If you have been injured at work, you may be entitled to temporary disability benefits / payments, medical treatment (reimbursement of mileage and approved associated costs), permanent disability benefits / payments, and job retraining (supplemental job displacement benefits / voucher). Treatments to relieve the effects of the work injury are available at no cost to you. Treatments can be medical, surgical, internal, chiropractic, dental, psychological, and any other necessary specialty; this includes hospitalization, medication, and medical supplies. And you are entitled to travel reimbursement for all medical appointments that are with approved doctors.

As your attorneys, we will help you obtain all of the workers’ compensation benefits which you are entitled to. These are complicated calculations of disability, review and comprehension of complicated medical records, and simply put, a complicated system that is evolving each year. Insurance companies have adjusters, doctors, and attorneys working on their behalf. It is important that you have a Law Firm and Attorneys who are ready to fight for you. Benefits are on a case by case basis, so please call us to discuss helping you receive the maximum benefits under California Law!

Temporary Disability Benefits / Payments

While you are injured, you are entitled to some temporary disability benefits / payments, if you are unable to return to work in any capacity or partial temporary disability payments if you are not about to return to full capacity work. There are two types of disability payments. First, you may be eligible for Temporary Total Disability (TTD) payments. The amount of TTD payments is based upon two thirds of your average weekly wages up to the statutory maximum limit that changes from year to year. You can receive TTD payments if you are unable to work during your medical treatment and you must be restricted from returning to work by your primary treating physician through workers compensation. If your physician returns you back to work and/or you return to any employment, these benefits will be interrupted. For all injuries occurring after 01/01/04, you are limited to a maximum of 104 weeks of TTD payments which must be used within a five year period from the date of your initial injury, subject to some statutory exceptions.

Medical Treatment

If your case is denied by your employer’s workers’ compensation insurance company, then you should seek medical attention for all of your pain, sensations, and symptoms.

If your case is accepted, then your medical treatment will be subject to the primary treatment physician / medical provider network system.

Be sure to mention to all doctors which body part / systems / conditions you believe are injured directly or at least in part, because of your work.

You are entitled to reimbursement for your mileage and approved associated out-of-pocket expenses. To start the process, you must formally, in writing, request reimbursement from the worker’ compensation insurance company.

Permanent Disability Benefits / Payments

Thirdly, you may be entitled to Permanent Disability (PD) benefits / payments once an injury has become “permanent and stationary” (P&S) or you are determined to have reached “maximum medical improvement” (MMI), both of which essentially mean your medical condition has stabilized and is not expected to significantly get better or worse over the next one year. It does not mean you are cured or relieved of your injuries. The amount of permanent disability for your injury is “rated” based on medical reports from your treating doctor, any secondary treating physicians, qualified medical examiners, and / or the agreed medical examiners. Permanent Disability is based on several factors largely on the limitations on your activities of daily living due to the work injury and whether you are able to return to gainful employment and if and what job restrictions you may have as a result. For injuries occurring before 1/01/2004, we use what is coined the old rating schedule which bases disability on a person’s work restrictions and ability to compete in the open labor market. For injuries after 01/01/2004, we consider a person’s’ diminished future earnings capacity and limitations on his/her activities of daily living and the AMA Guidelines which is a textbook guideline book for giving whole person impairments for a specified body part. Permanent Disability will also take into account your age, loss of future earning capacity, and the specific occupation you were work-in when you sustained your work injury.

Job Retraining (Supplemental Job Displacement Benefits / Voucher)

If your work injury interferes with your current occupation, you may be entitled to assistance in finding other employment including job retraining. For injuries sustained on or after January 1, 2013, you may in some instances qualify to receive a Supplemental Job Displacement Voucher in the amount of $6,000.00 to attend school or a vocational program as well as some to use for some school-related expenses. The voucher can be used at the school of your choice depending on several factors such as school accreditation. This voucher expires within two years, subject to some specific exceptions.

Three Ways to Resolve Your Case

Successful workers’ compensation claims typically resolves in one of three ways:

  1. A Compromise and Release (C&R) – This type of settlement is a cash-out settlement and can be available to injured workers, typically that no longer work for the company in which the injury was sustained. The C&R calculates any unpaid temporary disability, permanent disability, future medical treatment / costs, including medications and any future surgeries, and any unpaid benefits. The injured worker is awarded a lump sum of money and controls his/her own future medical care. Typically, this type of settlement closes the case forever and will not provide for future treatment on an industrial basis. Note that if you are receiving Social Security Benefits / Medicare, or will soon, other considerations may have to be included such as a Medicare Set-Aside Trust. Most injured workers prefer this option, if they do not want their medical care to be subject to the California Workers’ Compensation approval process.
  2. Stipulation (Stip) with Request for Award – With this type of settlement, the injured worker will receive a permanent disability award weekly as well as any unpaid benefits, and all future injury-related medical treatment will be covered, subject to the approval process. A Stip and Award is court approved and is generally a pre-trial settlement.
  3. Findings and Award (F&A) – This is an Award as a result of Trial. An F&A is a judge’s decision on the case after Trial. These awards may also be eligible for a Lump Sum Payment by commutation whereby a judge commutes part or your entire permanent disability award into a lump sum payment.

An advantage to [2] & [3] is, since you medical care is left open through the insurance company, your right to petition for new and further benefits is preserved should your condition worsen within five years of the original injury date or last date of injurious exposure, as in a cumulative trauma injury.