Workers’ Compensation LawToday, the California workers’ compensation law provides faster, fairer way to take care of injured workers, where fault doesn’t have to be proved to recover medical expenses and lost wages. This job injury-insurance is paid for by your employer and supervised by the state. It pays your medical bills and if you cant work due to a job-related injury or illness, provides money to help replace lost wages until you can return to work.
Who’s covered?Almost every employee in California is protected by workers’ comp, but there are a few exceptions. People in business for themselves and unpaid volunteers may not be covered. Maritime workers and federal employees are covered by similar laws. If you have a question about your coverage, ask your employer.
What’s covered?Any injury or illness is covered if its due to your job. It can be caused by one event like a fall, or repeated exposures, such as repetitive motion over time. Everything from first-aid type injuries to serious accidents is covered. Workers’ comp even covers injuries-including physical or psychiatric injuries—resulting from a workplace crime. Some injuries from voluntary, off-duty recreational, social or athletic activity—for example, the company bowling team—may not be covered. Coverage is automatic and immediate. There is no qualifying period, no need to earn a certain amount in wages before you’re covered…protection begins the first minute you are on the job.
What you have to do?If you have a work injury or illness, immediately notify your supervisor/employer so you can get medical help right away. If its more than a simple first-aid injury, your employer will give a claim form so you can describe the injury and how, when and where it happened. To file a claim, complete the employee section of the claim form, keep one copy, and return the rest to your employer. Your employer will then complete the “employer” section, give you a signed and dated copy of the form, keep one copy and send one to the claims administrator, the company that is responsible for handling your claim and notifying you about your eligibility for benefits. Benefits cant start until the claims administrator knows of the injury, so report the injury and file the claim form with your employer as soon as possible. State law requires employers to authorize medical care within one working day of receiving a claim form, and employers may be liable for as much as $10,000 in treatment until a claim is accepted or rejected. Delays in reporting may delay workers’ comp benefits, and you may not be able to get benefits if you don’t file a claim within one year of the date of injury, the date you knew the injury was work related, or the date benefits were last provided. To ensure your right to benefits, report every injury, no matter how slight, and request a claim form if its more than a minor injury requiring only first aid.
Benefits:The state of California’s workers’ compensation law guarantees you three kinds of benefits:
- all reasonable and necessary medical care for your injury or illness…with no deductibles. Medical benefits may include treatment by a doctor, hospital services, lab tests, x-rays, physical therapy and medicines. State law makes non-emergency medical services subject to preauthorization and limits some medical services.
- Tax-free payments to help replace lost wages while you are temporarily disabled. Additional payments are mad if the injury causes a permanent disability or death.
- If your injury or illness causes permanent disability that prevents you from returning to work within 60 days after your temporary disability ends and your employer doesn’t offer appropriate modified or alternative work, you may be eligible for a supplemental job displacement benefit. This is a nontransferable voucher for education-related retraining and/or skill enhancement at state-approved schools. Voucher amounts range from $4000 to $10000 depending on the level of permanent disability.
Medical care: all medical expenses for reasonable and necessary treatment will be paid directly by the claims administrator, so you should never receive a bill. The name and phone number of the claims administrator are at the end of this document and are posted at your workplace.
Temporary Disability: if you are unable to work for more than three days, including weekends, you are entitled to temporary disability (TD) payments to help replace your lost wages. About two weeks after reporting the injury, you’ll get a check. You will continue to receive TD checks every two weeks after that until the doctor says you can return to work, or that your medical condition is “permanent and stationary” (payments wont be made for the first three days, however, unless youre hospitalized as an inpatient or unable to work more than 14 days). The amount of these checks will be two-thirds of your average wage, subject to minimums and maximums set by the state legislature. It probably wont be the full amount of your regular paycheck, but there are no deductions and the payments are tax free. Under state law, TD payments for a single injury may not extend for more than 104 compensable weeks within five years from the date of injury. Or for more than 240 weeks within five years from the date of injury for a few long term injuries, such as severe burns or chronic lung disease. If you reach the maximum TD payment period before you can return to work or before your medical condition becomes permanent and stationary, you may be able to obtain state disability benefits through the California employment development department (EDD). You also may be able to get these benefits if your TD is deplayed or denied.
There are time restrictions, however, so contact EDD for when and how to apply.
Permanent disability: if you doctor says that your injury or illness will always leave you somewhat limited in your ability to work, you may receive permanent disability payments. The amount depends on the doctor’s report, how much of the permanent disability was directly caused by your work, and factors such as your age, occupation, type of injury, and date of injury. If your employer has 50 or more employees, your benefit payment also will be affected by whether or not your employer makes a suitable return-to-work offer. The minimum and maximum amounts are set by state law, and vary by injury date, but if you have a permanent disability, your claims administrator will send you a letter explaining how the benefit was calculated. In general, the total amount is set at a weekly rate spread over a fixed number of weeks. The first payment is due within 14 days after the final temporary disability payment, or if you were not receiving temporary disability, 14 days after your doctor says your condition is permanent and stationary. After that, the benefit will be paid every 14 days until you reach the maximum or until you settle your case and receive a lump sum.
Death benefits: if the injury or illness causes death, payments made be made to individuals who were financially dependent on you. These benefits are set by state law and the amount depends on the number of dependents and the date of injury. Generally, the payments are made at the same rate as temporary disability payments—however no payments will be less than $224 per week. Workers comp also provides burial allowance.
Supplemental job displacement benefits: if you receive temporary disability payments, within 30 days after that benefit ends, your claims administrator will send a letter advising whether your employer has a modified job or alternative work available for you, and explaining your potential rights to a supplemental job displacement benefit. If your employer does not offer modified or alternative work, and it is determined that you have a permanent disability that prevents you from returning to work for the employer within 60 days after your temporary disability ends, you may qualify for a nontransferable voucher to use at a state accredited school for retraining or skill enhancement. If you qualify, your claims administrator will provide a voucher up to a maximum set by state law: A) up to $4000 for permanent disability awards of more than 0 but less than 15% B) up to $6000 for permanent disability awards between 15-25% C) up to $8,000 for permanent disability awards between 26%-49% D) up to $10000 for permanent disability awards between 50%-99%