What Are the California Workers’ Compensation Benefits?By Kenton Koszdin Law Office on February 16, 2023 | In Blogs
Workers in Los Angeles and across the state have streamlined access to benefits for on-the-job injuries. Unfortunately, problems can sometimes arise when injured workers seek to claim these benefits. In some cases, workers with worthy claims are denied the benefits they deserve or receive far less than they should.
If you or a loved one has been injured on the job, a Los Angeles workers’ compensation lawyer can potentially help you overcome the obstacles many workers face in the claim process and help you access the maximum benefits you’re entitled to.
Workers’ compensation in California gives injured workers access to medical care for their injuries. However, recent changes to the rules mean the injured must seek treatment from a healthcare provider within their employer or insurer’s medical provider network (MPN).
Utilization review (UR) is the process by which employers or workers’ comp administrators verify the need for medical treatment. All employers or their workers’ comp claims administrators must have a UR program.
Time Limits for Utilization Review
After receiving the appropriate information, the UR process must issue a decision within five business days to either accept, deny or modify the treatment a worker is to receive.
Independent Medical Review
For those injured workers who dispute the findings of a UR, another review process is available, known as independent medical review (IMR). However, this process typically mirrors the findings of the initial UR.
Temporary Disability Benefits
Temporary disability benefits in California can either be classified under temporary total disability (TTD) or temporary partial disability (TPD). Both categories of temporary workers’ compensation benefits involve wage-replacement payments to workers who have been injured on the job.
The difference between the two is that workers with a TPD can sustain a limited work schedule and thus receive a partial wage from work and reduced wage-replacement benefits from their workers’ compensation claim. Employees with a TTD, on the other hand, cannot work and will receive the full wage-replacement benefit.
In order to qualify for temporary disability benefits, a doctor must verify that you’re no longer able to work or can only work in a limited capacity. Generally speaking, workers receiving temporary disability benefits must see their doctor every 45 days to reevaluate their condition for improvement or worsening.
It’s important to be aware that specific limits exist on the amount and duration of temporary disability benefits, regardless of whether they’re TPD or TTD benefits. In most cases, workers cannot receive more than 104 weeks of temporary disability payments within a five-year period from the date the work injury occurred.
That said, certain conditions allow you to receive up to 240 weeks of TD, including:
- Hepatitis B
- Hepatitis C
- Serious burns
- Certain eye injuries
- Pulmonary fibrosis
- Chronic lung disease.
For seasonal workers who are injured on the job, wage-replacement benefits are only available for the part of the year they worked.
In addition to duration limitations, there are also payment caps for disability payments. These limitations, which are based on the average weekly wage in the state, change each year.
For example, in 2022, the statewide average weekly wage was $1,570. This means that no worker in California who received CA workers’ compensation benefits that year was paid more than $1,570 per week, regardless of their salary. In 2023, the figure rose to $1,651.
Permanent Disability Benefits
Permanent disability benefits are awarded to those workers who become permanently disabled on the job. They are long-term benefits that usually last a lifetime and are intended to compensate workers for lost earning capacity and wages.
Limitation of Add-On Impairments
Add-on impairments are intended to supplement existing impairments. They increase the level of disability a worker is assigned by a maximum of 3%. Typical add-on impairments include:
- Psychiatric disability, in certain cases.
Regarding psychiatric disabilities, the injury must arise directly from an injury or employment event or have occurred as a result of a violent or catastrophic injury. For example, an injurious car crash may leave a survivor with anxiety or post-traumatic stress disorder.
Categories of PD Benefits
As with temporary disabilities, permanent disabilities are considered either permanent partial disability (PPD) or permanent total disability (PTD).
A worker who suffers a permanent total disability becomes injured on the job to such an extent that they can never return to work in any capacity. In other words, they no longer have the ability or means to make money to support themselves or their families.
Because permanent total disability has such serious and lasting repercussions, it’s classified and evaluated differently than partial total disability.
Some common examples of permanent total disabilities include:
- The loss of a limb or other vital body part
- Partial or total paralysis
- Loss of hearing or vision.
When a worker is deemed to have suffered a permanent partial disability, they aren’t considered 100% disabled for work purposes and may return to work in a limited capacity at some point in the future.
A disability rating is assigned to the worker’s injury or injuries to determine which category the injured worker falls into. The rating is based on a percentage scale. If a worker’s injuries total 100%, they’re considered totally disabled. In cases of severe injuries, such as paralysis, total disability is generally assumed to apply automatically.
As you might imagine, the determination of a disability’s rating is an involved medical process with numerous steps that include the review of medical reports and the assigning of impairment ratings to injuries. In many cases, the process can be quite contentious, and workers can often get disability ratings they don’t agree with.
For this reason, workers need to have a workers’ compensation lawyer fighting for them every step of the way.
Although often contentious, the assignment of impairment and disability ratings isn’t arbitrary. Doctors who treat patients after their initial emergency treatment follow the American Medical Association (AMA) Guides for determining a worker’s impairment rating.
Within this guide, some methods are used in conjunction with the doctor’s observation for rating body parts and injuries.
For example, a doctor might examine a person with severe neck pain that’s permanent and substantially interferes with their ability to engage in gainful employment. After consulting various tests, such as MRIs, the doctor might assign the worker a rating of 10%.
This figure is then converted into a disability rating that determines the extent of the benefits the worker is ultimately entitled to receive. To help them obtain a disability rating, physicians and workers’ comp caseworkers use the Permanent Disability Rating Schedule, which contains a formula for reaching the rating.
Some of the factors used in this formula include:
- The type and nature of the injury or injuries sustained;
- The workers’ customary job titles and duties;
- The age of the employee;
- The likelihood that the employee’s future earning capacity might change.
Keep in mind that it takes time to officially designate an injury as permanent, whether partial or total. For this reason, injured workers first begin to receive temporary disability benefits before they receive permanent disability benefits, but they never receive both types of disability together.
Increases Due to the Cost of Living Adjustment
Cost of living adjustments for permanent disabilities helps permanently disabled workers keep up with society’s costs. However, they only apply to workers determined to have a permanent total disability.
Supplemental Job Displacement Benefit
The Supplemental Job displacement Benefit (SJDB) is a voucher that injured workers can use to receive education and training to help them expand their avenues for employment.
Eligibility for the Voucher
This voucher is only available if the following conditions are true:
- The worker has been deemed permanently disabled due to a work injury;
- The worker’s employer does not have permanent work for the worker due to their injury.
Workers who receive the SJDB voucher typically use it to cover educational and vocational training expenses.
Amount of the Voucher
SJDB vouchers are worth up to $6,000 for workers. The money may be used to fund education and training to get injured workers back into the workforce in a new occupation.
Be aware that if you receive the voucher and would like to use it for education and training purposes, you must enroll in a state-approved school or one that’s accredited.
Some of the typical expenses vouchers may be used for include:
- School fees
- Mandatory school expenses
- Costs related to licensing and certification
- Exam and testing costs
- Tools need for educational and training courses
- Up to $1,000 for computer equipment
- Up to $600 for payments to licensed placement agencies and vocational counselors
- Up to $500 for general educational expenses, including transportation.
Remember that if your employer offers you certain types of employment within a certain period during your claim for a voucher and you turn down the opportunity, you may not be eligible for the SJDB voucher.
Payment and Settlement of the Voucher
If you’re entitled to a voucher, you don’t have the option of taking cash in its place. However, in the case of a dispute over benefits eligibility in general, voucher included, the voucher can be wrapped up into a cash settlement in a Compromise and Release agreement.
It’s important to note that the voucher ultimately requires workers to foot the initial bill for their voucher expenses.
After paying, the worker then makes a claim for reimbursement with the appropriate insurance company. The insurance company has 45 days to reimburse the injured worker. Unfortunately, failure to reimburse an injured worker’s voucher within 45 days comes with no penalty.
In terms of time limits, injured workers’ vouchers are good until:
- Two years after the voucher reaches the injured worker, or
- Five years after the worker suffered their qualifying injury.
For more information regarding vouchers and their approved uses and conditions, contact a Los Angeles workers’ compensation lawyer today.
Sadly, some workers are killed on the job as a result of workplace injuries.
When this occurs, death benefits may be available for those who depend on the deceased worker for financial support. If the death occurred due to a third party, the option of filing for wrongful death benefits might also be available. However, wrongful death is a different type of claim than a workers’ compensation claim.
Generally speaking, death benefits from workers’ compensation can be paid to a spouse, child (or children), or certain other dependents.
Both total and partial dependents may receive payments. A total dependent is an individual who relies on the deceased worker for their complete subsistence, whereas a partial dependent has some other form of support in addition to the support they receive from the deceased worker.
More specifically, total dependents are those who:
- Children under 18 years of age;
- Adult children incapable of earning a living due to physical or mental incapacitation;
- Surviving spouses who make less than $30,000 a year.
Any other dependent not fitting in either of the above-listed definitions is considered a partial dependent.
Amount of Death Benefits
Benefits paid after the death of a worker can be used for continuing support of dependents, as well as for funeral and burial expenses.
Currently, the death benefit for the latter is up to $10,000 for deaths that occurred on or after January 1, 2013, and $5,000 for fatalities occurring prior to that date. For the former, the death benefits are capped at $320,000.
The amount of benefits that are ultimately awarded depends on the number of dependents a deceased worker has left behind and their status as total or partial dependents.
Death Benefit Payments to Totally Dependent Children
The number of dependents will determine how the payments are doled out in a workers’ comp death case. If only one totally dependent child is left behind, that child will get $250,000. If two or more dependent children remain, they’ll split $290,000. In the event that three or more are left behind, the total payout is $320,000.
Death Benefit Payment Schedules
In many cases, there are no total dependents, only partial ones, or there may be a mix of total and partial dependents after a worker’s death. When this is the case, the payment calculations will differ from calculations made when only totally dependent individuals remain.
When only partial dependents figure into the calculation, they’ll receive eight times their annual support up to $250,000, be they one or more in number.
When there’s one total dependent plus one or more partials, the one total dependent will receive $250,000, and the partial dependents will get up to four times annual support, with an overall cap of $290,000.
Death benefits are typically paid in weekly installments. According to California law, the minimum death benefit payment must be at least $224 per week or $896 per month. Once a child under 18 has received the full amount of their benefit, they may still be eligible to receive support payments until they become an adult.
Keep in mind that there are strict time limits for filing death benefits. In no case may death benefits be requested more than 240 weeks after an injury that ultimately causes death.
Commutation in workers’ comp benefits in California refers to the process by which workers’ compensation benefits are commuted to a lump settlement.
Commutation can be an attractive option for many workers for many reasons, but it should only be considered after speaking with a workers’ compensation attorney who understands the repercussions of commutations on workers’ compensation benefits.
Without an attorney, it’s easy for a worker to experience a reduction in benefits, as well as significant delays in receiving the payments they deserve.
Types of Commutations
Three principal types of commutations exist for workers’ compensation benefits in California:
- Commutation off the far end of the award: A lump sum payment issued right away that’s calculated using the schedule for an award’s final stages.
- Commutation off the side of the award: A lump sum payment that occurs while an employee is still receiving weekly payments. With this type of commutation, the weekly payments are reduced in order to fund the lump sum payment.
- Commutation off the near end of award: A rarely used option where benefits cease until the commuted sums and interest savings have accrued.
There are two different methods typically used to reduce benefit payments to cover the lump sum payment with regard to commutation off the side of the award.
The first sees the weekly payments reduced over the entire award period, with all payments being reduced equally. The other method sees the reduction of weekly payments for a specific period determined during the initial stages of the arrangement.
Access Your Maximum Workers’ Compensation Benefits
Workers’ compensation benefits in California are a lifeline for many. However, the workers’ compensation process can be daunting, even when a worker has a valid claim for compensation.
Fortunately, Los Angeles workers’ comp attorneys can help employees get their hands on the workers’ compensation benefits they deserve.
If you or a loved one has been harmed on the job and need assistance navigating the workers’ compensation system, call today to get a free review of your case and information about how to proceed.