Workers’ Compensation Benefits for Public Safety Members:
Workers’ compensation benefits for uniformed members of the California Highway Patrol, local and county law enforcement officers and firefighters cover a wide variety of injuries and illnesses. Any injury, whether the result of direct trauma, cumulative work activities, or on-the-job exposure, is covered. Some claims, such as mental stress claims, have certain preconditions. Others, such as heart trouble, lower back trouble (if the officer is required to wear a duty belt), hernia, pneumonia, tuberculosis, blood-borne infectious diseases, meningitis, and cancer are presumptively job-related, even if no specific injury can be identified.
FAQ’s for Public Safety Members
How does my attorney get paid?
In workers’ compensation actions, attorneys’ fees are generally between 12% and 15% of contested benefits, and are set and awarded by the Workers’ Compensation Appeals Board. For personal injury and uninsured motorist claims, contingent fees are negotiated between the client and the attorney.
Can I see my own doctor?
Unless you preselect your doctor prior to your injury, you are required to see an employer-designated doctor for at least the first 30 days following your injury. Pursuant to Labor Code Section 5402, an employer is required to authorize all treatment, consistent with adopted occupational medicine guidelines, within one working day after a claim form is filed, and shall continue to provide treatment (up to a limit of $10,000) until a claim is accepted or rejected. Your employer may also choose to participate in a Medical Provider Network (MPN) which allows them to control medical care. If your employer has set up such a network, you are required to choose a treating physician from the network unless you have predesignated a physician. If you disagree with the diagnosis or treatment of the treating physician, you may seek a second or third opinion, although this must also be from a doctor within the MPN. In addition, the law now provides for a Utilization Review process for all prescribed treatment, which may impact the delivery of medical services. These rules and regulations apply to all claims regardless of the date of the injury.
Will I get paid while I miss work?
While you are unable to work you will receive “4800.5″ time (for members of the California Highway Patrol) or “4850″ time (for most other law enforcement officers and firefighters.) This benefit is your regular salary for a period of up to one year or until your treating doctor releases you to full or light duty. San Francisco Police Officers and Firefighters receive an equivalent benefit (disability pay) pursuant to the San Francisco City Charter. Such pay is not subject to state or federal income taxation. If you remain totally disabled beyond one year, you may be eligible for weekly temporary disability benefits. For injuries occurring after January 1, 2006, temporary total disability is paid at $840 per week or 100% of the State Average Weekly wage, whichever is higher. Currently the maximum payment for temporary disability indemnity is $916.33 per week.
What will my family receive if I die due to a job related injury?
The California Labor Code provides very substantial death benefits if death results from a work-related injury or disease. For 2006 injuries, the maximum is $320,000, and it may be greater if, after that amount is paid, there remain minor or totally disabled adult children of the deceased employee. Likewise, CalPERS will provide a substantial “special death benefit” to your dependents in the event of death while on active duty. Dependents of public safety officers who are killed or totally disabled may be eligible to receive scholarships to either two or four-year institutions of higher education. Presently, those scholarships are paid at a rate of a maximum of $6,000 over a six-year period, in $1,500-per-year increments. Students must also demonstrate financial need for such scholarships. The loved ones of a deceased employee should consult an attorney to determine how to proceed.
What if my injury results in permanent limitations?
If you have a residual disability, you may be entitled to a “permanent disability rating,” whether you return to work or not. For injuries occurring after January 1, 2005, disability is now measured using the American Medical Association Guidelines (AMA Guides). These guidelines are designed to define disability utilizing objective measures and tests (MRI’s, Surgeries, Loss of Range of Motion). In general, the value of a permanent disability rating is substantially less under these new guides than under the previous disability guidelines. For injuries occurring after January 1, 2005, the dollar value of a rating is increased by 15% if an injured employee can’t return to work, or decreased by 15% if there is a return to work. Most often you will not receive the maximum rating to which you will be entitled without the assistance of an attorney specializing in workers’ compensation matters.
What if I am unable to return to job?
If a uniformed member of the California Highway Patrol, or a law enforcement officer or firefighter becomes “substantially incapacitated” from his or her position as a result of an industrial injury or illness, he or she is entitled to a disability retirement allowance that is 50% of his or her “final compensation.” The disability retirement allowance may be greater depending upon one’s age and years of service. Generally, retirement benefits start after all Labor Code Section 4800.5 or 4850 benefits are exhausted.
What if I am injured by a third party?
In addition to workers’ compensation benefits, injured workers can collect damages for injuries that are caused by a third party, whether they result from a motor vehicle accident, use of a defective product, or being injured on property where a dangerous condition exists. While your employer may have substantial “subrogation” rights—the right to collect money they have paid on a claim—in most cases it will be to your advantage to coordinate these matters. Uninsured motorist claims have different applicable laws, so check with an attorney before settling any claim.