Q. What happens if I get injured at my job?
A. Report the injury to your employer immediately. Your employer is required to provide you with a state approved Claim Form to use when filing for workers’ compensation benefits. You complete the top half of the Claim Form and your employer completes the bottom portion. You are to be given a copy of the fully completed Claim Form. If your employer fails to give you a Claim Form, within 24 hours of knowing you were injured, then you should call the workers’ compensation insurance company of your employer and immediately report your injury to them. You should, also, seek legal counsel. Failing to timely file a Claim Form can jeopardize your right to receive workers’ compensation benefits, including medical care for your injury.
Once your injury is reported, your employer, or their workers’ compensation insurance carrier, will tell you whether they have a “network” of physicians that you must see for work-related injuries and provide you with a list of available doctors. If your employer does not have a network of physicians in place, the employer has the right to tell you where to get medical assistance for the first 30 days of the claim, after which you may choose your own doctor. We expect that most employers and insurance companies will have set up a network of physicians (called a Medical Provider Network (MPN)).
Choosing which doctor is going to treat your injury is a crucial step, in your workers’ compensation claim. Please see the Why Legal Representation is Important section of this web site, found on our Home Page.
Q. If I get injured on the job, how do I get medical treatment?
A. Effective April 19, 2004, the law requires the employer to authorize medical treatment for workers’ compensation injuries within one working day after an employee files a Claim Form. Medical treatment will be provided until the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to $10,000.00. Of course, if it is an emergency, seek medical care immediately.
Choosing your treating physician is crucial to receiving the appropriate benefits, including the appropriate medical care, under the California workers’ compensation laws. It is imperative the injured worker select a treating doctor who has the best interests of the injured worker as the doctor’s number one priority. Unfortunately, many doctors put the interest of the employer’s insurance/adjusting company (the people paying the doctor) ahead of the interest of what is best for the injured worker. Our law firm is very familiar with most of the doctors in the southern California area, who practice industrial medicine. Thus, we can help you in the selection of your treating doctor(s). Please refer to the Why Legal Representation is Important section of this web site (on our Home Page) for further information on why choosing whom your treating doctor is, is critical to receiving the appropriate workers’ compensation benefits.
Q. What is Temporary Disability? And, If I am taken off work by my doctor, how do I receive temporary disability monies?
A. Temporary disability (TTD) benefits are payments you receive from the insurance/adjusting company of your employer, if your doctor places you on temporary total disability status. You may, also, be eligible for TTD benefits if the doctor imposes work restrictions on you but your employer is unable to accommodate your work restrictions, by offering you a modified or alternative job.
Temporary disability (TD) is paid at a weekly rate during the time the doctor indicates the injured worker is unable to work, due to the industrial injury, and there is still a chance of improving the condition with medical treatment. The TD compensation rate is two-thirds (66%) of the employee’s gross earnings, up to the maximum amounts set by law. Since 2003, the maximum temporary disability rate has steadily risen.
For injuries occurring on or after January 1, 2014, the minimum TTD date will increase to $161.19 per week. The maximum TTD rate will increase to $1,074.64 per week.
For injuries occurring in 2013, the maximum TTD rate is $1,066.72 per week.
The current maximum temporary disability weekly rate, for injuries occurring on or after 01/01/2012, is $1,010.50 per week. For injuries on or after 01/01/2011 and 1/01/2010, is $986.69; For injuries occurring on or after 1/1/2009, the weekly maximum TTD rate is $958.01. The maximum for injuries occurring on or after 1/1/2008 is $916.33. The maximum TD rate for injuries occurring in 2007 is $881.66. For injuries that occurred on or after 1/1/06, the maximum TD rate is $840.00 per week. Please note that there is, also, a minimum TTD. The minimum TTD rate for 2012 injuries is $151.57 per week.
Some employers have plans that pay either all your wages, or more than the usual 2/3 of your wages, for all or part of the time your are temporarily disabled. These plans are often called Salary Continuation. There are different types of salary continuation plans. We will check with your employer and/or their insurance/adjusting company to see if you are entitled to salary continuation, in lieu of the usual TD payments.
It usually takes about two weeks from the date of injury before the first payment is made. Temporary disability is not payable for the first three days of disability unless you are hospitalized or you are disabled for more than fourteen days. Once your claim has been accepted, payments should begin within 14 days. For most injuries occurring on or after 4/19/2004 through 12/31/2007, aggregate temporary disability payments will not extend for more than 104 compensable weeks within a period of two years from the date the workers’ compensation insurance carrier/adjusting company commenced payment of TD. In other words, once the first payment of temporary disability benefits is made, no additional payments can be made beyond two years from that first payment. However, due to a recent change in the law, employees injured on or after January 1, 2008 will be eligible to receive the 104 weeks of temporary disability payments within a five-year period. The five-year period is counted from the date of injury. If the temporary disability benefits from the workers’ compensation insurance carrier/adjusting company cease and you are still disabled, it may be possible to receive state disability benefits, from the Employment Development Department (EDD). Please contact our law firm for more information.
Q. What can I do if the insurance company does not pay temporary disability?
A. If for some reason (e.g. your claim is delayed or denied by the insurance/adjusting company of your employer) the insurance company will not pay temporary disability, it is often possible to receive disability payments from the Employment Development Department (EDD). These are called SDI (State Disability Insurance) benefits. SDI benefits are often paid at the same, or similar, rate to what you would receive under the workers’ compensation laws. Please note, an injured worker cannot receive benefits from both the workers’ compensation carrier and from the Employment Development Department simultaneously. Please contact us for more information.
Q. How can I be eligible for permanent disability compensation?
A. An injured worker may be entitled to receive a permanent disability award if the injury leaves him/her with any residual disability or permanent impairment. Permanent disability indemnity is not payable until the medical condition becomes “permanent and stationary” (aka “maximum medical improvement”), which means the doctor has stated the medical condition has leveled off and will stay substantially the same in the future. “Permanent & Stationary” or “Maximum Medical Improvement (MMI)” does not necessarily mean that the person has recovered from their injury(ies). In fact, if the doctor indicates the injured worker has had a total recovery, there would be no permanent disability/impairment award. Otherwise, the information in the doctor’s final report will be put into a formula to determine your percentage of disability. Permanent disability is expressed as a percentage, after the doctor’s report has been “rated.”
Again, often times the doctor your employer (or your employer’s insurance/adjusting company) sends you to will indicate a lower percentage of disability than a doctor you or your attorney choose. This is because a doctor selected by your employer, or your employer’s workers’ compensation insurance company, is often times more loyal to the entity that is referring them patients than they are to the injured worker.