Workers' Compensation Benefits and Returning to Work

An employee injured at work is eligible for compensation. Employers should have insurance coverage in place to cover an employee if they get injured or develop a work-related illness. However, these benefits do not always come easy. You will need a committed workers’ compensation lawyer by your side who will fight to ensure your employer doesn’t leave you stranded with bills that the law compels them to cover, or punish you for failing to report to work due to your injuries.

Workers’ benefits fall in different categories. For instance, we have hospital and medical benefits, permanent and temporary disability benefits, lost wages, death benefits and supplemental benefits.

Hospital and Medical Benefits

As Labor Code 4600 dictates, employers have a duty to pay for medical and hospital bills for any employee that sustains a work-related injury or illness. However, there are several limitations like the amount of the medical bills the employer should cover and the timeframe that qualifies the benefits. For instance, your treatment has to be connected to the injuries, and it has to be proven to cure that injury. Note that your employer has to cater for your hospital and medical bills even if you were only slightly injured and can still report to work as you seek medical attention. Medical bills to be covered include:

• Doctor’s visits
• Surgeries
• Medication
• Specialized equipment to ease the condition. For example a modified vehicle, a wheelchair or crutches
• Rehabilitation and physical therapy
• Acupuncture
• Occupational therapy
• Chiropractic treatments
• Nursing
• Mileage reimbursement which includes travel expenses to and from a doctor’s appointment, hospital and picking up your prescriptions.

Employee medical treatment depends on a process known as Utilization Review. In this process, your employer has to review your medical treatment and determine whether it is necessary. The treatment has to follow medical treatment rules and guidelines that are scientifically-based. These rules include the Medical Treatment Utilization Schedule found under the California Division of Workers’ Compensation. These rules determine the duration, frequency and the appropriateness of any treatment done in cases involving workers’ compensation. Any treatment that is not based on these rules may be paid for by your employer if it is based on other scientifically-based rules that are acknowledged by the national medical community.

Disability Benefits

The aim of disability benefits is to compensate for lost wages you incurred due to your injuries or illness since they made it difficult for you to report to work. There are two main categories of disability benefits, classified based on whether the disabilities are permanent or temporary. They include;

• Permanent disability benefits
• Temporary disability benefits

Permanent Disability Benefits

If you cannot recuperate completely from your injuries or illness, or if the injury results in a permanent loss of mental or physical abilities, you may be entitled to permanent disability compensation. The permanent disability compensation amount you will be awarded depends on:

• The circumstances under which you were injured
• The nature of the injuries
• The medical care you will require
• Your age
• The degree of impairment
• Your occupation
• Your monthly wages prior to the injuries

Permanent disability benefits are further divided into two parts, permanent total, and permanent partial disability benefits. To determine which one you qualify for, your doctor will give a report about your disability in which he or she will include your disability rating. From this report, you are awarded either one of the benefits. It is uncommon for injured employees to be granted permanent total disability benefits. However, if it is determined that you are eligible for these benefits, you will receive compensation for your entire life.

When it comes to permanent partial disability, the total amount of your benefits is released in a stipulated period (a few weeks to be precise). Once you receive a disability rating, most employers will want to negotiate an agreement on the total permanent disability benefits amount they owe you. We recommend that you don’t participate in these negotiations on your own. An experienced workers’ compensation attorney is familiar with what most employers would settle for, and he or she may be able to negotiate a better deal on your behalf.

Temporary Disability Benefits

If an injury or an illness you suffered on the job resulted in only a temporary disability, you might be entitled to temporary disability benefits. Like permanent disability benefits, this too is divided into two parts, temporary total disability, and temporary partial disability benefits. Temporary disability compensation benefits are reimbursements for the lost wages for the entire period of your temporary disability. They are given to employees whose disability lasts past three days or those that are hospitalized overnight, as long as their employers do not offer them alternative works that pay similar wages to what they were earning prior to the injuries.

If you are completely unable to resume work for a limited amount of time, you may be eligible for temporary total disability benefits. These payments end the moment you recover or if your doctor decides that you will not recover completely. The state has time limits on these benefits.

Temporary partial disability benefits are given to employees who cannot do their usual job for a certain amount of time, but they can perform a few tasks. It is also given to employees that can do modified tasks for a limited amount of time before they can fully go back to work. For example, your doctor could recommend that you work only three hours a day before making a full recovery from your injuries.

Temporary partial disability benefits are usually 2/3 of your lost wages. For example, if you earned $5000 per month prior to the injuries, then after the injuries you are earning $3500 per month, your lost wages equal to $1500. This means that your temporary partial disability benefits will be $1000. Temporary disability benefits are not taxable be it at the state, local or federal level.

Supplemental Job Displacement Benefits

You may be entitled to this kind of benefit if you are unable to go back to work. They are additional compensations given to injured employees for the purposes of retraining or enhancing their skills. You will receive these benefits if;

• You qualify for permanent disability benefits
• Your employer doesn’t let you resume work or does not offer an alternate position
• You don’t otherwise go back to your former job

These benefits are given to you in the form of a check. You can use it to cater for your education or any other retraining offered at schools approved and accredited by California State. Supplemental job displacement benefits are usually valued at $6,000, and you can utilize it for admission and tuition fees, school books and other supplies, computer equipment, licensing fees, and exam fee. If your employer doesn’t want to give you this voucher, he or she must provide you with a modified, regular or an alternative job. The job has to;

• Pay at least 85% of the income of the previous job
• Last at least a year
• Be located at a reasonable distance that you can commute from your home

The benefits have to be sent to you in 60 days after your employer receives a doctor’s report that you are permanently disabled.

Death Benefits

In case an employee passes away due to an on-job illness or injury, California law permits that his or her family can claim death benefits. It is the close relatives of the deceased who were partially or totally dependent on him or her that are eligible for these benefits. They include the deceased’s;

• Children (inclusive of adopted and step-children)
• Parents
• Spouses
• Siblings
• Grandchildren
• Uncles and aunts
• Grandparents
• Nephews and nieces

Total dependents to the deceased include incapacitated family members, minors and spouses who earn $30,000 or less in a year. Any other family member claiming these benefits has to prove their total or partial dependence on the dead in order to receive them (California Labor Code 3501-3503). The claimant of the death benefits is also entitled to burial costs.

The death benefits amount you will receive is contingent on how many entitled dependents are present. One total dependent would receive $250,000, two total dependents $290,000 while $320,000 is given to three or more total dependents. In case two or more total dependents are claiming the benefits, the amount will be divided equally between them.

It is also possible for partial dependents to receive these benefits. However, they will only receive if there is only one total dependent. In situations where there are no total dependents, the partial dependents are eligible to an amount equivalent to 8 times what they were receiving for yearly support from the dead worker up to $250, 000 at the maximum. This amount is divided equally among the dependents. In the event that there is only one total dependent, partial dependents are eligible to four times the amount they were receiving for annual care, up to $290,000 at the maximum. You will receive death benefits in installments.

Late Payment Benefits

In the event that you are not paid any of the benefits you are entitled to on time, you may receive an additional payment meant to penalize the insurance company. The purpose of this penalty payment is to;

• Make delayed payments costly for the insurance company
• Prevent you from facing economic hardship by ensuring immediate payments

Labor Code 4650 of the State of California regulates the penalties incurred in case of late temporary disability and permanent disability benefits payments. The code dictates that in the event that an insurance provider makes late payments of these benefits, the payment will be increased by 10%. A late payment is one that is not made within 2 weeks of the start of the payments and for subsequent payments, the ones not made after every 14 days from the previous payment.

California Labor Code 5814 regulates the payment of any other benefits. According to this code, if your payment has been delayed for no good reason, or if the insurance company refuses to pay, the payment will be increased by a maximum 25% of the delayed amount, or $10,000 depending on which is less.

If you suffer an on-the-job illness or injury, it will mean that you have time off work in order to recover. The time you take off is important since it helps in speedy and healthy recovery. The purpose of this period is to allow you to seek proper medical care for faster healing. Workers’ compensation law allows employees to take time off work without having to worry about the security of their jobs and the wages they will lose.

After you have recovered, you may want to return to work and resume your duties. Although it may appear to be simple, going back to work has to happen in a manner that considers your well-being and the ability to do the job. Mostly, the process of returning to work is planned by your employer and doctor. Both parties have to reach an agreement as to how and when you will resume work. However, the process sometimes becomes difficult for the parties to handle. You will need a workers’ compensation lawyer to help with where you are stuck. The Workers Compensation Attorney Group’s attorneys are able to negotiate a return-to-work deal that favors both you and your employer.

California workers’ compensation laws provide that an employee be permitted to have time off if they have suffered an on-the-job illness or injury in order to seek medical care and to heal. After they have recovered their health and abilities, they can go back to work. Returning to your job needs planning. For instance, you need to consult a number of people to know whether you are ready to resume your duties. People you can consult include;

• Your supervisor, employer, or manager
• Your attorney
• Your doctor
• Your claims administrator

By consulting all these parties, you can plan out how and when you will resume work. This ensures that you’re healthy enough and ready to perform job-related tasks. You will also know the level in which you can work, whether you need to shift to a different type of job, and whether you require modified hours or not. Generally speaking, these parties can help you make an appropriate decision about returning to work. Each employee’s case varies. Thus, it is important you check with these parties to determine a return-to-work strategy that best suits you.

You may go back to work when still recovering from an on-the-job injury or illness. However, it is the seriousness of your illness or injury that will determine this. Also, your doctor has to approve your return to work.

After sustaining a work-related illness or injury, you should consult your physician regarding how serious your case is. After the doctor examines you properly, he or she has to forward a report of your working ability and health to your claims administrator. Your physician will then determine whether or not you are able to resume your job.

If the doctor says you can go back to work while still recovering, he or she may set certain work restrictions and limitations to make sure your health is not endangered. These limitations are created after dialogue is held amongst you, your doctor, and your employer about the demands and physical duties of your work. We recommend that you present full facts of your work to your physician for them to accurately determine what to and what not to do during recovery. This is important as it helps protect your well-being.

In addition to this, your physician may need to make certain modifications or changes so that you may be able to resume work when still recovering. The changes could be done to your schedule, equipment to use, the tasks you get assigned to, and your working conditions. In the event that your employer doesn’t follow the limits and restrictions set out by your physician, you should not work. However, if the doctor does not set any restrictions and consents you to resume work, your employer may need you to perform as usual provided it is the very job you are going back to, and the pay is the same as before. Working modifications may include;

• Setting limits on how much weight you can handle or lift while working
• Being provided with neck support or rest for a neck or head injury
• Setting limits on how many hours you can work

All of these restrictions depend on the approval of your doctor. If for any reason your doctor believes you are unfit to go back to work, the workers’ compensation laws of California compel you not to work.

You may go back to work even if you haven’t fully healed. However, this is not based on if your employer will offer you a job that will sustain your condition or not.

For employees who sustained injuries in 2013 or later, in case of a permanent partial disability, your claims administrator has to send you a ‘Notice of Offer of Modified, Alternative or Regular Work.’ Should your employer offer you a job, he or she will be informed of your condition. Thus, your employer has to offer work that you can handle. The work should also;

• Meet any work limitations your doctor set out
• Last for a year at the minimum
• Be located in a place you can commute from your home

In addition, the work has to be either modified, regular or alternative. Modified work refers to your initial job, but the job limitations are set by your physician. The pay has to be at least 85 percent of the income and the compensation you got during the injury. Alternative work refers to a different job from your initial one which meets the job limitations set out by your physician. The job has to pay at the minimum 85 percent of the income and the compensation you received during the injury. Regular work, on the other hand, is the same work you were doing before the injury. It has to pay the same income and benefits you received during the injury.

In case your employer offers a job that follows all the above requirements, then you will have thirty days to agree to the offer. Moreover, if by the end of 30 days you did not have given an answer, your employer is at liberty to withdraw the offer. In addition, you may not be provided with supplementary job displacement benefits whether you accept the job offer or not. In case your employer offers you a job that does not meet the said requirements, you may receive a supplementary job displacement benefit voucher which will enable you to search for other employment. Note that this applies only to employees with a permanent partial disability.

As an employee in Orange County, CA, you should know that you are entitled to fair compensation once you sustain a work-related injury/illness. In addition, you are entitled to a proper plan to return back to your work. At The Workers Compensation Attorney Group, we have the objective of fighting for you to get the benefits you are entitled to receiving. If you have sustained a work-related injury, you should not worry about retaining your job or how to recover lost wages. Call our Orange County Workers Compensation Lawyer at 562-485-9694 and let us review your case.