 |
 |
 |
 |
 |
 |
 |
 |
|
|||||||||||
 |
|||||||||||
 |
|||||||||||
 |
|||||||||||
 |
 |
Workers’ Compensation Benefits A. Medical Expenses An employee is entitled to receive all medical care necessary to cure or relieve her/his injury or illness. This is the obligation of the employer’s workers’ compensation insurance company. During the first 30 days after the industrial injury is reported, the workers’ compensation carrier has control over the medical treatment to be furnished to the injured employee. If the injured employee does not want to be treated by the doctor chosen by the insurance company, she/he is entitled to demand a panel of 5 doctors from which she/he may select a treating physician. After these 30 days, the employee is entitled to seek medical care from a physician of her/his own choice. However, if an employee has notified her/his employer, in writing, of the name of her/his personal physician before her/his injury, the employee has the right to be treated by her/his physician from the date of his injury. Notifying your employer that you wish to be treated by your personal physician is probably the most important act you can take to protect yourself BEFORE you sustain an on-the-job injury. Your choice of a treating physician is a very important one. For injuries after 1994, the law specifies that the opinion of the treating physician is presumed correct on issues in the case including temporary disability, permanent disability, need for future medical treatment, and vocational rehabilitation. In the event you choose an unsympathetic treating physician or remain in the care of a physician chosen by your employer, you may run a risk in the event the doctor renders an unfavorable, unfair or biased report. Under certain circumstances, the workers’ compensation judge could apply the rule that presumes the treating doctor’s opinion is correct. It is for this reason that injured workers are advised to seek a doctor of their own choice whenever possible. If the employer or its insurance company is not aware of the injury, it is not obligated to provide medical care. An employee may have suffered an injury and have obtained medical treatment on her/his own but, if no notice was given to the employer, the employee may have to bear her/his own medical costs until such notice is given. There are some circumstances when the injured worker may, from the beginning, receive treatment from a doctor of her/his choice at the insurance company’s expense. If she/he requests medical treatment and it is refused, she/he may go to a doctor of her/his own choice for treatment. If the Workers’ Compensation Appeals Board finds that this treatment (called “self procured”) was reasonably necessary to cure or relieve the effects of the injury, the insurance company will have to pay for all reasonable medical costs incurred. Medical treatment may be awarded by the Workers’ Compensation Appeals Board for an indefinite period, even for life, depending on the facts of the case. B. Temporary Disability When the injured employee is unable to work because of an injury or illness which was caused by her/his employment, she/he is entitled to temporary disability compensation payments at the rate of 2/3 of her/his weekly earnings with the maximum as follows: Date of Injury - Maximum Weekly Payment from 7/1/95 to 6/30/95 is - $448.00. After 7/1/96 - is $490.00. From time to time, the Legislature may make further adjustments to the temporary disability rate. The rate applicable to your injury is the rate in effect at the time of your injury. Check with your lawyer or business agent to confirm the proper rate. Some employers have supplemental or short/long term disability plans or sick leave programs which may supplement the regular temporary disability payment. You may wish to check with your union or personnel department about this. No temporary disability compensation benefits are paid during the first 3 days off work unless: 1. The injury requires hospitalization as an in-patient; C. Permanent Disability “Permanent Disability” can be defined as that disability or impairment that remains after the employee has reached the point of maximum healing. California uses a rating system to compensate for permanent disability. California workers’ compensation law does not provide for full wage loss. Remember: If an injury is caused by a defective product or dangerous premises not owned by the employer or negligence of someone other than the employer, you can seek full wage loss in a civil third party lawsuit. Ratings may be based on a QME doctor’s exam (see p. 13) or a treating doctor’s report (see p. 7). Permanent disability ratings are provided under the law in the form of monetary payments. The amount of these payments depends on a number of items, including the injured’s age and occupation, as well as the extent of disability or impairment. The rating can range from 1% to 100% depending on how the permanent disability interferes with the ability to engage in work in the general labor market. A total disability for any type of work carries a 100% rating. Some of the more obvious examples of total disability would be the loss of both arms, both legs or the loss of sight in both eyes. Lesser disabilities would naturally produce lower ratings. The number of weeks payable will vary depending upon the extent of disability. The weekly rate is 2/3 of average weekly earnings subject to maximums set by law.For injuries occurring after 7/1/96, the weekly rate payable varies between $140.00 per week - to $230.00 per week - depending on the percentage of disability. For injuries occurring after 1/1/92, the number of weeks payable will increase slightly for injuries over 25% disability. Permanent disabilities of 70% or more pay, in addition to normal payments, a supplemental pension. Payments for permanent disability are payable in addition to any payments that the injured worker may receive for temporary work disability and are over and above the cost of medical care. These payments are made at the weekly rate commencing the third day after the injury becomes permanent and stationary or the third day after the last date of payment for temporary disability, whichever date occurs first. These payments are required by law to be made at least twice in each calendar month and the benefits are payable until the total amount awarded is paid or until the death of the injured worker. Substantial problems may occur in determining what rating is due the injured worker where she/he has a pre-existing disease or impairment and then suffers an injury which involves the same part of the body. It is often medically difficult to determine how much disability is due to the injury and how much is due to the pre-existing condition. Frequently arguments arise because of this problem which may have to be resolved by the Workers’ Compensation Appeals Board. If a person suffers a permanent disability, she/he is entitled to a permanent disability rating even though she/he is able to continue work. D. Death Benefits When an injury or illness causes or contributes to the death of the employee, the surviving dependents are entitled to recover death benefits. For death due to injury after 7/1/96, the death benefit is:One Surviving Total Dependent: $125,000.00Two Surviving Total Dependents: $145,000.00Three or More Total Dependents: $160,000.00The death benefit may be raised periodically by the Legislature. If there is no surviving total dependent, partial dependents may be entitled to benefits under some circumstances. In addition, actual burial expenses are payable up to $5,000.00. E. Vocational Rehabilitation Under the Federal Americans With Disabilities Act (ADA) and under State law, the employer may be required to give consideration to reasonable accommodation to a worker handicapped by injury. Demand should be made for reasonable accommodation if you believe that you can perform essential functions of your job with accommodation, or if there is another open available position that you can perform. Issues concerning reasonable accommodation and the ADA can be very complicated and you may wish to consult a lawyer. If the injured worker is unable to return to her/his usual employment because of her/his injury and reasonable accommodation is not possible, she/he may be entitled to a vocational rehabilitation benefits. These may include continued temporary compensation, schooling and necessary living expenses. If the injury occurred after 1994 there is a $16,000.00 cap on rehabilitation benefits. F. Settlements Workers’ compensation awards are paid on a weekly basis. The injured employee may receive a lump sum if her/his claim is settled by a Compromise and Release Agreement. Frequently, the insurance company will try to negotiate an end to the medical treatment in exchange for a lump sum. All settlements must be approved by the Workers’ Compensation Appeals Board. A settlement, when approved by the Board, closes the case completely. 
|
|
 |
||
©Copyright Boxer & Gerson, LLP, 2007. All Rights Reserved.
Web Development and Hosting | Graphics Design and Editing
Web Development and Hosting | Graphics Design and Editing