What benefits is an injured worker entitled to after they suffer an injury at work?
Under California Workers Compensation Law, you are entitled to four different types of benefits:
Temporary Disability – If your injuries prevent you from performing your job duties while you recover such that you miss at least 3 days from work, you will be entitled to Temporary Disability benefits. Each year, California assigns a maximum benefit payable for this missed time from work depending on the year you were injured. In 2017, for instance, the maximum weekly allowance for temporary disability is $1,172.57. What this means is that if your average weekly earnings are $1,758.85 or less, you will be entitled to be paid temporary disability benefits equal to 2/3 of your average weekly salary. Consequently, if your average earnings are $1,000 per week and you miss time due to work injury, you will be entitled to payment of $666.67 every week while you are off of work. Because the maximum payment for 2017 is $1,172.57, if you earn more than $1,758.85 per week, your benefits will max out at 2/3 of that amount or $1,172.57.
The next question is why does the insurance company only pay 2/3 of your salary while you are off of work due to injury? That is because the general rule is that every employee pays approximately 1/3 of their salary for State and Federal taxes. Because temporary disability benefits are tax free, the purpose behind the reduction is to try to make sure that the injured worker received approximately what they would see in their standard paycheck once taxes are taken out.
Lastly, for injuries that occurred between 4/19/04 through 12/31/07, the maximum amount of time that temporary disability benefits have to be paid is 104 weeks (2 years) from the first payment of benefits. For injuries that occur from 1/1/08 to the present, temporary disability benefits are payable for up to 104 weeks over a 5 year period from the date of injury. What this means is that if you suffer an injury, for instance, on 1/1/15, the maximum that the insurance company/employer has to pay for temporary disability benefits is a total of 104 weeks up through 1/1/2020. This change in the law was to protect injured workers who return back to work following an injury only to have their condition worsen months or years later causing them to miss work again. While it is unfortunate that there is a 104 week cap on these payments, at least they can be paid over the course of 5 y\ears if the injury causes you to miss work over different periods of time as often happens when a worker returns back to work following an injury but then ends up missing time later due to a surgery.
Medical Benefits – Every injured worker is entitled to have all reasonable medical treatment to help cure their injury or otherwise to relieve the effects of the injury on the injured worker. This means that you should never have to pay out of your own pocket for any medical treatment you receive due to your work injury. Even your mileage expenses and parking going roundtrip to medical appointments are to be reimbursed to you. In serious injury cases where the injured worker in unable to care for him or herself, the insurance company/employer is obligated to provide home healthcare assistance, cleaning services and even make home modifications when reasonably required to help an injured worker deal with their injury. This means that you should never need to use your private insurance to pay for medical treatment and you should certainly never have to pay medical bills out of your own pocket.
Lastly, if your injuries will require treatment in the future, you will be entitled to a lifetime award of medical treatment for the work injury you suffered. This lifetime benefit cannot be taken away from you although oftentimes the insurance company will offer to pay a lump sum in advance to buy out this right. Only you have the power to choose whether or not to accept a buy out of future medical care. Oftentimes, when an injured worker knows that she or he is going to continue with private medical coverage through the employer or would otherwise prefer to obtain their own medical insurance, negotiating a buy out of future medical makes sense. If you have any doubt about what benefits you are entitled to receive, do not hesitate to contact Turchin Law for guidance.
Permanent Disability – Unfortunately, not every injury is 100% curable. Oftentimes, medical treatment only brings the injured worker part of the way back to the physical condition they were in before their injury. For instance, if a worker suffers a back injury that requires surgery, while the procedure may relieve some of the pain, the reality is that the back almost always end up permanently weakened in some respect. When an injury is significant enough that a full recovery cannot occur, the extent of that impairment is measured by the reporting physicians and results in a valuation that seeks to reimburse the injured worker for this permanent impairment. While it seems impossible to put a money value on a permanent injury, the California workers’ compensation system is designed to do exactly that. Hiring an attorney who understands these complicated issues and who is capable of communicating with your treating physicians to make sure that every aspect of your injuries is accounted for is extremely important to making sure you receive all of the benefits to which you are entitled.
In the unfortunate event that your injuries are so severe that you can no longer work, your attorney should be arguing that you are 100% totally disabled. In such cases, your entitlement to permanent disability is equivalent to payment at the temporary disability rate for the rest of your life. Depending on the injured worker’s age, the values of such payments can exceed millions of dollars over a worker’s lifetime.
Supplemental Job Displacement Voucher – For injuries that occur on or after 01/01/2004 which cause some permanent disability where the injured worker cannot return back to work within 60 days after temporary disability stops or is otherwise not timely offered their job old position from the employer, the injured worker may be entitled to receive a Supplemental Job Displacement Voucher (SJDB Voucher) which can be used to pay for school and/or equipment and supplies in a new line of work. For workers injured during the period between 1/1/2004 through 12/31/2012, with injuries that result in permanent disability who do not return to work for the employer within 60 days of the termination of temporary disability, may qualify for the SJDB Voucher. The benefit comes in the form of a non-transferable Voucher that can be used to pay for job retraining at state-approved or state-accredited schools. The Voucher covers school tuition, fees, books and expenses required by the school for training. No more than 10% of the value of the Voucher can be used for vocational & return to work counseling. The amount of the Voucher varies from $4,000 to $10,000, depending on the level of permanent disability.
Workers injured on or after 1/1/2013, with injuries that result in permanent disability, may also qualify for the SJDB Voucher. The offer must be made within 60 days after receipt by the claims administrator of the Physician’s advisement that you will not be able to return to your old occupation due to your injuries. The Voucher amount is $6000 for all levels of permanent disability and can be used for training at a California public school or any other provider listed on the state’s eligible training provider list. It can also be used to pay licensing fees, purchase tools required by a training course, purchase computer equipment of up to $1,000 and even $500 for miscellaneous expenses such as a new suit to attend job interviews. Up to 10% of the Voucher may be used to pay for the services of a licensed placement agency or vocational counselor.