Workers Compensation

Under California law, if you get hurt or sick while working, your employer is required to pay for workers" compensation benefits. Workers" compensation offers the possibility for four basic benefits: medical care, temporary disability benefits, permanent disability benefits, and supplemental job displacement benefits, formerly known as vocational rehabilitation.

Why do I need an attorney?

California's workers compensation system is supposed to be designed to help injured workers obtain a quick, easy resolution to their claim. Unfortunately, many injured workers never get the compensation, medical care and rehabilitation services they need. Often, they simply allow their employers to ignore their injury, or later accept the initial medical evaluation performed by a doctor chosen by their employer's insurance company. By not obtaining an alternative and objective evaluation, you may be denying yourself the care and treatment you need to recover to the greatest extent possible. This may also decrease the monetary value of your case.

Your employer, or more often, your employerís insurance company, wants to limit the benefits you receive. They will use the system to deprive you of anything they can. Although you are not required to hire an attorney to pursue your workers compensation claim, oftentimes it helps to have somebody who knows the system, the people in it, and how to navigate through it.

What should I do if I am injured at work?

The most important thing to do if you are injured at work is immediately report the injury to a supervisor so a written record can be made. Your employer is required to provide you with a claim form as soon as they are notified of a work injury. If you report the injury and are not provided paperwork to complete within 24 hours you should contact an attorney or an Information and Assistance Officer at the nearest Workers Compensation Appeals Board.

What is Temporary Disability?

Temporary disability (TD) benefits are payments you get from your employer or your employer's insurance company if you canít do your usual job while recovering from your injury or illness. TD benefits are not taxable. If you can do some work while recovering but earn less than before the injury, you are entitled to receive temporary partial disability (TPD) benefits. If you canít work at all while recovering you are entitled to receive temporary total disability (TTD) benefits. Some employers have plans that pay all your wages for all or part of the time you are temporarily disabled. These plans are called salary continuation. There are different types of salary continuation plans. Some use your vacation and/or sick leave to supplement the temporary disability payments required by state law.

How is Temporary Disability Calculated?

Generally you will receive two-thirds of your gross (pre-tax) wages at the time of your injury, with minimum and maximum rates set by law. Your wages are determined by using all forms of income you receive from work: wages, food, lodging, tips, commissions, overtime and bonuses. Wages can also include earnings from work you did at other jobs at the time you were injured.

How Long Will I Receive Temporary Disability?

If your claim is accepted by your employer or your employer's insurance company, temporary disability benefits continue as long as your doctor says you are unable to work due to your work-related injury, up to a certain period of time. If you were injured between April 19, 2004 and Jan. 1, 2008, your TD payments wonít last more than 104 weeks from the first payment for most injuries. Those injured on or after Jan. 1, 2008 are eligible to receive 104 weeks of disability payments within a five-year period. The five-year period is counted from the date of injury. Payments for a few long-term injuries, such as severe burns or chronic lung disease, can go longer than 104 weeks. TD payments for these injuries can continue for up to 240 weeks of payment within a five-year period.

You can also file a state disability insurance (SDI) claim with the Employment Development Department. This may allow you to receive temporary disability payments for up to 52 weeks if your workers compensation claim is denied, or to receive SDI payments after 104 weeks of TD payments if you are still too sick or hurt to go back to work.

Generally, TD payments stop when you return to work, when the doctor releases you to work, or says your injury has reached "maximum medical improvement". MMI generally means that you have reached a state where your condition cannot be improved any further. It can mean that you have fully recovered from your injury or that your medical condition has stabilized to the point that no major medical or emotional change can be expected.

What is Permanent Disability?

At some point after your injury, your doctor, an agreed-upon doctor, or a doctor from a state panel, will examine you, review your records, and write a medical report about your impairment. Impairment means how your injury affects your ability to do normal life activities. The report will also discuss "apportionment", whether any portion of your disability was caused by something other than your work injury.

The doctorís report will assign your injuries a number entitled "whole person impairment". ("WPI".) WPI is then put into a formula to calculate your disability. Disability means how the impairment affects your ability to work. Your occupation and age at the time of your injury and your future earning capacity are all included in the calculation.

Your disability will then be stated as a percentage, or rating. Your percentage of disability will be worth a specific dollar amount, depending on the date of your injury and your average weekly wages at the time of injury.

If you were injured on or after Jan. 1, 2005 your PD award may be increased or decreased by 15 percent, depending on whether you work for an employer with 50 or more employees and your employer offers -- and you accept, or decline -- regular, alternative or modified work.

Can I Receive Job Retraining?

In some instances, if a doctor determines that the lasting effects of your injury prevent you from doing the same type of work you did when you were hurt, you will be designated a Qualified Injured Worker. (QIW.) You will then be entitled to a Supplemental Job Displacement Benefit. (SJDB.) You can use the SJDB for education and/or retraining at a school certified by the State of California. The value of the SJDB is determined by the amount of your PD rating, and will be worth $4,000, $6,000, $8,000, or $10,000.

How Does My Claim Resolve?

After the amount of your PD is determined, your case is in a position to be settled. Claims may be settled in one or two ways, and all settlements must be approved by a workers compensation judge.

A Compromise & Release (C & R) is a one-time lump sum payment, which is generally a settlement of your permanent disability and future medical care. Sometimes, depending upon your age or whether you are receiving or eligible to receive Medicare or Social Security, a portion of your settlement will have to be placed into a separate account called a "Medicare Set Aside", which must be used only for medical care related to your work injury.

A Compromise & Release extinguishes any past and future benefits your employer and its insurance company may owe you arising out of your work injury. This means you will not receive any future money from them, and they will not be required to provide you medical care. Most of the time, if you are still employed by the company where you got hurt and wish to keep working for them, you will not be able to obtain a lump sum settlement. Or, if you want the lump sum settlement, in most cases you will have to stop working for that employer.

A Stipulations and Request for Award (Stipulation) arises either when an injured worker wishes to remain employed by the company where he got hurt, or wants to leave future medical care open. In this instance, an agreement is reached regarding your PD rating , entitling you to a specific dollar amount, and the employer or insurance company will make permanent disability payments every two weeks until that is paid. You may continue to receive medical care related to your injury through the insurance company, within certain guidelines established by the State of California. If you settle the claim this way, you can petition to reopen your claim within 5 years of the date of the original injury, if your claim worsens.

What if My Claim Does Not Settle?

If we are unable to agree upon a settlement for a C & R or Stipulation, your case will have to be tried before a Workers Compensation Judge. The WCJ will issue a ruling, usually within 30 days, and that ruling will result in an Award of Permanent Disability and medical care. The case can still be settled for a lump sum or Stipulation at any time if both sides are willing.

The Law Offices of Marc Appell has been helping injured workers maximize the value of their cases for over 15 years. We can help you. Call our office for a free consultation.

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Law Offices of Marc Appell
5850 Canoga Avenue, Fourth Floor
Woodland Hills, CA 91367
Tel: (818) 710-7177
Fax: (818) 710-7179