Benefits: What am I entitled to?
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Under Workers’ Compensation, injured workers and their families may be entitled to a variety of benefits. These benefits include Medical Care, Temporary Disability Benefits, Permanent Disability Benefits, Vocational Rehabilitation, and Death Benefits.
An injured worker is entitled to have medical treatment related to their industrial injury to be paid for by their employer. Further, an injured worker is entitled to be paid for mileage incurred going to medical appointments, therapy and the pharmacy. The current rate for travel expense reimbursement is $.31 per mile.
Temporary Disability Benefits (TTD):
If an injured worker is unable to perform their work as a result of their injury, the worker is entitled to total temporary disability benefits when they are recovering from their injuries. Generally, the worker is entitled to receive 2/3rds of their salary up to a maximum of $490.00. Generally, temporary disability benefits are payable after 3 days of missing work or are hospitalized overnight. Payments must be made every two weeks for as long as the worker is eligible. If the worker is able to work part-time, the worker is entitled to Temporary Partial Disability. The amount of benefit the worker is entitled to depends upon how much the worker works during each particular week.
Maximum Weekly Temporary Disability Benefits: For injuries on or after 7/1/94, $406.00, per week, for injuries on or after 7/1/95, $448.00, for injuries on or after 7/1/96, $490.00.
Permanent Disability Benefits (PD):
Permanent disability benefits are benefits a worker receives if the worker’s injury has caused impairments or limitations which effects the worker's ability to work in the future. There are many ways upon which permanent disability is calculated. It can be based upon many factors including work restrictions, prophylactic work restrictions, subjective complaints, limitations of motion, limitation in grip strength, loss of body parts, and partial loss of body parts. These factors via the workers’ compensation system are translated into percentages of disability. These percentages are then adjusted based upon the age and occupation of the injured worker.
For example, an individual who is a furniture mover will receive a higher percentage of disability for a back injury than a secretary. Also, an older worker with the same disability as a younger worker will receive a greater percentage of disability than the younger worker.
Maximum Weekly Permanent Disability Benefits: for 0-14 3/4 % Disability, for injuries on or after 7/1/94, $140.00 per week, for 15-24 3/4, $148.00 per week, for 25-69 3/4 % $158.00 per week, for 70-99 3/4% $168.00 per week, for 100% 406.00.for 0-14 3/4 % Disability, for injuries on or after 7/1/95, $140.00 per week, for 15-24 3/4, $154.00 per week, for 25-69 3/4 % $164.00 per week, for 70-99 3/4% $198.00 per week, for 100% 448.00.; for injuries on or after 7/1/96, $140.00 per week, for 15-24 3/4, $160.00 per week, for 25-69 3/4 % $170.00 per week, for 70-99 3/4% $230.00 per week, for 100% 490.00.
Vocational Rehabilitation Benefits (VR):
If a worker is unable to return to their usual and customary occupation as a result of their industrial injury, the worker is entitled to vocational rehabilitation benefits. For injuries on or after 1/1/94, the employer has the first opportunity to offer the worker alternative or modified work. There are certain time deadlines for the employer to make such an offer. The offer must also meet certain conditions. These conditions include (a) that the worker is able to perform the essential job function of the job, (b) it is in a regular position that is available for a 12 month period, (c) the wages and compensation are within 15 percent of those paid to the employee at the time of the injury, and (d) the job is located within a reasonable commuting distance of the employee’s residence at the time of the injury. If the offer complies with all of the Labor Code requirements, if the offer is not accepted within the time deadlines specified, then the employer has no further obligation to provide vocational rehabilitation services.
If no position is available, the worker is entitled to receive vocational rehabilitation services outside of the employer. This may include training via a trade or technical school, placement with another company or self-employment. Also, attendance at one of the State Universities or Community Colleges is possible. Although there are some exceptions, for injuries on or after January 1, 1994, vocational rehabilitation benefits are capped at $16,000.00. The $16,000.00 is to pay for the school, maintenance allowance, up to a maximum of $246.00 per week, mileage expenses, school expenses, counselor costs and attorney’s fees, if indicated. Since benefits are most likely capped, it is very important that the worker act swiftly to decide on a program and complete it within the time deadlines indicated.
While participating in vocational rehabilitation, if it has been established that the worker has a percentage of permanent disability, the worker is also entitled to request that their vocational rehabilitation maintenance allowance be supplemented with permanent disability payments. If the worker wishes to receive them, the worker should contact their claims administrator.
Death Benefits:
In event of a death which is either caused or partially caused by a work injury, spouses, children and other dependents of the injured worker may be entitled to benefits. Reasonable burial expenses are also payable. For injuries after 1/1/91, the burial expenses are up to $5,000.00. The death benefits payable depend upon whether the dependents are considered total dependents or partial dependents. For injuries on or after 7/1/96, the amount of the benefits can range from $125,000.00 to $160,000.00. Further, minor children, after those benefits are paid out, are entitled to receive continued benefits payable at the total temporary disability rate until they reach the age of 18 years. No payment, however, shall be made at a weekly rate less than $224.00.
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