What Workers’ Compensation Benefits Are Available in California?

The California workers’ compensation system is intended to be a safety net for employees who suffer from work-related injuries. In theory, workers injured on the job simply need to fill out a claim form to begin collecting benefits.

There are five main categories of workers’ compensation benefits available in California:

1. Medical treatment
2. Temporary disability
3. Permanent disability
4. Supplemental job displacement benefits
5. Death benefits for surviving dependents

In this FAQ, we’ll cover each of these categories in detail.

1. Medical Treatment

Workers’ comp pays for any reasonable medical care needed to fully heal or provide relief from your on-the-job injuries. There’s no time limit on this benefit—as long as your treatment is still medically necessary, workers’ compensation will cover it. Workers’ compensation insurance will even reimburse you for transportation costs to and from doctor’s appointments or to pick up medications.

If you need emergency care after an injury, don’t hesitate to go to the emergency room and be treated. You can file your compensation claim and other paperwork afterward.

But once you’ve reported an injury to your employer, there are a few rules you must follow:

• If your employer has a medical provider network (MPN), you need to see a doctor within the network. An MPN has physicians from many different medical specialties, so you should be able to find one who can help you.
• If your employer does not have an MPN, they can specify which doctor you should see in the first 30 days after you report an injury. After 30 days, you can choose your own doctor.
• All treatment must conform to a set of published guidelines called the medical treatment utilization schedule (MTUS).
  • First, your doctor recommends a course of treatment.
  • Your employer (or their insurance company) completes a utilization review (UR). In a UR, your doctor’s recommendations are examined and compared to the MTUS and either approved or rejected.
  • If the recommendations are approved, you can proceed with the treatment, and your workers’ compensation benefits will cover the cost.

2. Temporary Disability

You might not be able to work while recovering from a workplace injury. Temporary disability benefits don’t cover all your lost wages, though. Instead, they cover two-thirds of your average weekly wages before taxes are withheld, with a set maximum and minimum amount.

To receive temporary disability payments, your doctor must agree that you need to miss three or more days of work or stay in the hospital overnight because of your injuries. You’ll receive a payment every two weeks until one of the following occurs:

• You reach the maximum benefit of 104 weeks
• Your doctor says
  • You can return to work, or
  • You’ve reached maximum medical improvement (MMI), meaning your injuries have healed as much as they can

3. Permanent Disability

Once you reach MMI, it may be clear that your injuries have long-lasting impacts that affect your ability to work. In this case, you are most likely eligible to receive permanent disability benefits.

Permanent disability benefits are payments that compensate you for your losses due to a reduced ability or complete inability to work—referred to as partial or total permanent disability, respectively.

Determining your benefit amount begins with a doctor’s examination. The doctor determines how impaired you are, expressed as a percentage: 0% means not impaired at all, and 100% means completely disabled.

Your permanent disability benefits are then calculated using a formula that considers your age, occupation, weekly earnings at the time of your injuries, and other factors.

• If you have a permanent total disability, you’ll receive payments every two weeks for the rest of your life.
• If you have a permanent partial disability, you’ll receive biweekly payments over a set period of time that varies depending on the details of your case.

4. Supplemental Job Displacement Benefits

If you have a permanent partial disability, you may be unable to return to your previous job. Once your employer has been notified of your disability, they have 60 days to offer you alternative work that you can do in your present condition. But not every employer has suitable work available.

That’s where supplemental job displacement benefits come in. Under the California workers’ compensation system, you may be eligible for a non-transferable voucher that can help pay for your transition into another line of work. You can use the voucher to pay for the following:

• Training at California public schools or institutions on the state’s approved provider list
• Testing or certification fees
• Licensing fees
• Computers (up to a set amount)
• Vocational counseling (up to a set amount)

5. Death Benefits

Death benefits are payments to the spouse and dependents of a worker killed in a workplace accident or who dies because of a work-related illness.

Death benefits include:

• Up to $10,000 for funeral and burial expenses
• Weekly payments at the temporary disability rate the deceased worker qualifies for

Bakersfield Workers’ Compensation Attorneys

Sometimes, workers’ comp claims proceed exactly as planned, with minimal hassle. To get workers’ compensation benefits, you fill out a claim form, and the system kicks in with the benefits you need. Too often, however, injured workers are overloaded with regulations, paperwork, deadlines, and delays—the last thing they need as they’re trying to heal.

You may disagree with the insurance company, your employer, or even your doctor about your treatment and benefits. In each case, there are specific ways to appeal, but they all have their own rules and filing requirements.

Because the workers’ comp system is so complex, a lawyer’s help is invaluable. The experienced workers’ compensation lawyers at Chain | Cohn | Clark can guide you through the maze of the California workers’ compensation bureaucracy, making the process as painless as possible and fighting for you to get the benefits you deserve.

Contact us today for a free, no-obligation consultation.