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The Availability of Long-Term Benefits in California Workers’ Comp
When someone is injured on the job, their first thoughts often focus on how they’ll financially support themselves. Fortunately, such concerns are often alleviated once they recognize how broad employee protections are in our state. However, some still question how California’s workers’ compensation system addresses long-term occupational injuries.
This is an understandable concern. After all, one might not expect coverage from their employer to pay them for years on end — or even permanently. Fortunately, workers’ compensation is highly regulated in California. And due to the extensive nature of the law, nearly any employee can file a workers’ comp claim that may cover long-term injuries.
When Financial Support Becomes Permanent
When a person is injured on the job in California, they are typically entitled to workers’ compensation benefits. This financial support is meant to cover medical expenses and lost wages related to an occupational injury. In most cases, these benefits are short-term and merely assist injured employees until they’re able to return to work.
However, not everyone will fully recover from their injuries or condition. There are times when medical treatment can only do so much, and in these instances, injury victims will eventually reach a plateau in their treatment. At this point, the treating physician may decide that a person’s condition is “permanent and stationary.”
Put simply, this means additional treatment won’t help a person recover further. For instance, someone who is paralyzed in an accident will eventually reach a point where medical treatment can no longer improve their situation. When this happens, the physician will create a Permanent and Stationary Report that is forwarded to the workers’ compensation claims administrator and, if your claim is filed in court, to the Workers’ Compensation Judge.
Disability Reports and Ratings
To understand how California’s workers’ comp system addresses long-term occupational injuries, it’s important to know the function of a doctor’s Permanent and Stationary Report. This document will outline critical information to the claims administrator that assists with calculating benefits for long-term or permanent injuries.
A Permanent and Stationary Report includes the following:
- Work restrictions or limitations faced by the employee
- Any medical care expected in the future
- Specifics regarding medical issues (e.g., mobility, pain levels, etc.)
- The employee’s ability and a timeline for returning to their former position
- An estimate of how much a disability is related to a person’s work-related injury
Once active treatment concludes, the injured worker will also receive a permanent disability rating. This rating estimates how much a person’s disability will limit their daily life and functional activities. A wide range of factors are considered when calculating this rating, but doctor’s are required by law to use the 5th Edition of the AMA Guides to arrive at their rating of your impairment or disability.
However, not everyone with some measure of disability rating will receive the same benefits.
Calculating Long-Term Injury Benefits in California
When people seek out a California workers’ compensation benefits calculator, they’re often surprised at what they find. In some cases, calculations are straightforward. This is particularly true when employees are only out of work for a short time — since a maximum benefit of two-thirds of a person’s pre-tax gross wage is allowed.
This money is provided in addition to medical care. However, things can get more complicated when California’s workers’ comp system addresses long-term occupational injuries. That’s because a person’s future medical needs must be considered. For those without a permanent disability rating, benefits are typically paid over a certain number of weeks.
When it comes to those with permanent injuries, financial support could continue for the remainder of the person’s life. In some cases, your workers’ comp attorney may be able to secure a settlement on your behalf. In such a situation, your benefits will be paid in a lump sum, so you can worry less about the financial burdens you may eventually encounter.
What If an Employer Doesn’t Have Workers’ Comp Insurance?
All employers who have at least one worker in California must have workers’ compensation insurance. This makes our state one of the most protective of employees. However, not all employers abide by the law. In such cases, you may need to file a personal injury claim and/or seek workers’ compensation benefits from the state Uninsured Benefits Trust Fund. These cases tend to be more complicated than your typical workers’ compensation case and can take longer to resolve.
Put simply, workers’ compensation helps avoid the delays, litigation costs and legal burdens applicable to personal injury law. Workers can secure benefits without a lawsuit, but they are also unable to seek certain types of damages (e.g., non-economic and punitive). These restrictions no longer exist when an employer fails to carry proper insurance, but, ultimately, the injured worker would still need to show that the employer’s negligence caused his or her injuries. Make sure you work with an attorney in these instances.
What If You’re Denied Workers’ Comp for Long-Term Injuries?
It’s an unfortunate fact, but not everyone who is injured on the job will be entitled to workers’ compensation benefits for long-term injuries in California. For instance, benefits may not be available for independent contractors, business owners, and domestic workers. However, there are some instances where those who do qualify will be denied benefits.
This is a common occurrence that can stem from anything ranging from clerical errors to missing documentation. A person may also not receive benefits due to being improperly classified as an independent contractor. Whatever the underlying reason, there are options to appeal workers’ compensation benefits denials.
While you can go through the appeal process alone, seeking legal assistance is advisable. Without addressing the underlying issues of your denial, an appeal will likely not change anything. At Espinoza Law Group, our team of dedicated legal professionals is here to help. Contact us at 213-510-1624 to schedule your free case screening today.
