How Workers’ Compensation Benefits are Calculated

The basis for calculating Workers’ Compensation benefits in California begins with a calculation of Average Weekly Wage (AWW.)  As a general rule, Average Weekly Wage is two-thirds of the gross (pre-tax) wages at the time of injury.

This is the basis for paying Total Temporary Disability benefits as well as Permanent Disability benefits. Payments are calculated with maximum and minimum amounts for the weekly payments. In 2016, the maximum TTD rate is $ 1,128.43. The minimum TTD rate is $169.26. The rates are subject to annual change. 

Wages are figured out by using all forms of income received from work: wages, food, lodging, tips, commissions, overtime and bonuses. Wages can also include earnings from work done at other jobs at the time of injury. It is important for the injured worker to gather proof of these earnings to provide them to the claims administrator. The claims administrator will consider all forms of income when calculating TTD benefits.

Also, there is a Labor Code Section that deals with persons who have unusual earnings. Labor Code Section 4553, states  “(4) Where the employment is for less than 30 hours per week, or where for any reason the foregoing methods of arriving at the average weekly earnings cannot reasonably and fairly be applied, the average weekly earnings shall be taken at 100 percent of the sum which reasonably represents the average weekly earning capacity of the injured employee at the time of his or her injury, due consideration being given to his or her actual earnings from all sources and employments.”   This section allows an injured worker to claim higher earnings. In most circumstances, to obtain a higher rate will require both good evidence and litigation.  The Workers’ Compensation Appeals Board has the power to assign a wage.

 

When does Total Temporary Disability Begin?

TTD payments begin when the injured workers’ treating doctor says that the injured worker can no longer do their usual work for more than three days or the injured worker gets hospitalized overnight. Payments must be made every two weeks. Generally, TTD stops when the injured worker returns to work, or when the doctor releases the injured worker to work, or says that the injury has improved as much as it’s going to and as a result is now Permanent and Stationary. It is important to know that benefits are only paid if the claim is accepted by the claims administrator. If the claim is not accepted, benefits will not be paid.

For those injured on or after Jan. 1, 2008 are eligible to receive 104 weeks of disability payments within a five-year period. The five-year period is counted from the date of injury. Payments for a few long-term injuries, such as severe burns or chronic lung disease, can go longer than 104 weeks. TD payments for these injuries can continue for up to 240 weeks of payment within a five-year period.

In certain circumstances, filing for State Disability may yield benefits during the TTD period. If the claim is denied, the claims administrator will not pay benefits, therefore filing for State Disability is indicated.  Further, if the injured worker is not receiving the maximum benefit, it is possible that additional benefits may be claimed from State Disability Insurance.  This would depend on the injured workers earnings that have been reported to State Disability.  A request for these benefits should be filed through the Employment Development Department.

In sum, an injured worker should file a claim with State Disability even if their workers’ compensation case is accepted. This will allow the injured worker to get SDI payments after the 104 weeks of TTD payments if you are still too sick or hurt to go back to work. To learn more call 1-800-480-3287 or visit their website at www.edd.ca.gov/disability.

At the Law Offices of Edward J. Singer, we specialize in helping our clients with their workers’ compensation claims. With more than 20 years of expertise in defending workers’ rights, we are here to assist with any questions a person in Southern or Central California who receives workers’ compensation may have. We welcome anyone who needs assistance to contact us today concerning any workers’ comp questions or issues.