Types of Benefits Under Workers’ Compensation

Wave Image

If you or somebody you care about has sustained a workplace injury or illness in California, you should be able to recover various types of benefits through the workers’ compensation system. However, most people do not tend to think about what types of benefits they will receive until after they sustain an on-the-job injury. Here, we want to discuss the various types of benefits that are available through a California workers’ compensation claim.

It is absolutely crucial to work with a skilled workers’ compensation attorney in California if you have any questions about the benefits you should be receiving. If an insurance carrier or employer denies your claim, you will have to go through the appeals process. An attorney can help you get through this.

Medical Coverage

Perhaps the most important thing about workers’ compensation is the ability to ensure that all medical care is covered after a workplace injury or illness occurs. Injured workers in California receive a standardized level of care, and all treatment is based on medical treatment guidelines. 

Injured workers must be treated by a doctor in a network called the Medical Provider Network (MPN). Doctors in the MPN are required to follow medical treatment guidelines through a process known as Utilization Review (UR). In this system, medical treatment requests are sent to independent physicians who can approve, deny, or modify the treatment plan. 

Medical care will continue until the treating physician believes that any further medical treatment will not be effective, meaning the patient has reached maximum medical recovery. 

As part of the medical care reimbursement, injured workers will typically be reimbursed for mileage to and from all of their medical appointments. This includes travel to pick up prescription medications. 

Disability Benefits

There are various types of disability benefits available through the California workers’ compensation system. 

Temporary disability benefits

These benefits are paid for the wages a person loses if they are injured and cannot work while they recover. Temporary disability benefits are only paid after the insurance carrier agrees that the injury is work-related. Payments will be made every two weeks, with the first payment coming within 14 days after the insurance carrier receives a medical report stating the injured worker is unable to perform their job functions. Workers will receive two-thirds of their average weekly wage (AWW) through temporary disability benefits. In California, temporary disability benefits are limited to 104 weeks within a five-year period after the date of the injury. 

Permanent disability benefits

These benefits are designed to pay an injured worker for loss of future earning capacity caused by the permanent effects of their work injury or illness. Permanent disability benefits are rated on a scale from 0% to 100%. For those who have a disability rating below 100%, they will be considered partially disabled and entitled to weekly payments for a specific amount of time. For workers that are considered 100% disabled, they will be considered permanently disabled and entitled to weekly payments for the remainder of their life.

In California, the permanent disability rate is determined by calculating two-thirds of a person’s average weekly wage. However, the maximum amount of permanent disability benefits is much lower than most workers’ calculated rate. Payments for permanent disability will begin 14 days after the last payment of temporary disability.