s restrictions.

  The main aim of temporary disability benefits is to substitute the lost wages and replace what you would earn during the recovery period. The payment for temporary disability will be made every two weeks, and in the case where your benefits are late, you are entitled to a 10% addition. For most injuries, temporary disability benefits are limited to 104 weeks from the injury date. However, for injuries such as amputations, chemical burns, eye injuries or lung diseases, you are likely to get up to 240 weeks of benefits. The duration within which you get these benefits is determined by your doctor’s restrictions. The temporary disability benefits will stop when your condition improves, and the doctor advises you to go back to work.

  A temporary disability could be either total or partial. If you cannot work at all, then you will receive compensation for temporary total disability, and the number of benefits will be two-thirds of your weekly earnings. Your average wage is calculated depending on the nature and situation of your work.

  On the other hand, you will receive temporary partial disability if you can work part-time after a work-related injury. The amount you will get as compensation will be equated to the amount of time you lose from work. After the benefits are calculated, they have to be compared with the state’s acceptable amounts. If you are a part-time worker, you will only receive temporary disability benefits for the part of the year you are at work. It is important to consult with a worker’s compensation attorney for proper representation to receive the temporary disability benefits you deserve.

• Permanent Disability benefits

  Permanent disability benefits seek to compensate your lost earning capacity due to permanent impairment. These benefits are calculated as a percentage of your ability to secure a job. If the rating of your disability is less than 100%, you will receive benefits for permanent partial disability weekly. The higher the rating of the disability, the more the amount of money you will receive as compensation.

  For people who get total disability, they will receive these weekly benefits for the rest of their lives.

  If your disability is over 70%, you are entitled to a pension. This will be given after the completion of all your weekly permanent disability benefits.

  The doctor’s report on your injuries must be evaluated to determine the percentage of your disability. However, the ratings must follow guidelines from the AMA Guides, 5th Edition. Once the rating is established, the disability is converted into its equivalent dollar value. Weekly permanent disability payment is lower than the temporary disability payment. This is because the permanent disability benefits last for a lifetime. You cannot receive permanent disability benefits while you are still on temporary disability benefits.

  If the injury you suffered causes you a permanent disability, you are entitled to receive your first payment within two weeks after your last temporary disability benefit. However, your employer may offer you another job, which will earn you at least 85% of the previous salary. In this case, they can delay your permanent disability benefits.

  After your condition stabilizes, your doctor will determine your final level of disability. Therefore, the benefits you will be receiving are calculated. In situations where you and the insurance company cannot agree on the payments, the case has to be determined by the judge.

  It is crucial to understand that even when the permanent disability does not necessarily have an effect on your health, you can still get compensation. In some cases, you get permanent scars and disfigurement which affect your social image and relationships. If you can show that the injury you suffered left a long-lasting effect on your body, your benefits could increase significantly.

The job displacement benefits, also known as the return to work fund, are given to injured workers who cannot return to their jobs. The eligibility criteria for these benefits targets individuals who have suffered significant permanent disability.

To get the return to work voucher, you must file for a worker’s compensation claim. The voucher will apply to almost all occupations as long as you are a documented employee.

You qualify for the worker’s compensation supplemental displacement voucher if your employer does not offer you alternative work after a permanent disability. Before giving you the voucher, the insurance company will contact your employer to check if they are willing to offer you another job. If your employer does not offer you an alternative job within the first sixty days after receiving the medical report, the voucher will be given. However, if you are entitled to the voucher, you cannot accept a cash settlement.

However, if your employer decides to offer you an alternative job, it must be within a reasonable commuting distance from your place of residence. The job offered must also earn you a salary of more than 85% of what you earned in your previous employment. In the case where you are injured again while using the voucher, your employer is not responsible for the injuries. If you have multiple injuries at the same time, you are eligible for more than one return to work voucher.

The determination of whether you receive your voucher or not will start with the medical report evaluation. This will determine your working ability after the injury. The report must indicate that you suffered a stationery injury and you are medically incapable of returning to your previous employment. You have control over the return to work fund, and you can opt to return to your job rather than receive the voucher.

The return to work compensation benefit is $6,000, and it can be used for

• Payment for education or retraining and skill enhancement,

• Occupational licensing,

• Vocational counseling,

• Purchasing tools and equipment required for training like the books or paying tuition fees,

• Purchase of computer equipment not exceeding $1000,

• Miscellaneous expenses up to $500.

Death benefits are received by the deceased’s immediate dependents after a work-related injury leads to death. The main aim of the death benefits is to facilitate the burial expenses and to support the individuals who depended on the deceased. The nature of dependency is determined for each individual case at the time of injury. If your spouse succumbs to death after the injuries, you are considered a total dependent if your total earnings in twelve months don’t exceed $30,000.

To be considered a dependent of the deceased, you must be a member of the immediate family and have lived with them. Relatives who get death benefits include:

• Spouses,

• Children both biological and adopted.

• Siblings,

• In-laws,

• Grandparents

If you depended on the deceased for almost all your financial needs, you are considered a total dependent. This is the case even when you have another source of income. Before payment of the death benefits, the insurance company will carry out an investigation to verify the legitimacy of those claiming to be dependents of the deceased. To acquire the death benefits, you need to fill special workers’ compensation application forms.

The amount to be given as death benefits will be determined by the number of individuals claiming to be dependents. The benefits will include $10,000 for burial expenses and up to $ 320,000 for the dependents. In the case where there is a single total dependent, they will receive $ 250,000. If there are other partial dependents, they will receive $25,000 each. If there is more than one total dependent, they will have to share the death benefits. In this case, there can’t be partial dependents. In the case where there are minor dependents, the death benefits will continue until the children attain the age of eighteen years.

The Compensable consequence benefits are given to individuals whose workplace injuries result in other injuries. For example, if you have a knee injury from a fall at your workplace, it may have an effect on your ability to walk properly. As a result of this difficulty in walking, you may fall again and get other injuries. Your employer is liable for those injuries, and their insurance coverage is supposed to compensate you for these additional injuries.

Any damages caused by medical malpractice from your original injuries, as well as automobile accidents on your way to seek medical attention, will get compensated. Unlike other compensation benefits, the compensable consequence claims are difficult to navigate. If you don’t file your claim within the accepted time frame, your rights to these benefits will get forfeited. It is wise to seek legal representation when you find yourself in this situation.

1. Does the Worker’s Compensation Cover all Work-related injuries?

   No. Workers’ compensation will cover most of your work-related injuries. If you get injures while you were intoxicated or under the influence of any illegal drugs, your coverage claim may be denied. You may also get benefits denial if your injuries were self-inflicted or resulted from self-initiated violence. In the case where you were committing a crime, or your conduct violated the company policies, you are not entitled to get compensation for your injuries.

2. Will I Get Workers Compensation Benefits if I was Volunteering?

   No. The worker's compensation insurance coverage covers an employee who works and gets paid. Since as a volunteer you work without pay, you will not receive the benefits even when you are injured at the workplace. However, if you are volunteering in high-risk work environments, you retain the right to sue whomever you report to at the volunteer company. If you can prove their negligence or liability to your injuries, there is a likelihood you would get compensated for the damages.

3. How is a Partial Day out of Work Treated in the Determination of Workers’ Compensation Benefits?

   If you are absent from work for a percentage of the day as a result of a work-related injury, the time spent away from work is still counted when it comes to compensation benefits. Since disability is the inability to work as a result of injury, all hours that you miss from work will eventually add up to a full day of absentia.

4. Will I receive Workers’ Compensation Benefits if I resign or Get Fired?

   If you are entitled and you qualify for compensation benefits, you will receive them even when you quit your job or got fired after an injury. Sometimes your employer may try to get your claim dismissed, even when you had legitimate reasons to quit your job.

   In this case, it is best to work with a worker’s compensation attorney to ensure your claim is well addressed.

After a work-related injury, it may be difficult for you and your employer to agree on the compensation terms. In this case, you may be forced to file a formal compensation claim. If you are in this situation in Long Beach, California, consider seeking legal representation from The Workers Compensation Attorney Group. Our attorneys are well versed with worker’s compensation laws and will work passionately to help you get the benefits that you are entitled. Call our Long Beach workers compensation lawyer at 714-716-5933 today to talk to us!