Types Of Workers Compensation Money Benefits

A. TEMPORARY DISABILITY – Temporary Total (TTD) or Temporary Partial (TPD)

An injured worker is entitled to receive TTD benefits if the effects of the injury cause the worker to be unable to perform their regular job, the employer has no modified/alternate work, and the employee has a doctor’s note indicating that they are TTD.

TTD benefits are owed 14 days after the employer is notified that the worker is TTD.

No TTD benefits are owed if the only period of disability is three days or less.

The total period an injured worker can receive TTD benefits is during a period of 104 weeks from the first payment of TTD benefits. NOTE that the injured worker is not entitled to receive 104 weeks of actual payments, they are entitled to receive payments during a period of 104 weeks beginning with the first payment. If a worker returns to work for 50 weeks and then goes off work again, they will only be entitled to 54 weeks of TTD payments.

For injuries occurring on or after 01/01/2008, the law has been changed again. Now, an injured worker can receive 104 weeks of temporary disability within a five years from the date of injury.

Temporary partial disability (TPD) is paid to an injured worker who works but does not earn am amount equal to their temporary disability rate.

The temporary disability rate is 2/3 of average weekly earnings.

Currently (2006), the minimum weekly rate is $ 126 per week for workers earning $ 189 and below.

Currently (2006) the maximum weekly rate is $ 840 per week. To qualify for the maximum rate, the injured worker must have average weekly earnings of $ 1,260. Maximum rates for temporary disability will be higher in future years because rate increases will be tied to increases in the state average weekly wage.

If you are receiving TTD two years after your injury and your were paid at the maximum rate, please call this office so that we can make sure you are receiving the correct amount of temporary disability. You may be entitled to receive TTD and the increased adjusted rate.

Temporary disability benefits end when the MPN doctor, treating doctor, AME or QME reports that you have reached maximum medical improvement (MMI). Temporary disability benefits will end at the 104 week limit, even if the doctors say that you are still temporarily totally disabled and have not yet reached MMI.

B. PERMANENT PARTIAL DISABILITY (PPD)

Permanent disability benefits are met to compensate the injured worker for long term diminished future earnings capacity directly caused by the effects of the injury.

In most cases, in order to qualify for PPD benefits, you will have show that you have rateable impairment as defined by the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th Edition (AMA Guides).

The AMA Guides ignore the effect of pain and subjective complaints. As a consequence, 37% of cases that received a PPD rating under the old California rating system receive NO PPD rating under the AMA Guides. In many cases, PPD benefits are 40% to 70% lower using the AMA Guides than under the old California rating system.

The AMA Guides gives detailed instructions to the rating doctor on how to determine an impairment percentage for injuries to the various parts of the body. The introduction to the AMA Guides explains that the term “impairment” is not the same as “disability.” An injured worker may have impairment under the AMA Guides and be entitled to a PPD award and be able to return to the same job they had before they were injured. It is also possible that an injury that receives a zero or low rating under the AMA Guides may be very disabling as to prevent the injured worker from retuning to their prior job.

Many injuries are rated under the AMA Guides by measuring loss of range of motion on the date of the examination. Consequently, how you feel on the day of the examination and the impact the medications you are taking on the date of the rating examination can have an impact on the AMA Guides rating in a given case.

Not every injury requiring a surgery will result in a PPD rating under the AMA Guides. Injured workers are evaluated based on how well they are on the day of the rating examination. Consequently, how you feel on the day of the examination and the impact the medications you are taking on the date of the rating examination can have an impact on the AMA Guides rating in a given case.

PPD benefits are supposed to start 14 days after the last payment of temporary disability. In many cases, there are gaps in between these two benefits.

PPD benefits are payable at the following weekly rates (neutral rates) for 2006 and later dates of injury:

Ratings between 1% and 69% - $ 230

Ratings between 70% and 99% - $ 270

PPD benefit rates are increased by 15% if there is no return to work offer within 60 days of reaching MMI and the employer has 50 or more employees at the start of the workers compensation insurance policy.

PPD benefit rates are decreased by 15% if a return to work offer is made to the injured worker. This applies to all employers, regardless of the number of employees.

If a worker is terminated or laid off within 12 months of MMI, than the worker receives PPD at the increased 15%

If a worker is rated at 70% or greater, they will also receive a life pension weekly payment. The life pension is payable at weekly rates (2006 and later dates of injury) between $ 77.31 and 301.50 depending on the percentage of disability. The life pension weekly payment will increase based on increases in the State Average Weekly Wage. The life pension payment starts after the regular permanent disability award is paid and continues thereafter for the remaining life of the injured worker.

Please note that while the disability is permanent, in almost all cases, the permanent disability benefits do not last for the duration of the permanent disability. The disability is permanent, but the benefits are not permanent.

C. PERMANENT TOTAL DISABILITY – 100% Disability

If an injury causes a complete loss of future earnings capacity, the injured worker is entitled to receive weekly payments payable at the temporary disability rate in effect at the time of their injury for the reminder of their life.

Very few injuries will qualify for this type of award. The use of the AMA Guides in rating disabilities makes it very difficult to reach 100% disability. It is anticipated that use of vocational experts will be required to establish a complete loss of earnings capacity.

The use of the new AMA Guides rating system is just beginning in California. It is anticipated that there will be changes as we gain more experience using the AMA Guides.

D. SUPPLEMENTAL JOB DISPLACEMENT VOUCHER (SJDV)

Vocational Rehabilitation benefits were eliminated for workers injured on or after 01/01/04. THERE IS NO MORE VOCATIONAL REHABILITATION.

In place of vocational rehabilitation, the legislature enacted the Supplemental Job Displacement Voucher (SJDV).

THE INJURED WORKER GETS NO MONEY IN THEIR POCKET.

The voucher is to be used by the injured worker to pay for tuition, books, and supplies. If the injured worker wants to use the voucher, they will have to have other resources to pay for living expenses and transportation to and from training.

To be eligible for the SJDV, the injury must cause permanent disability and the injured worker is not employed at the at injury employer 60 days after the last payment of temporary disability benefits.

The amount of the SJDV depends on the percentage of permanent disability. The amounts are as listed below:

$ 4,000 for permanent disability between 1% and 14%

$ 6,000 for permanent disability between 15% and 25%

$ 8,000 for permanent disability between 26% and 49%

$ 10,000 for permanent disability between 50% and 99%

If the injured worker wants to have help from a vocational rehabilitation counselor in finding a school or vocational goal, they will have a difficult time finding a counselor who will help them because counselors are limited to receiving on 10% of the total voucher as fees.

E. DISCRIMINATORY ACTIONS BY THE EMPLOYER

Please call this office immediately if you learn that your employment has been terminated by your employer. Don’t confuse termination of employment with your employer telling you that they have no work for you because of your injury. If you are terminated, your employer will tell you that you are fired.

If the termination is for reasons connected with your injury (such as not being able to perform your job due to your injury) or retaliation for getting medical treatment for filing your workers’ compensation claim, you may be entitled to receive additional benefits such as an increase in benefits of 50% up to $ 10,000 and reimbursement for lost wages and work benefits caused by the acts of the employer. Reinstatement to the job is also possible.

The time limit for filing a claim for this type of benefit is one year from the discriminatory act.

F. PENALTY FOR DELAYED BENEFITS

The penalty for unreasonable delay and refusal of benefits has been significantly reduced by the workers’ compensation reform. Before the reform, an injured worker could get a ten percent penalty on the entire benefit being delayed, past, present, and future. Often, injured workers obtained multiple penalties under the old statutes. The old penalty system was irrational and often lead to award of significant sums of money.

Under the current law, the penalty for unreasonable delay can be based on up to 25% of the amount delayed. If the delay is discovered by the employer and the employer pays 10% of the amount delayed, than there is no other penalty. In practice, the Judges at the Appeals Board will rarely award more than 10% on the amount delayed.

In summary, penalties for unreasonable delay could be significant before the reform, but have now been significantly cut back to the extent that they are almost meaningless deterrence to unreasonable delay by the insurance company.

G. SERIOUS AND WILLFUL MISCONDUCT

If an employer has failed to provide a safe workplace, and that failure caused the injury, the employer may be liable for additional fines. The employee must show almost gross disregard by the employer for safety. Ordinary negligence is not enough. I have won several of these cases and settled others. These cases for the most part are difficult to win absent compelling facts.

The time limit for filing a Petition for Serious and Willful Misconduct in one year from the date of the event.

H. DEATH BENEFITS

If an injury at work or occupational exposure contributed to a workers death, the workers’ spouse and minor children can recover significant death benefits under workers’ compensation.

One must not overlook the fact that consequences of a work injury such as the effects of medications or treatments for the work injury can also contribute to the death of an injured worker.

The time limit for filing a death claim in workers’ compensation is one year from the date of death but in no event, more than 240 weeks from the date of injury.