Frequently Asked Questions.
Here are some common questions about Worker’s Compensation
What is Workers Compensation?
If you have a work-related injury or illness, your employer is required by law to pay for workers’ compensation benefits. You could get hurt by:
One event at work, such as hurting your back in a fall, getting burned by a chemical that splashes on your skin or getting hurt in a car accident while making deliveries.
Repeated exposures at work, such as hurting your wrist from doing the same motion over and over or losing your hearing because of constant loud noise.
What should I do if I have a job injury?
Report the injury to your employer by telling your supervisor right away. If your injury or illness developed over time, report it as soon as you learn or believe it was caused by your job.
Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need. If your employer does not learn about your injury within 30 days and this prevents your employer from fully investigating the injury and how you were injured, you could lose your right to receive workers’ compensation benefits.
Get emergency treatment if you need it. Your employer may tell you where to go for treatment. Tell the health care provider who treats you that your injury or illness is job-related.
Fill out a claim form and give it to your employer. Your employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn’t give you the claim form you can download it from the forms page of the DWC website
Do I need to fill out the claim form (DWC 1) my employer gave me?
Yes. Giving the completed form to your employer opens your workers’ compensation case. It starts the process for finding all benefits you may qualify for under state law. Those benefits include, but are not limited to:
A presumption that your injury or illness was caused by work if your claim is not accepted or denied within 90 days of giving the completed claim form to your employer
Up to $10,000 in treatment under medical treatment guidelines while the claims administrator considers your claim
An increase in your disability payments if they’re late
A way to resolve any disagreements between you and the claims administrator over whether your injury or illness happened on the job, the medical treatment you receive and whether you will receive permanent disability benefits.
What benefits am I entitled to?
Workers’ comp insurance provides five basic benefits:
- Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
- Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering
- Permanent disability benefits: Payments if you don’t recover completely
- Supplemental job displacement benefits (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer
- Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.
Can my employer take part of my check to pay for workers’ compensation insurance?
What kind of medical care will I receive for my injury?
Doctors in California’s workers’ compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body regions guidelines adopted from the American College of Occupational and Environmental Medicine’s (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain and therapy after surgery. The DWC has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
Do these guidelines apply if my case is already settled?
They may. Treatment guidelines are considered correct even in cases that settled before the guidelines were added to workers’ compensation law in 2003. Your claims administrator may continue to pay for medical care you’re accustomed to for your injury. If you have a question about whether you should still be receiving a certain kind of medical treatment and you can’t work it out with your claims administrator, call your local information & assistance officer for guidance.
If your medical treatment has been denied you can request an expedited hearing before a workers’ compensation administrative law judge to get the situation resolved. Contact the Jeffery M. Klein for a free consultation today for help.
The claims administrator hasn’t accepted or denied my claim yet, but I need medical care for my injury now. What can I do?
The claims administrator is required to authorize medical treatment within one working day after you file a claim form with your employer, even while your claim is being investigated. The total cost of the treatment provided while your claim is being investigated is limited to $10,000. If the claims administrator does not authorize treatment right away, speak with your supervisor, someone else in management or the claims administrator about the law requiring immediate medical treatment. Ask for treatment to be authorized now, while waiting for a decision on your claim. This should be a good sign that you may need to speak to an attorney like Jeffery Klein to deal with your employer and handle any kind of medical care that is needed for you to get back to normal.
What are temporary disability benefits?
Temporary disability (TD) benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering. See the DWC fact sheet on TD for more information.
How much will I receive in TD payments?
As a general rule, TD pays two-thirds of the gross (pre-tax) wages you lose while you are recovering from a job injury. However, you cannot receive more than the maximum weekly amount set by law. Your wages are figured out by using all forms of income you receive from work: wages, food, lodging, tips, commissions, overtime and bonuses. Wages can also include earnings from work you did at other jobs at the time you were injured. Give proof of these earnings to the claims administrator. The claims administrator will consider all forms of income when calculating your TD benefits. Please see the benefits chart for current benefit rates.
The minimum and maximum rates are adjusted annually.
I really just want to get back to work. How can I make that happen?
Injured workers who return to the job as soon as medically possible have the best outcomes. They recover from their injuries faster and suffer less wage loss. Your decision about returning to work will be influenced by your doctor, your employer and the claims administrator. Communicate honestly and frequently with them for the best results.
If your doctor decides you cannot return to work while recovering from your injuries you cannot be required to go back to your job.
Sometimes you can go back to your job with work restrictions if your employer is willing and able to make accommodations. For example, your employer may change certain parts of your job or provide you with new equipment.
If your doctor says you can go back to work with restrictions but your employer is unwilling or unable to accommodate your injuries, you are not required to return to work.
Meanwhile, depending on your injuries, you may be eligible for TD, supplemental job displacement benefits or PD benefits.
What if my employer offers me work?
If the claims administrator’s letter says your employer is offering you work, the job must meet the work restrictions in the doctor’s report. The offer could involve:
Regular work: Your old job, for a period of at least 12 months, paying the same wages and benefits as paid at the time of an injury and located within a reasonable commuting distance of where you lived at the time of your injury
Modified work: Your old job, with some changes that allow you do to it. If your doctor says you will not be able to return to the job you had at the time of injury, your employer is encouraged to offer you modified work instead of supplemental job displacement benefits (SJDB). The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured and be within a reasonable commuting distance of where you lived at the time of injury
Alternative work: A new job with your employer. If your doctor says you will not be able to return to the job you had at the time of injury, your employer is encouraged to offer you alternative work instead of SJDB. The alternative work must meet your work restrictions, last at least 12 months, pay at least 85 percent of the wages and benefits you were paid at the time you were injured, and be within a reasonable commuting distance of where you lived at the time of injury.
If your employer offers you modified or alternative work:
You may have only 30 days to accept the offer. If you don’t respond within 30 days, your employer could withdraw the offer
If you fail to respond to the offer of modified or alternative work within 30 days or reject the job offer, you will probably not be entitled to supplemental job displacement benefits.
The workers’ comp system seems very confusing. Should I get an attorney?
The Worker’s Compensation system is very confusing and is difficult to navigate on your own. While it is possible to do this on your own, one of the main issues many people run into is their employer not paying out enough for their injury. Many injuries require long term care and this should be covered by a company’s workers’ compensation insurance. The insurance companies have lawyers for a reason. They want you to get the minimum benefits for you claim and don’t care about your needs.
Jeffery Klein is a professional Lawyer and deals with these types of cases on a daily basis. He will send you to a trusted doctor that will give you an honest evaluation and will give you the time off and care that is required to return to work. Jeffery Klein will deal with the insurance company so you can focus on resting and eventually returning to work. Jeffery Klein will give you the maximum payout for your claim and not leave you with the bills that are often overlooked with other attorneys. If you feel you may have a claim or have any questions for your workers’ compensation case, call us today for your free consultation today!