Workers’ compensation is a system set up by the State of California to compensate workers when they have been hurt on the job. If you are injured while working or become ill because of your employment, your employer is required by law to pay workers’ compensation benefits to you.
There are two types of injuries that can occur in the work environment. The first type of injury is a specific injury. This may occur when the employee is engaged in either apprehension and detention, or physical methods of arrest, or involved in fire suppression activity, and lifting, pushing and pulling. A specific injury is an event that occurs at a particular time and place. It could be akin to lifting an item and your back is injured.
The next type of injury is a cumulative trauma or continuous injury which evolves over a period of time. It is not necessarily one event, but a combination of many exposures throughout the career. This is similar to bending a paperclip, you bend it and bend it and eventually it breaks. It is not one bend but a combination of bends.
Repeated exposures at work such as damage to your hearing from continuous loud exposure, hurting your hands, back, neck from doing the same or similar motions over a period of time, exposure to toxic or carcinogen chemicals, or exposures to stress-related events at work. Workers’ Compensation may cover some stress-related injuries caused or made worse by one job (heart, high blood pressure, psychology).
California provides a rebuttable presumption for many safety officers and the presumption is that if they develop a medical problem to a particular system or body part, it can be presumed to be work related. It should be noted that this is a rebuttable presumption and if the proper foundation is not developed, the employer can successfully deny any and all benefits.
The presumption may have application for heart trouble, back trouble, hernia, pneumonia, meningitis, blood-borne pathogens, tuberculosis and cancer. Again, the key on the presumptive cases is to have an adequate foundation that articulates exposures.
Once the medical condition has been found to be job related, the California worker is entitled to medical treatment to cure or relieve the effects of the job-related injury. This medical treatment can be a lifetime award of medical treatment for that body part or system that is involved. The medical care or treatment can be expansive. Example: If the worker has a heart condition and the only way to control the work-related heart condition is to control the non work-related diabetes, the employer can be responsible not only for the work-related heart condition but also the non work-related diabetes that impacts the heart.
Unless you have predesignated your doctor prior to your industrial injury, you are required to see the employer’s doctor for the first 30 days. If you have taken a PROACTIVE step, you then can receive medical care from the doctor that you have designated. (Form for Predesignation)
The importance of designating your own personal physician to treat you or have your personal physician refer you to a specialist in the event that you have a job-related injury is a must for the California worker that wants to protect himself/herself from employer interference in their medical care.
If your employer has created a Medical Provider Network known as the (MPN) by law the employer is allowed to perform an economic profile on the doctors within the MPN. This means that many of the treating physicians develop an economic fear of being patient advocates. If they are patient advocates they are aware that the employer or third-party administrating the medical care can unilaterally remove the doctor from the MPN.
If you have designated your own treating doctor, this allows your doctor to have economic independence from your employer and they can be a true patient advocate without concern for reprisal by the employer or its agent (economic profile).
Labor Code Sections 4850, 4800.5, Industrial Leave Temporary Disability Payment
If you are unable to work because of the job-related injury, you may have eligibility for benefits pursuant to Labor Code Sections 4850, 4800.5, or industrial leave. These benefits, i.e. 4850, 4800.5 provide a regular salary up to one year or until your treating physician releases you to full or light duty. Such pay is not subject to State of Federal income taxation. If you remain totally disabled beyond one year, you may be eligible for weekly temporary disability benefits. For injuries occurring after January 1, 2009, the maximum temporary total disability rate payable is $958.01 per week or 100% of the State average weekly wage, whichever is higher. Effective 1/01/2012, the maximum temporary total disability rate payable is $1010.50.
Some employers do not provide to the safety members benefits pursuant to Labor Code Section 4850 or 4800.5 and they have their own industrial leave program. Each program has to be examined on its own and determined the qualifications or limitations placed. Temporary disability monies might be an option – of these benefits are to be paid during a healing period after the injury. There are limitations regarding the length paid.
Permanent Disability / Impairment Benefits
For the California worker that has a residual disability or impairment, they may be entitled to a permanent disability or permanent impairment rating. It does not make a difference as to whether you have returned or not returned to work as to the eligibility of this rating, but the amount of disability can be raised or lowered by 15% depending if you return back to work. New case law that developed in 2009 and 2011 has created a new avenue to determine levels of impairment. There existed what is now characterized as the old system that generally had application to injuries that occurred before January 2005. This old system gave the California worker a more equitable level for their disability or impairment.
The new system that commenced as of January 2005 is inequitable. This lack of justice is demonstrated by the worker that lost their leg from below the knee, they are entitled to $150,000. The new system established in 2005 would pay the same worker for the same loss $50,000. This unfair system continues to be challenged because of its inequities.
The case law that has developed since this implementation has allowed some California workers with injuries after 2005 to approach the level of justice that was available to them under the old system.
This requires additional knowledge and expertise of the attorney to reach this goal.
Vocational Rehabilitation / Supplemental Job Displacement Voucher
For the California worker that cannot return to his previous occupation because of his job-related injury that occurs after January 1, 2004, the vocational retraining program has been eliminated. It has been replaced with an inferior supplemental job displacement benefit. The inferior supplemental job displacement benefit has a range of monies that may be accessible by the worker. This is a non-transferable voucher for education related to training or skill enhancement.
The California worker who sustains death as a result of a work-related injury or disease, his/her family may have eligibility for death benefits. There are restrictions as to the time line from the date of injury to date of death that controls the family’s eligibility. The death benefits can be paid to family members whether partially or totally dependent, or to individuals who can prove dependency regardless as to family or lack of family involvement. Currently, the maximum death benefit payable for three or more total dependents would be $320,000. If there are minor children, there may be eligibility for additional benefits beyond the $320,000.
The California Workers’ Compensation System has many pitfalls. If the injured worker or the family is not knowledgeable or relies upon the employer to take care of them, they are at great risk in not receiving the full cup of justice that the injured worker has entitlement to receive.
You, as the California worker, are entitled to take proactive steps to protect you and your family:
1. Designate your personal physician to treat you in the event you have a job-related injury, keep a copy of this designation, many employers seem to lose this form. (Form for Predesignation)
2. Report all job-related injuries or illnesses to your supervisor as soon as possible. Again, keep a copy of this claims form, known as DWC form 1, and have yoursupervisor sign your copy of the document. Again, this is a document that is lost by some employers.
3. Keep a record of all the periods of time that you have missed from work, copies of your medical expenses, and a log of mileage incurred for treatment.
4. If your case is important enough for the adjuster or a private investigator, or other third-party to seek a written or recorded statement from you, your case is important enough for you to obtain your own attorney.
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