Worker’s Compensation FAQs
Workers’ compensation is a limited system intended to provide protection to employees injured in the course and scope of their employment. California Workers’ compensation in is a “no fault” system in which neither the employee nor employer is considered at fault before benefits are paid. Therefore, negligence or intentional wrong doing are generally irrelevant as to whether you receive workers’ compensation benefits. You do not receive general damages such as pain and suffering under workers’ compensation law.
There are four primary benefits you may receive when injured on the job:
- Temporary Disability Compensation
- Medical Treatment for the Industrial Injury
- Permanent Disability Compensation
- Job Displacement Allowance
If your case is accepted by your employer, you are entitled to receive temporary total disability (TTD) benefits when you are temporarily disabled pursuant to your doctor’s orders. There is a two year limit on temporary disability payments.
The amount of compensation you receive while temporarily disabled depends on whether you work for a private employer or a public entity. If you work for a private employer you will receive two thirds of your average weekly earnings up to a maximum of $1,067.00 per week for injuries occurring on or after January 1, 2010. This compensation is normally paid by the employer’s workers’ compensation insurance carrier.
If you work for a public entity, your benefits vary depending on the agency you work for, and your position with the agency. Generally, public entities provide for higher benefits.
When you are injured on the job, you are entitled to medical treatment provided by your employer and/or its’ workers’ compensation insurance carrier. The employer must pay for all costs without liability to you, the injured employee. Medical care can include doctor’s consultations/visits, hospitalization, surgery, physical therapy, medications, laboratory and diagnostic testing, nursing care, psychiatric treatment, and mileage costs for travel to and from doctors, therapists, etc.
As a result of various workers’ compensation legislative reforms, medical treatment, particularly for orthopedic injuries, is severely limited. All medical treatment is now subject to “utilization review” which allows the employer/ insurance carrier, to submit the treatment requests to a doctor for review to determine if the treatment is appropriate.
Further, for all orthopedic injuries occurring after January 1, 2004, there is a lifetime limit of 24 physical therapy and chiropractic sessions. While a claims examiner may approve more therapy, there is no appeal process if they deny medical treatment beyond the limit stated above.
Employers may create a Medical Provider Network (MPN) to control medical treatment for your work related injury. If your employer creates a MPN, you must treat within the network. While you have the right to choose a doctor within the network, you do not have the right to treat outside the network.
You may be able to avoid treating within the MPN if you pre-designate a doctor to treat you for a work related injury. This doctor must be one who has been your primary treating doctor or surgeon and who consents to the pre-designation. Pre-designation may be done at any time so long as it is prior to an injury.
In most cases an injured worker needs to retain an attorney as soon as possible to protect his or her rights even if you are receiving benefits. However, if you are not receiving benefits in a timely manner, have difficulty obtaining appropriate medical care, have residual permanent disability justifying final permanent disability compensation, or a need for future medical care benefits, you should consult with an attorney immediately to ensure that all appropriate benefits are and will be provided to you.
Yes. There are various statutes of limitations that apply to filing a workers’ compensation claim, and they can be extremely complex. Any injury that requires treatment should be reported immediately to your employer, who should then provide to you, within 24 hours, an Employee Claim for Workers’ Compensation form. You must return the completed form to your employer.
Whether your employer denies or accepts your work-related injury, you should consult with an attorney. An attorney will file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board. The time limits to file an Application may be one year from the date of the injury, or possibly five years from the injury date, depending on whether liability has been accepted and if any workers’ compensation benefits have been provided. Again, time limitation questions are complex, and if you have any question at all, you should seek the advice of an attorney.
Legally, an employer may not discriminate in any way against an employee who files or threatens to file a workers’ compensation claim. Labor Code Section 132(a) prohibits such action by an employer and allows for increased compensation and possible reinstatement with back benefits if the employer is found to have violated this policy. Often, the acts of discrimination may not be actual termination, but rather a demotion or denial of a promotion. Further, refusal to provide normal work benefits that other non-injured employees may receive could constitute a violation of this section. A petition for violation of this section must be filed with the Workers’ Compensation Appeals Board within one year from the act of discrimination.
Discrimination by your employer resulting from an injury may also give rise to civil actions such as claims with the California Department of Fair Housing; EEOC, Americans With Disability Act. You may wish to consult with your attorney to see if you have a viable claim under any such statute.
Normally, if injured on the job, you are limited to recovering from your employer in workers’ compensation only. You may not sue your employer for “damages” in a separate civil action. However, there are various exceptions to this rule which do allow you to sue the employer in a court of general jurisdiction, and recover general and special damages. These exceptions generally cover situations where the employer may have intentionally caused the injury or violated some public policy when the injury occurred (i.e., sexual or racial harassment).
You may also have legal rights against a third person or party as a result of a work-related injury. A common example is an on-duty traffic accident where the accident was caused by the negligence of the other driver. In such a case, you could pursue a separate civil action against the other driver and/or the driver’s automobile insurance carrier.
As with all legal actions, time limitations apply in filing separate civil actions against an employer and/or a third party, and an attorney should be consulted if any questions exist.
If you are unable to return to work, you may be entitled to a “job displacement allowance” ranging from $4,000 to $10,000 which is payable in a voucher form to a school or training facility.
You may be entitled to receive permanent disability compensation if you suffer any permanent residual effects from the injury. A determination of the extent of permanent disability is based upon a review of the medical evidence, which can come from your treating physician, or an independent physician. The percentage of disability you receive is based on impairment and may be payable even if you return to your usual and customary occupation. The actual monetary value of any settlement is based on the percentage of permanent disability as determined by the physician in his or her report.
Yes, and you probably would not be reading this! But, your surviving dependents (total or partial) may be entitled to any benefits that accrued while you were alive. Surviving dependents may also be entitled to workers’ compensation death benefits, including burial expenses if your death was job related. There are specific time limitations to file a death claim with the Workers’ Compensation Appeals Board and each case should be discussed with an attorney to ensure a statute does not expire.