California workers’ compensation insurance is designed to provide workers who suffer work-related injuries with the following benefits: medical care, wage loss benefits, vocational rehabilitation benefits, and death benefits.
While this may seem straightforward, there are lots of variables that impact just how much you can receive.
When you suffer a work-related injury, your top priority should be receiving adequate medical care.
If your work-related injury requires immediate medical attention, your employer is required to make sure you have access to treatment right away. For non-emergency care, your claims administrator must authorize treatment up to $10,000 within 1 day after you file your workers’ compensation claim form.
What treatments are covered?
Under California’s workers’ compensation laws, all medical care that’s “reasonably required” to cure or relieve the effects of your injury is covered.
This begs another question:
What treatments are “reasonably required”?
Doctors in California's workers' compensation system are required to provide scientifically-supported medical treatment. These treatments are laid out in an ever-evolving set of guidelines, which provides details on which treatments are effective for certain injuries, how often these treatments should be administered, and for how long.
If your doctor recommends treatment that’s not in the guidelines, the treatment will still be covered so long as it follows other scientifically-based guidelines that are generally recognized by the medical community.
California employees injured on the job are entitled to compensation for days taken off work (sometimes called “wage loss benefits” or “income replacement benefits”). The available compensation depends on the type of injury suffered by the employee.
Temporary disability (TD) benefits are payments you receive when your injury prevents you from doing your usual job while recovering. There are 2 types of temporary disability benefits:
If you’re entitled to TD benefits, you’ll be paid two-thirds of the difference between the average gross monthly wage you earned before your injury and the average gross monthly wage you earn after your injury. The payments will be made for as long as your TD persists.
With all that being said, you can’t receive more than the maximum weekly amount set by California law. The maximum amount is set annually by the California Department of Industrial Relations (DIR). In 2020, the maximum weekly amount is set at $1,299.43.
TD payments begin when your doctor says you can't do your usual work for more than 3 days or you’re hospitalized overnight. Payments must be made every 2 weeks. Generally, TD stops when you return to work, when the doctor releases you for work, or when the doctor says your injury has improved as much as it's going to improve.
Permanent disability (PD) is any lasting disability that results in reduced earning capacity after maximum medical improvement (MMI) is reached. To put it another way, an injury that prevents you from returning to your pre-injury condition no matter how much medical treatment you receive is a permanent disability.
A permanent disability can be partial (an injury that is a permanent part of your life, but that still allows you to work in some capacity) or total (an injury that’s so severe that you’ll never be able to work again).
Your PD benefits are determined by your claims administrator based on several factors, including:
If you don’t agree with your disability rating, you can ask the California Division of Workers’ Compensation (DWC) to review the rating. The DWC will determine if mistakes were made in the medical evaluation process or the rating process. This is called reconsideration of your rating.
If you have an attorney, you can’t request reconsideration. Instead, your attorney can present your case to a workers' compensation administrative law judge.
A supplemental job displacement benefit is a voucher that promises to help pay for educational retraining or skill enhancement, or both, at eligible schools. The voucher is redeemable up to $6,000.
In order to receive a supplemental job displacement benefit, both of the following statements must be true:
The voucher expires 2 years after the date the voucher is given to you, or 5 years after your date of injury, whichever is later. All expenses must be incurred and submitted with required receipts and other documentation before the expiration date.
If a work-related injury results in death, reasonable burial expenses up to $10,000 will be paid to dependents of the deceased employee.
In addition, certain compensation will be paid to dependents and partial dependents. The amount of total compensation paid is based on the number of dependents and partial dependents. Death benefits are typically paid in weekly installments.
|California Workers’ Compensation Death Benefits|
|Burial expenses||1 total dependent||2 or more total dependents||3 or more total dependents||1 total dependent plus 1 or more partial dependents||1 or more partial dependents (and no total dependents)|
|$10,000||$250,000||$290,000||$320,000||$250,000 plus 4 times what the partial dependents received in annual support from the deceased not to exceed $290,000||8 times what the partial dependents received in annual support from the deceased not to exceed $250,000|
If you have questions about the workers’ compensation claims process, or you feel that you’re not getting the benefits you deserve, consider reaching out to a California workers’ compensation attorney.