Workers’ Compensation Benefits:
Workers’ Compensation benefits for California employees cover a wide variety of injuries and illnesses. Any injury, whether the result of direct trauma or cumulative work activities or on the job exposure, is covered.
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 temporary total disability indemnity until your treating doctor releases you to light or full work activities. This benefit is not subject to state or federal income taxation. 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.
Is there a limit on how much temporary disability I receive?
Yes, there is a cap of 104 weeks of temporary disability within 5 years of the date of the injury. There are some limited exceptions to this rule.
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 can’t return to my job?
For those injured workers unable to return to work with injuries that occur after January 1, 2004, the vocational retraining benefit has been eliminated and replaced with a Supplemental Job Displacement Benefit. This benefit, which ranges from $4,000-$10,000, depending on the permanent disability rating, is a nontransferable voucher for education-related training or skill enhancement that can be presented at state-approved or accredited schools.
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.