California's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers.
Exemptions from coverage may apply to certain employees, including domestic workers and independent contractors.
Medical Benefits are provided to employees entitled to workers' compensation benefits, subject to limits on chiropractic care, physical therapy and occupational therapy.
The employee makes the initial choice of treating physician from a list provided by the employer, or from doctors participating in the employer's managed care plan. The employee may change physicians starting thirty days from the date of injury. Either the employer or employee can request a review by a qualified medical examiner (QME) to resolve a medical issue. The waiting period may be waived in the employee is hospitalized.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 21 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's weekly wage, subject to a cap, and continue for up to 104 weeks.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In California PTD benefits are calculated based upon 2/3 of the injured worker's average weekly wage, subject to a cap, and may continue indefinitely. Benefits are periodically adjusted for cost of living. rate increase subject to yearly increase in state average weekly wage.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In California PPD benefits are determined based on a statutory schedule, payable for a period of weeks set by the legislature. Benefits are calculated based upon 2/3 of the injured worker's average weekly wage, with a minimum benefit and a cap.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In California, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Most workers can potentially receive TPD benefits for up to 104 weeks.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to limits both in amount and duration. Benefits to minor children end at the age of 18, but may continue in the event of disability.
Attorney fees are paid out of the award made to the injured worker, and are subject to review by the workers' compensation appeals board.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
California Department of Industrial Relations
Division of Workers' Compensation
455 Golden Gate Avenue, 2nd Floor
San Francisco, CA 94102-7014
(415) 703-5020 or 1-800-736-7401