Workers' Compensation Summary
Workers' Compensation In A Nutshell
Four Basic Workers’ Compensation Benefits:
Medical Treatment
- Medical Treatment is paid for by the w/c ins. co. subject to various limitations
- The w/c ins. co has the right to utilization review (UR)
- Independent medical review (IMR) is the only appeal process
Temporary Disability
- Temporary disability (TTD) is 2/3 of your before-tax average weekly earnings. For example, if your regular earnings are $600, TTD would be $400 per week
- For most cases, there is a 2-year (104 week) limit on total temporary disability (TTD)
- Regardless of the 104 weeks, TTD ends when you are declared permanent and stationary (P&S).
- P&S means that your condition has stabilized, that it is not expected to get any better or any worse in the immediate future. P&S does not affect your right to medical treatment.
Permanent Disability
- Permanent disability (PD) is addressed by an AME/PQME once your condition is P&S
- PD is a percentage (%) between 0 - 100% - 0% means that you recovered from your injury with no residuals or limitations. 100% means that you are in very, very bad way (ex. Paralyzed from the neck down). Almost all cases fall somewhere in between. (ex. 5%, 15%, 30% etc.)
- For each percentage of disability, there is a dollar value attached. The higher the percentage, the higher the dollar value. The dollar value for each percentage of PD is determined by the legislature.
- PD does not take into account loss of past or future earnings (How much you would have made had you not been injured?)
Voucher
- If your injuries prevent you from returning to work for the employer, you may be entitled to a voucher.
- For dates of injury before 1/1/2013, the voucher is $4,000-$10,000 depending on the PD percentage
- For injuries after 01/01/2013, the voucher is $6,000 (includes $500 misc./$1,000 computer)
- For injuries after 01/01/2013, $5,000 RTWSP from the State of California
Two Ways to Settle Your Workers’ Compensation Case
Stipulated Award
- You preserve two very important rights:
- Lifetime medical treatment for your injury
- Five years from the date of injury to reopen your case if it worsens
- You will receive your settlement in bi-weekly payments
- Your case settles for the dollar value of the percentage of disability.
Compromise and Release
- You give up any right to medical treatment
- You give up any right to reopen your case
- You will receive your settlement in lump sum
- Your case settles for the dollar value of the percentage of disability plus more money because you are giving up the right to future medical/right to reopen
(Ex. 10% PD for a 2015 injury = $8,772.50 but your case settles for $25,000 – the extra value is because you gave up medical treatment/right to reopen)
Attorney/Attorney Fees
- An attorney can be helpful because this is their job. Different people have different jobs for a reason. I don’t know how to work on my truck I take it to a mechanic. Same thing.
- Attorney fees are typically 12-15% of the PD or settlement.
- Attorney fees are contingent, if you get nothing the fee is nothing.
- Get an attorney before attending a PQME evaluation. I cannot stress this enough. If you pick a doctor to evaluate you without first consulting with an attorney it can really hurt your case.
Helpful Resources
- www.dir.ca.gov - Workers’ Comp Tab at top of page – Injured Worker from drop down menu
- Information and Assistance Officer– 250 Hemsted Drive, Suite B, Redding 96002 – (530) 225-2047
Thank You
The information provided herein may not apply to your particular facts or circumstances; therefore, you should seek legal counsel prior to relying on any information contained herein. Furthermore, information provided may not reflect the most recent developments in the law and may not be applicable in your particular jurisdiction. Therefore, you should not act on any of the information until you obtain legal counsel from a qualified individual in your jurisdiction.