A Santa Rosa workers’ compensation lawyer can evaluate work injuries to estimate the benefits that the injured worker should receive
The California workers’ compensation system pays a variety of benefits to injured workers. The benefits depend on the nature of the injury and its impact on the injured workers’ ability to work. Some benefits offered by workers’ compensation are easier to predict than others. After the full extent of the injury is known, a Santa Rosa workers’ comp attorney can evaluate an injured workers’ claim and provide some insight about the benefits he/she is likely to receive.
All employees who suffer a work-related injury are entitled to have their medical expenses paid by their employer or its insurance company. Once the employee reports the injury to the employer, the employee will usually be told where to obtain medical treatment at the employer’s expense.
Payment of medical expenses is not typically an issue early on in the process, unless an employer takes the position that an injury is not work related or that the treatment is not needed. In those cases, employees should ask a Santa Rosa workers’ compensation lawyer for advice.
Wage Replacement (Temporary Disability Benefits)
The workers’ compensation system replaces a portion of the wages an employee loses when she can’t work due to a work-related injury. The injured worker receives that compensation in the form of Total Temporary Disability (TTD) benefits.
Temporary disability benefits are paid after an injured worker misses three days of work, or is hospitalized overnight, for a work injury. The TTD benefits continue until the injured workers’ treating physician releases her to return to work or the physician determines that her injury has healed as much as it ever will.
Workers compensation insurance companies are only obligated to pay temporary disability benefits for a maximum of 104 weeks, even though an injured worker may be disabled for a longer period of time. Injured workers may then be eligible to receive State Disability Insurance (SDI) benefits. SDI benefits are paid by the state of California through its Employment Development Department (EDD).
In most cases, an injured worker will receive weekly TTD benefits amounting to two-thirds of the gross wages she was earning at the time of the injury. There are certain minimum and maximum weekly TTD benefits payable. For injuries occurring in 2017, the minimum weekly TTD benefit is $175.88 and the maximum weekly benefit is $1,172.57. These benefits are not taxable.
Calculating temporary disability benefits can be complicated. Generally they depend on the wages the employee earned and the year in which the injury occurred. Still, employees need to keep in mind that benefits are based on all wages earned, including overtime, commissions, tips, and bonuses. When an injured worker was working two jobs, wages paid by another employer can also be included in the calculation. Sometimes those factors lead to disputes about the amount of the benefit that should be paid.
Calculating benefits may also be difficult when an employee was seasonal, or was scheduled to receive a raise if the employee had continued working. Employees should seek advice from a workers’ compensation attorney in Santa Rosa if they need help calculating their entitlement to temporary disability benefits.
Permanent Disability Benefits
The most difficult benefits to estimate are those that are paid for a permanent disability. Unless it is immediately obvious that an injury will result in a permanent impairment, such as an amputated hand or the loss of an eye, the injured worker will not know whether an injury is permanent until the injury reaches its maximum stage of healing.
Injured workers who are fortunate and heal completely do not receive permanent disability benefits. They simply collect temporary disability benefits until they are able to return to work.
Permanent disability benefits are paid when the injured workers’ physician determines that the employee will never completely heal. The benefits depend on the degree of healing that takes place. For that reason, permanent disability benefits cannot usually be estimated at the time the injury occurs. Unless the full extent of the disability is immediately apparent, the injured worker will need to let nature (supplemented by medical treatment) take its course before determining the permanent disability benefits to which the employee is entitled.
Even after healing has reached a plateau, the injured worker may be dissatisfied with the settlement offer made by the insurance company. Benefits are based in part on a “permanent and stationery” report written by the treating physician. The employee may disagree with that report, or with the insurance company’s interpretation of it.
Benefits are also based on a “rating” which estimates the injured workers’ percentage of permanent disability. Ratings are also based on how much of the disability was caused by the work injury, as opposed to other factors.
Ratings are necessarily subjective, and insurance companies have a financial incentive to minimize the settlements they pay to injured workers. A Santa Rosa workers’ compensation lawyer will often be able to negotiate a better settlement than what the insurance company initially offers. Challenging the rating and the evidence upon which it is based can lead to a more favorable award of benefits to the injured worker.
Estimating Workers’ Comp Benefits
The payment of medical expenses and temporary disability benefits is easier to estimate than the amount of permanent disability benefits an injured worker might receive. An employer might deny that an injury occurred for instance, or that it is job-related. An employer might argue that the injury is less serious than what the injured worker believes it to be.
Injured workers stand the best chance of maximizing their benefits by working with an experienced workers’ compensation lawyer. The Santa Rosa law firm of Kneisler & Schondel has years of experience evaluating and settling workers’ compensation claims on behalf of injured workers. To schedule an evaluation of your claim, call us at (707) 542-5132 or tell us about your injury by using our online contact form.