Workers’ Compensation Benefits
After determining whether an injury occurred on the job and depending on what type of injury occurred, you may begin receiving workers’ compensation benefits. Some of the types of benefits are as follows:
- Medical treatment – A worker injured on the job is assured reasonable and necessary medical treatment to cure or relieve the effects of the workplace injury. California Labor Code Section 4600(a) states that, “Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer. In the case of his or her neglect or refusal reasonably to do so, the employer is liable for the reasonable expense incurred by or on behalf of the employee in providing treatment.”
- Medical Provider Network – For treatment of a work injury, the employer or insurer may establish a medical provider network (MPN) to treat work injuries. If your employer has an MPN you must receive treatment for your work related injury through that list of doctors. If you dispute the MPN doctor’s treatment you must obtain a second opinion from within the MPN. If there is no MPN you can select your own treating physician after 30 days from the date of injury. As an injured worker you are entitled to only one treating doctor at a time and this doctor manages your case. The primary treating doctor can refer you to other specialists within the MPN, to help coordinate the treatment you need.
- Treating Physician – The treating physician is defined in California Code of Regulations, Title 8, Section 9785, which states in pertinent part, “The ‘primary treating physician’ is the physician who is primarily responsible for managing the care of an employee, and who has examined the employee at least once for the purpose of rendering or prescribing treatment and has monitored the effect of the treatment thereafter. The primary treating physician is the physician selected by the employer, the employee pursuant to Article 2 (commencing with section 4600) of Chapter 2 of Part 2 of Division 4 of the Labor Code, or under the contract or procedures applicable to a Health Care Organization certified under section 4600.5 of the Labor Code, or in accordance with the physician selection procedures contained in the medical provider network pursuant to Labor Code section 4616.”
Often times, after treatment has been reviewed and deemed unnecessary by an outside doctor who has never seen the injured
worker, the treating doctor’s recommendations for medical treatment are denied by the workers’ compensation insurance company. This process is known as a Utilization Review (UR). Medical treatment that is denied by the UR can be resolved by an Independent Medical Review (IMR), which may be requested by the employee. The IMR is completed by an anonymous doctor, that the injured worker never sees and there is no right of appeal on the decision.
- Temporary disability – If an employee cannot work or can do modified work but none is available and the employee is not yet permanent and stationary, then temporary disability is payable to the employee. Per California Labor Code Section 4650 (a), “If an injury causes temporary disability, the first payment of temporary disability indemnity shall be made not later than 14 days after knowledge of the injury and disability, on which date all indemnity then due shall be paid, unless liability for the injury is earlier denied.”
- Permanent disability – There is no statutory definition of permanent disability, however, courts have recognized that “permanent disability is one which causes impairment of earning capacity, impairment of the normal use of a member, or a competitive handicap in the open labor market.” Luchini v. WCAB (1970) 7 Cal.App.3d 141.
Once you are declared permanent and stationary you will be evaluated by a doctor to determine whether you have a permanent disability as a result of your workplace injury. Permanent disability is determined on a scale from 0% to 100%. A 100% permanent and total disability means that it has been determined that it is impossible for you to work in any capacity. It is important to note that, under California Workers’ Compensation Law the injured worker is not entitled to any benefits or monetary award for pain and suffering.
- Vocational Training (Voucher) – Per California Labor Code Section 4658.1, “Except as provided in Section 4658.6, if the injury causes permanent partial disability and the injured employee does not return to work for the employer within 60 days of the termination of temporary disability, the injured employee shall be eligible for a supplemental job displacement benefit in the form of a nontransferable voucher for education-related retraining or skill enhancement, or both, at state-approved or accredited schools…”
For injuries after January 1, 2004, but before January 1, 2013, injured workers who cannot return to their usual and customary job will receive a non-transferable voucher of between $4,000.00 and $10,000.00 payable to a state approved or accredited school chosen by the injured worker. The amount of the voucher is linked to the permanent disability rating. Pursuant to California Labor Code Section 4658.5, for injuries after January 1, 2013, the voucher is still only
payable to a state approved or accredited school, but is a flat rate of $6,000.00.
- Death benefits – Death benefits may be due when the death of an employee occurs through a single industrially related event. Pursuant to California Labor Code Section 5406, a claim must be brought within a year after the death of the employee or within 240 weeks of the date of injury. The benefits are available to the surviving dependents that relied on the employee for financial support, such as the decedent’s spouse, children, and other dependents. Workers’ compensation must pay for reasonable burial expenses. The death benefits amount however is determined by the number of dependents eligible to collect the benefits.
Our knowledgeable and skilled workers’ compensation attorneys will help you understand what benefits are available to you. Knowing from the outset will help ease your stress so that you can focus on your recovery.
Please contact us today for a FREE 30-minute consultation. Our attorneys are available to meet with you during business hours, evenings, and weekends. Allegiance Law is located in San Francisco, but we will be happy to drive and meet you. You may contact Allegiance Law, experienced attorneys and workers’ compensation attorneys, at (415) 404-6395. Or you may contact us by filling out the client inquiry form on this page.