1. What am I entitled to? What are my rights? - SB899 Changes
These are some of the benefits available for an injured worker in California.
Temporary Disability (TD):
TD is paid for the period during which the employee is recovering, and in the opinion of the treating doctor, is unable to work. TD ends when the injured worker is returned to work or when the disability becomes "permanent and stationary" (released by the doctor). The following qualify as being returned to work: light duty, modified, or full duty positions.
There is a three day waiting period between the injury and the beginning of payments. If disability extends beyond fourteen days or the worker has been off for fourteen days, the insurance company must either begin TD or send what is called a "delay letter" indicating that the claim is being investigated. TD payments equal two-thirds of the employee's weekly gross income up to a maximum benefit rate. Note that other benefits and income can sometimes be included in gross income.
If your check is late, the insurance company may be liable for penalties, depending on the circumstances. Keep track of the amount of your payments and the period of time for which the checks cover, to be sure you are receiving all of your benefits on a timely basis. If possible, keep either a copy of the check before it is cashed or the check stub for your records.
Under SB 899, TD benefits are now limited to 2 years, with certain exceptions.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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Permanent Disability (PD):
You are entitled to a PD rating if your injury leaves you with a disability. The amount will vary based on your disability
level and income. This is not payable until your condition becomes permanent and stationary (P&S). You may receive weekly
PD advances pending the conclusion or settlement of your case. These advances will be deducted (as credit to the carrier)
from any settlement or award. Depending on your date of injury, the procedure when you become P&S can vary.
Pre -1991 - Your doctor makes the initial determination as to your level of disability. You may also be seen by evaluating doctors.
1991 - 1993 - The amount of Permanent Disability is determined by a Qualified Medical Evaluator (QME). If you are not represented by an attorney, you will be sent a list of three QME's, called a Panel QME List. You will select a doctor from this list, and his opinion will be binding, unless you later hire an attorney, who will have the right to either send you to another QME, or agree with the insurance company to send you to an Agreed Medical Examiner (AME).
Post 1/1/94 - Your treating doctor should evaluate your level of PD. If you or the insurance company disagree, and you are unrepresented, you will be sent a Panel QME List. However, once you have seen the Panel QME, you will not be able to select another evaluator, even if you later decide to hire an attorney. You will be bound by the Panel QME's decision. Therefore, it is very important, if you think you may wish to have an attorney, to contact the attorney before you have selected a Panel QME.
PD payments may now be either increased or decreased by 15%, depending on whether a modified position is offered to an injured worker, regardless of whether the position is accepted or not.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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Medical Treatment:
You have the right to select your own treating doctor as long as certain procedures are followed. Do not begin seeing a doctor on your own without first requesting a change of physicians from the insurance company, in writing. Your first such request should be granted, but after that additional changes may be challenged based on whether they are reasonable. The Insurance Company also has the right to send you for a consultation, but they cannot force you to change doctors without following certain procedures.
While injured workers may still choose their own treating doctor after 30 days post injury, changes to the Labor Code now require that injured workers choose their doctors from a Medical Provider Network (MPN), if the insurance company has created one. This network consists of doctors that the insurance company has chosen to be part of their network. Additionally, injured workers who were treating with doctors outside of a MPN previously can be forced to change their treating doctor to a doctor inside the MPN. Some of the injured workers rights regarding doctors within a MPN can be complex, so please feel free to call Walters and Zinn at (916) 363-7840 to discuss in more detail.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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Mileage and Related Expenses:
You are entitled to be compensated for your travel expenses at up to 48.5 cents per mile for your round-trip mileage to health care providers for treatment, evaluation, physical therapy or picking up prescriptions related to your industrial injury. Therefore, keep track of your mileage to health care providers and any related expenses such as parking or toll fare. This money can be paid for expenses you have already incurred.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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Future Medical Expenses:
Workers' compensation cases are concluded by Stipulation and Award, Compromise and Release, or by trial. If a Compromise and Release is entered into, the worker is selling his right to future medical treatment. A Stipulation and Award or trial may entitle the employee to future medical treatment for the industrial injury at the employer's workers' compensation carrier's expense. Any award following a Stipulation and Award or a trial may be reopened within five years of the date of injury to seek further benefits should your amount of disability increase.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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Vocational Rehabilitation:
If your treating doctor or the doctors who evaluate you find that you are a Qualified Injured Worker (QIW), you may be entitled to Vocational Rehabilitation. A title of Qualified Injured Worker would mean that you are permanently unable, or likely to be unable, to engage in your usual and customary employment at the position in which you worked at the time of injury. Rehabilitation must be requested within five years of the date of injury or one year of any settlement, whichever is longer.
The purpose of rehabilitation is to return the injured worker to suitable gainful employment. The rehabilitation plan may provide for alternative work with the same employer, direct job placement assistance, on-the-job training or retraining. A person is paid vocational rehabilitation, temporary disability (VRTD), or vocational rehabilitation maintenance allowance (VRMA) benefits while undergoing rehabilitation. VRTD/VRMA pays 2/3 of your wages, up to a maximum TD rate. Please note that you may be eligible to supplement this payment with Permanent Disability advances up to your maximum TD rate. Feel free to call our office at (916) 363-7840 if you have any questions on this or any other information on this web site.
Recent changes to the VR system have eliminated the old system of VRMA and job retraining, depending on your date of injury. Under these changes, the new VR system is now a school voucher system where the insurance company will provide a Qualified Injured Worker who is not offered a modified position ‘school vouchers’ which are redeemable at select schools, generally post secondary schools. The amount of the voucher depends on the amount of disability and income. Like before, an injured worker may, instead of receiving the vouchers, sell their rights to the vouchers in exchange for a lump sum payment if they are represented by an attorney. Injured workers should call Walters and Zinn at (916)-363-7840 to discuss in more detail.
If you have questions about how this will effect your case, please call us at (916) 363-7840.
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