California Worker's Compensation - Help For Injured California Workers

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  1. #1
    Join Date
    Jul 2008
    Posts
    141

    Default Maximum Worker's Comp Benefits

    Hello,

    Can someone tell me the current CA law for workers compensation benefits:
    weekly $ and length of time when benefits are payable?

    Thank you and regards,

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,017

    Default Re: WC and Max Benefits

    Depends on your DOI...

    4650. (a) If an injury causes temporary disability, the first
    payment of temporary disability indemnity shall be made not later
    than 14 days after knowledge of the injury and disability, on which
    date all indemnity then due shall be paid, unless liability for the
    injury is earlier denied.
    (b) If the injury causes permanent disability, the first payment
    shall be made within 14 days after the date of last payment of
    temporary disability indemnity. When the last payment of temporary
    disability indemnity has been made pursuant to subdivision (c) of
    Section 4656, and regardless of whether the extent of permanent
    disability can be determined at that date, the employer nevertheless
    shall commence the timely payment required by this subdivision and
    shall continue to make these payments until the employer's reasonable
    estimate of permanent disability indemnity due has been paid, and if
    the amount of permanent disability indemnity due has been
    determined, until that amount has been paid.
    4653. If the injury causes temporary total disability, the
    disability payment is two-thirds of the average weekly earnings
    during the period of such disability, consideration being given to
    the ability of the injured employee to compete in an open labor
    market.
    4656 (c) (1) Aggregate disability payments for a single injury
    occurring on or after April 19, 2004, causing temporary disability
    shall not extend for more than 104 compensable weeks within a period
    of two years from the date of commencement of temporary disability
    payment.
    (2) Aggregate disability payments for a single injury occurring on
    or after January 1, 2008, causing temporary disability shall not
    extend for more than 104 compensable weeks within a period of five
    years from the date of injury.
    The TTD cap is 104/wks, paid within 2 years or 5 years from the date of your first receipt of payment of the benefit.
    Your AWW must support the TTD rate...66.6666% of your AWW at the time of injury...now it's around $890/wk. (last I saw..could be a little higher due to COLA)

    If you're looking for the PDA rate, the rate is capped at $260/week, and the number of weeks is based on your PD/WPI rating..
    You could be subject to the 15% +/- in PD as defined in section 4658.2.


    Information on TTD/TPD/PD indemnity can be found in the labor code here...http://www.leginfo.ca.gov/cgi-bin/di...file=4650-4664, or the DWC fact sheets for IW's...http://www.dir.ca.gov/dwc/iwguides.html

  3. #3
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: WC and Max Benefits

    basic info from the factsheets are here
    http://www.dir.ca.gov/dwc/iwguides.html
    links to other information start here
    http://www.dir.ca.gov/dwc/InjuredWorker.htm
    there is no single pay rate; they vary depending on the type of benefit, wages, date of injury etc.
    for specific information on your situation contact an Information & Assistance Officer
    http://www.dir.ca.gov/dwc/IandA.html

  4. #4
    Join Date
    Jul 2008
    Posts
    141

    Default Re: WC and Max Benefits

    Is there some difference in WC benefits for wages versus a disability payment after MMI? I am so confused. I have not been out of work yet, but will lose time when surgery takes place. I am concerned on how this will impact my financial obligations. Are WC wage benefits prorated based on % of injury attributed to the WC injury, and if so... then does private (company) long-term disability insurance pickup any of the lost wages?

    Regards,

  5. #5
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: WC and Max Benefits

    InPain, as BvIA has pointed out, due to SB888, the length of time you can receive TTD benefits depends on your ORIGINAL DATE OF INJURY.

    So, here is an explanation of the LC, and how it might apply to you:

    LC 4656 (c) (1) Aggregate disability payments for a single injury
    occurring on or after April 19, 2004, causing temporary disability
    shall not extend for more than 104 compensable weeks within a period
    of two years from the date of commencement of temporary disability
    payment.


    Now, under THIS section of the LC, if you were injured PRIOR to April 19, 2004, then this does NOT apply to you, and you basically have NO CAP on your TTS benefits.

    HOWEVER, if your injury IS after April 19, 2004, your TTD IS CAPPED at 104 weeks, BUT, due to recent case law, the date that the 104 week cap STARTS to run, is now the FIRST DATE THAT YOU ACTUALLY RECEIVED YOUR TTD benefits check, even IF it INCLUDES periods of RETRO-TTD!

    So, depending on WHEN you FIRST received your TTD, this is the DATE that you start to apply the 104 weeks. Unfortunately, you can NOT "break up" periods of the aggregrate TTD. In other words, once that date starts to rum, even IF you are TTD for ONE WEEK, then P&S, then find out you need a surgery at week number 103, you are SCREWED...you only have ONE WEEK LEFT of TTD, and no matter WHAT your status is, the IC/CA will start advancing your estimated PD, which is udsually based on the P&S report from "way back when", until you ARE deemed P&S following surgery....

    Regarding apportionment, even if you have a PRE-EXISTING, or PRIOR "Non-Industrial" injury to the same body part that you are NOW claiming as a INDUSTRIAL injury, the IC/CA can NOT APPORTION TREATMENT COSTS. For example, they can't say that they are only going to pay 50% of the treatment cost, and YOU are going to be on the hook for the OTHER 50%. The IC/CA must pay ALL THE COSTS OF TREATMENT, regardless.

    IF, however, the IC/CA has DENIED TREATMENT that has been recommended by your PTP for you industrial condition, since the DENIED treatment is NOT being paid for by the IC/CA, THEN you are permitted to have the denied treatment covered by your private or group health insurance...most times, there isn't a problem with this, but it DEPENDS on the INDIVIDUAL health insurer.

    At some point AFTER you have "self-procured" treatment through private insurance , and it is THEN SUBSEQUENTLY DETERMINED that the IC is LIABLE for your previously denied treatment, you/the prvate insurance can be REIMBURSED, PROVIDED that the treatment was "REASONABLY necessary medical treatment to cure or relieve the effects of the industrial injury".

    Since treatment for WC injuries is determined by ACOEM Treatment Guidelines, if your self-procured treatment is PURSUANT to ACOEM, "Evidence Based Medicine" and Scientific Literature/Evidence that SUPPORTS the NEED for YOUR paricular injury/condition, then you will likely be entitled to reimbursement. Usually, the issue of reimbursement will go to a Hearing, and the "REASONABLY necessary medical treatment" issues will be determined by the WC Judge, based on the evidence, medical records, and perhaps the depositions of the PTP and AME/QME, if they were obtained....

    Once you are FINALLY deemed P&S/MMI, then THAT is when your residual impairment/PD will be RATED. And, THIS is where APPORTIONMENT will come in.

    The ER is ONLY LIABLE for the percentage of PD that is ACTUALLY CAUSED by , and ATTRIBUTED to the INDUSTRIAL INJURY.

    Here are the California Labor Codes that applies to APPORTIONMENT:

    4663. (a) Apportionment of permanent disability shall be based on
    causation.

    (b) Any physician who prepares a report addressing the issue of
    permanent disability due to a claimed industrial injury shall in that
    report address the issue of causation of the permanent disability.
    (c) In order for a physician's report to be considered complete on
    the issue of permanent disability, the report must include an
    apportionment determination. A physician shall make an apportionment
    determination by finding what approximate percentage of the permanent
    disability was caused by the direct result of injury arising out of
    and occurring in the course of employment and what approximate
    percentage of the permanent disability was caused by other factors
    both before and subsequent to the industrial injury, including prior
    industrial injuries.
    If the physician is unable to include an
    apportionment determination in his or her report, the physician shall
    state the specific reasons why the physician could not make a
    determination of the effect of that prior condition on the permanent
    disability arising from the injury. The physician shall then consult
    with other physicians or refer the employee to another physician from
    whom the employee is authorized to seek treatment or evaluation in
    accordance with this division in order to make the final
    determination.

    4664. (a) The employer shall only be liable for the percentage of
    permanent disability directly caused by the injury arising out of and
    occurring in the course of employment.

    (b) If the applicant has received a prior award of permanent
    disability, it shall be conclusively presumed that the prior
    permanent disability exists at the time of any subsequent industrial
    injury.
    This presumption is a presumption affecting the burden of
    proof.

    (c) (1) The accumulation of all permanent disability awards issued
    with respect to any one region of the body in favor of one
    individual employee shall not exceed 100 percent over the employee's
    lifetime
    unless the employee's injury or illness is conclusively
    presumed to be total in character pursuant to Section 4662.
    As used
    in this section, the regions of the body are the following:
    (A) Hearing.
    (B) Vision.
    (C) Mental and behavioral disorders.
    (D) The spine.
    (E) The upper extremities, including the shoulders.
    (F) The lower extremities, including the hip joints.
    (G) The head, face, cardiovascular system, respiratory system, and
    all other systems or regions of the body not listed in subparagraphs
    (A) to (F), inclusive.
    (2) Nothing in this section shall be construed to permit the
    permanent disability rating for each individual injury sustained by
    an employee arising from the same industrial accident, when added
    together, from exceeding 100 percent.



    So, in a nutshell, because of SB899, APPORTIONMENT CAN be applied, REGARDLESS of your DATE OF INJURY.

    And, if you have ANY pre-existing conditions, or "other factors" that are contributing to your PD, including PRIOR WC AWARDS for ANY INJURIES that are CONTRIBUTING TO your CURRENT RESIDUAL IMPAIRMENT/PD, the IC/CA is entitled to DEDUCT THE PERCENTAGE that an Evaluator/PTP has determined to be responsible for CONTRIBUTING TO and/or CAUSING your CURRENT PD as a result of your INDUSTRIAL injury.

    A LOT more needs to be discussed regarding apportionment, and HOW to attack apportionment, but that can be addressed later....

    I hope this information helps you understand what is, and what may occur in the future, regarding your case, InPain!

    Keep us posted!

    Charlie
    Last edited by Charles Stevens; 10-01-2008 at 03:15 PM.

  6. #6
    Join Date
    Oct 2006
    Posts
    9,108

    Default Re: WC and Max Benefits

    yes. Permanent Disability payments have a lower maximum rate.
    when/if you have surgery you will be temporarily disabled again.
    If the surgery occurs within 5 yrs of your date of injury you can petition the comp court to order the payment of temporary disability benefits.
    Wage benefits or Temporary Disability payments are not "prorated" or "apportioned" like permanent disability.
    Many private disability insurance have policies that pay in addition to work comp or benefits; it depends on the particular policy conditions.

  7. #7
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: WC and Max Benefits

    ADDENDUM: InPain, I see from a different post that your WC laim also involves third-party liability sue to a MVA....so, apportiornment as it pertins to the MVA injury,will also be taken into consideration.

    HOWEVER, because of your third-party claim against the person(s) involved in the MVA, although WC is entitled for reimbursement, under the third-party claim, you can be compensated for your "losses", that you would OTHERWISE NOT BE COMPENSATED FOR UNDER WC, like the DIFFERENCE between your TTD/TPD benefits and your ACTUAL weekly salary, PAIN AND SUFFERING, loss of consortium, FUTURE wage loss and OTHER forms of "compensation" from your ER, etc.

    As it appears that you are currently UNREPPED, then I would STRONGLY advise you to consult with SEVERAL EXPERIENCED WC Attorneys, and EXPERIENCED Personal Injury Attorneys, who have the knowledge and expertise necessary in litigating third-party claims such as yours....

    Good Luck, and keep us posted!

    Charlie

  8. #8
    Join Date
    Dec 2006
    Posts
    2,165

    Default Re: WC and Max Benefits

    InPain, once you have been declared P&S/MMI after your surgery, and you will start receiving your PD advances, there IS the potential that your PD benefits can either be INCREASED by 15% or DECREASED by 15%, depending on a few factors:

    You should have receive a "NOTICE THAT TTD IS TERMINATED" by your IC/CA, and what your RIGHTS are if you DISAGREE with your PTP's P&S report. Unless the IC/CA has disputed what your PTP has stated about your P&S and your factors of PD for rating purposes, then regardless, you should recive your PD advances WITHIN 14 DAYS of the date you were deemed P&S.

    Then, if your Employer has 50 or more employees,your Employer is REQUIRED to make you an "offer of modified work", WITHIN 60 DAYS of you being declared P&S, which you can either accept or deny, but it is YOUR best interests to ACCEPT the offer.

    However IF the Employer's offer of modified to work does NOT conform with your doctor's work restrictions, or otherwise is not a LEGITIMATE ("bonafide") offer, then you have every right to DENY the legally deficient "offer of modified work".

    Here is what the California Labor Code says about you and YOUR EMPLOYER'S REQUIREMENTS, once you have been deemed P&S:

    LC 4658 (2) [I]If, within 60 days of a disability becoming permanent and stationary, an employer does not offer the injured employee regular
    work, modified work, or alternative work,
    in the form and manner
    prescribed by the administrative director, for a period of at least
    12 months,
    each disability payment remaining to be paid to the
    injured employee from the date of the end of the 60-day period shall
    be paid in accordance with paragraph (1) and increased by 15 percent[/I].This paragraph shall not apply to an employer that employs fewer than 50 employees.

    (3) (A) If, within 60 days of a disability becoming permanent and stationary, an employer offers the injured employee regular work,modified work, or alternative work, in the form and manner prescribed by the administrative director, for a period of at least 12 months, [I]and regardless of whether the injured employee accepts or rejects the offer,[/I] each disability payment remaining to be paid to the injured employee from the date the offer was made shall be paid in accordance with paragraph (1) and decreased by 15 percent.

    (B) If the regular work, modified work, or alternative work is
    terminated by the employer before the end of the period for which
    disability payments are due the injured employee
    , the amount of each
    of the remaining disability payments shall be paid in accordance with
    paragraph (1) and increased by 15 percent.
    [U]An employee who voluntarily terminates employment shall not be eligible for payment under this subparagraph. [/U]This paragraph shall not apply to an employer that employs fewer than 50 employees.

    Once you ARE deemed P&S/MMI, it is CRITICAL that you SAVE EVERY NOTICE and the ENVELOPE with the post-marked date of it, that you receive from your IC/CA, and do the SAME THING for ANY LETTERS you may receive from the EMPLOYER.

    If you DO have tlephone converstations with your Employer, be SURE TO DOCUMENT DOCUMENT, and folow-up with a "letter of understanding" to your ER, that basically contains your understanding of the substance of the conversation,whart the ER said, offered you re modified work, and so forth.

    Again, I hope this helps you understand the procedures a little bit more, and how your PD will be affected, depending on what your ER does, or does NOT do!

    As always, keep us posted!

    Charlie

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