How Workers' Compensation Payments Are Calculated for Injured Employees in California
If you have been injured on the job while working in the state of California and are currently exploring the benefits available to you through the California Division of Workers' Compensation (DWC), a division of the Department of Industrial Relations, you will have a lot of questions about what benefits you are entitled to receive and what steps you'll need to take in order to receive your benefits. This article addresses one of the most common questions that injured workers ask: What payments am I entitled to receive as a part of the California workers' compensation program?
Medical Treatment and Benefits
The first set of payments that you are entitled to receive is payment for your medical care. Under California law, the DWC provides that an injured worker will receive all medical treatment necessary to "cure or relieve" the effects of the injury, with no deductible or out-of-pocket cost to the employee. This includes doctor's bills, hospital bills, prescription medicines, and medical equipment, and up to 24 chiropractic sessions and 24 visits to a physical therapist for any rehabilitation necessary. Until your employer's insurance company accepts or denies your workers' comp claim, it is liable for paying up to $10,000 of your medical costs, even if it ultimately rejects the claim.
Calculating Payments for Lost Work Days
The second category of payments and reimbursement that you are entitled to receive under California worker’s compensation law is "temporary disability" payments, which are intended to replace some of the wages lost due to your inability to work during the time period that you are disabled. Your employer cannot force you to take vacation or sick time rather than collect temporary disability payments through the worker's comp system. You are eligible for temporary disability if you miss three days of work or more.
California provides for replacement of two-thirds of your average weekly wages during the time that you are considered temporarily disabled and not able to perform the necessary functions of your job. As part of your average weekly wage, overtime and income from a second job or business that you own can be included.
The average weekly wage is subject to a maximum of $986.69 per week (for 2010-2011). The state maximum weekly payment is adjusted annually, indexed to the state’s average weekly wage. However, for two years from the date of injury, you are locked into the maximum weekly payment in effect at the time of your injury. If you continue to receive temporary disability payments after two years, your rate will bump up to any higher rate in effect.
You can receive temporary disability payments even if you are working part time, if your doctor has limited your hours. There is a formula for determining your benefits if you are receive only temporary partial disability (TPD). (If you are off work completely, your payments are termed temporary total disability (TTD).) You are entitled to two-thirds of your weekly wage loss, which is calculated as the difference between your average weekly wage (up to the maximum weekly payment discussed above), and the weekly amount you are earning for part-time work. (California Labor Code Section 4657.)
Calculating Compensation for Permanent Disability
A third category of payments that are paid to injured workers under California law is permanent disability benefits. If you're determined to be permanently unable to return to the job that you had held prior to your injuries, or you have any impairment that remains (the doctor doesn't think you'll recover further in the next year), you are entitled to a weekly permanent disability benefit.
Your permanent disability benefit is significantly less than the temporary disability benefit. As with temporary disability payments, you are entitled to two-thirds of your average weekly wage, up to a maximum, but the weekly maximum is much lower for permanent disability payments. The maximum rates that apply to your injury depend on what percentage of permanent disability the doctor gives you. In 2011, the maximum is $230 per week for most injuries, or $270 per week for severe injuries. You will receive the weekly payment for permanent disability for anywhere from three to 99 weeks. The length of time depends on the percentage of your permanent disability.
If you settle your workers' comp claim so that all of your weekly permanent disability payments are rolled in to a lump sum, you can also ask for anticipated future medical payments, in case you’ll need surgery, prescription medicine, or doctors' visits.
Supplemental Job Displacement Benefit
If your employer doesn't offer you modified or alternative work, and you don't return to work for your employer within 60 days of being cut off temporary disability, you are eligible for the supplemental job displacement benefit, which used to be called vocational rehabilitation retraining. This benefit consists of a voucher for education-related training. Depending on your percentage of permanent disability, the voucher is worth from $4,000 to $10,000, and can be spent on tuition, books, and school fees.
If you are a surviving dependent (either a spouse, minor child, or parent) of an employee that died due to a work-related injury, you are entitled to a death benefit. The primary death benefit is a lump sum, ranging from $250,000 to $320,000. Minor children are also entitled to a weekly death benefit until they turn 18, to be divided among them. The weekly death benefit amount is the same amount as temporary disability weekly payment, subject to the same maximum of $986.69 per week (for 2010-2011).