California workers compensation system and it’s laws provide benefits to employees who are injured at work

workers compensation explainedThe California Constitution at Article 2 Section 4, authorizes the state legislature to create “a complete system of workers’ compensation” that makes “adequate provisions for the comfort, health and safety and general welfare of any and all workers” because of “any injury or death incurred or sustained by workers in the course of their employment, irrespective of the fault of any party…”

The California workers compensation system in 1937. The system has been “reformed” from time to time, most recently in 2013. Here are answers to questions that Santa Rosa workers’ compensation lawyers often hear about California’s workers’ compensation laws.

What Is Workers’ Compensation?

Workers’ compensation is often referred to as the grand bargain between employees and employers. Like all bargains, the workers’ compensation bargain was intended to give something of value to both sides.

Employers wanted to avoid the cost and unpredictable outcomes of civil lawsuits brought by injured workers. The workers’ compensation system was intended to be a benefits delivery system which would efficiently and quickly resolve claims arising out of workplace accidents, and determine compensation according to schedules that were established by state government.

Injured workers wanted security. They wanted to know that they would not become impoverished if they were injured at work, and that they would not put their jobs at risk by applying for workers’ compensation benefits. The workers’ compensation system guarantees that all injured workers will receive benefits if they are unable to work due to a work-related injury, even if the injury was not the employer’s fault. California workers’ compensation law also requires employers to make attempts to return employees to work after an injury under some circumstances, and prohibits retaliation against an injured worker for filing a workers’ compensation claim.

What Benefits Does Workers’ Compensation Provide?

Under California law, the primary workers’ compensation benefits are:

  • Medical treatment necessary for work injuries
  • Temporary disability benefits
  • Permanent disability benefits
  • Death benefits
  • Supplemental job displacement benefits

These benefits are available for any work-related injury or illnesses.

What Medical Treatment Can I Receive for a Work Injury?

California workers’ compensation law requires employers to provide all treatment that is reasonably required to cure an injury and to relieve the symptoms of the injury. Necessary treatment may include hospitalization, surgery, outpatient medical treatment, chiropractic care, or acupuncture. It may also include prescription drugs, crutches, and other medical devices (such as prosthetic and orthotic devices).

Most workers’ compensation insurance companies provide medical care through medical provider networks (MPN) they create. MPN’s are a network of medical providers who are preauthorized to provide medical care to injured workers. Employers are required to notify employees of the steps they must take to receive medical treatment for work-related injuries.

What Happens If the Insurance Company Will Not Authorize My Treatment?

Treating physicians make treatment recommendations for the injured workers they treat. If those recommendations are consistent with standard treatments which are described in the “medical treatment utilization schedule” (MTUS) adopted by the Division of Workers’ Compensation, then workers’ compensation insurance companies will generally approve them.

Insurance companies will generally authorize recommended treatment unless one of their reviewing physicians determines that the treatment request is outside of the MTUS guidelines. If treatment is denied, the injured worker has a right to appeal the denial through a system called Independent Medical Review. This second medical review also attempts to determine whether the recommended treatment is within the MTUS guidelines and, if it is not, whether it is nevertheless required to cure the injured worker’s condition or to relieve the symptoms.

What Are Temporary Disability Benefits?

Temporary disability benefits are a form of income replacement that an injured worker receives during the time that he is recovering from an injury and unable to work. Total temporary disability benefits are due when the injured worker cannot work as a consequence of the injury. Temporary partial disability benefits, or wage loss benefits, are due if functional limitations caused by the injury prevent the injured worker from earning the same wages she earned prior to the injury.

Temporary total disability benefits are two-thirds of the injured worker’s wages at the time of the injury, subject to a minimum and maximum weekly payment. Temporary partial disability benefits are two-thirds of the difference between the employee’s earnings prior to the injury and the wages the employee is capable of earning after the injury.

What Are Permanent Disability Benefits?

Permanent disability benefits are awarded to injured workers who suffer Permanent functional impairment as a result of a work-related injury. Permanent disability is calculated based on the severity of the impairment as well as the age, occupation, and earnings of the injured worker.

Who Decides Whether or not I Have a Permanent Disability?

Initially, your treating physician will determine whether your injury will continue to improve or not. If your medical condition will not improve any more, the law allows you to ask for a Qualified Medical Evaluation (QME) to be performed by a doctor who is certified to evaluate permanent disabilities.

In addition to evaluating your impairment, the QME must decide how much of your permanent disability was caused directly by your work injury.

Who Decides What Benefits I Should Receive for a Permanent Disability?

If you or your attorney cannot come to an agreement with the workers’ compensation claims administrator, the evidence is presented to a workers’ compensation judge. The judge then decides whether a permanent impairment exists, whether (and to what extent) it is work-related, and how the impairment should be “rated” for the purpose of determining permanent disability benefits.

Your attorney and the claims administrator will have their own opinions about the appropriate rating. In most cases, they will negotiate a settlement of the claim, rather than leaving your fate in the hands of a workers’ compensation judge. Your Santa Rosa workers’ compensation lawyer can advise you whether it would be better to settle your case or to take your case to a hearing with a judge.

Do I Get Permanent Disability Benefits in a Lump Sum?

A settlement may provide for payment of permanent disability benefits in a lump sum. Injured workers often find it preferable to receive these benefits all at once. However, with this arrangement, the injured worker must give up their right to have the employer provide future medical treatment in exchange for a lump sum settlement. Claims administrators are often willing to provide a higher value settlement in order to induce employees to be responsible for their future medical care costs.

Whether it makes sense to accept a lump sum settlement or to negotiate a settlement that provides for future medical care depends on the facts of the case. A Santa Rosa workers’ compensation lawyer can help employees make the right decision.

Getting Help with Workers Compensation

How California workers’ compensation laws may apply to a work-related injury depends on the facts of the case. To get advice in Santa Rosa about receiving workers’ compensation benefits for a work-related injury, call Kneisler & Schondel at (707) 542-5132. You can also ask us a question by submitting our online contact form.