California Worker's Compensation
The California Worker's Compensation system provides several benefits to employees who are injured during the course and scope of their employment.
Do you know what Workers' Compensation Temporary Disability Benefits are? What if you were injured at work and able to return to work, however, at a modified position, earning less income? Do you know whether or not you would be entitled to temporary disability benefits? Do you know what a Claim Form (DWC 1) is and do you need to fill one out to be eligible to receive temporary disability benefits?
Temporary disability benefits are paid to an injured worker who is temporarily medically disabled from returning to work as a result of his or her industrial accident. These benefits are payable at two-thirds of the injured employee's wages, with a maximum amount set forth by the State of California.
Temporary Total Disability
There are two types of temporary disability benefits. The first is Temporary Total Disability (TTD). These benefits are calculated at two-thirds of the injured employee's wages with a maximum set by the State of California.
Temporary total disability payments are payable when the treating physician has determined that an injured employee is unable to return to work for more than 3 days.
The first 3 days of temporary total disability are known as the waiting period. They are not payable until the injured employee has been off work on medically authorized disability for over 14 days. Therefore, if someone was injured and off work for 4 days, they would be entitled to 1 day of TTD benefits. If a person was disabled and off work for 15 days, they would receive all 15 days of TTD benefits.
The exception to the waiting period rule is if an injured worker is hospitalized overnight. An injured employee will be paid TTD from day 1when hospitalization overnight.
Temporary total disability benefits are payable until an injured worker is released to return to his or her regular work, or to modified work duties, provided the employer offers alternative work in conjunction with the medical restrictions. In addition, temporary disability benefits will end, even if an employee has not returned to work, when an injured worker's condition is declared "Permanent & Stationary" by a physician. (For information on permanent disability see the article California Workers' Compensation: Permanent Disability Benefits.)
Temporary Partial Disability
The second type of temporary disability benefits are Temporary partial disability (TPD). These benefits are paid to an employee who is disabled due to an industrial injury and cannot return to his or her usual job, but is able to return to work in some type of modified capacity, which results in the employee receiving less than normal wages.
Temporary partial disability benefits are calculated by deducting the amount of money the injured worker earns per week from the amount they would normally earn, provided they earn less than the maximum rate of pay as set forth by the State of California. If the injured employee normally earns more than the maximum rate of pay, the insurance company will use the State maximum as a starting figure and deduct the amount of the partial earnings. The second step in calculating TPD is to calculate 2/3's of the balance and that is what the insurance company will send to the injured worker.
Example of TPD: An employee normally earns $250.00 per week. They are injured, return to modified work and now earn $150.00 a week. $250.00 - $150.00 = $100.00; 2/3rds of $100.00 = $66.67. So the injured worker would earn $150.00 from work and receive a TPD check in the amount of $66.67 for a total of $216.67 for the week.
*Note; if the injured worker's modified wages are higher than the State maximum, he or she will not be eligible for temporary partial disability benefits.
The filing of the Claim Form (DWC 1) is not a prerequisite to receive temporary disability, however, it is extremely important that an injured employee complete and return the DWC 1 as soon as possible.
The return of the DWC 1 provides the following:
The presumption that an injury or illness was caused by work if the claim is not accepted or denied within 90 days of the provision of a completed claim form to the employer.
- If the claim is under investigation; up to $10,000.00 in medical treatment, under the medical treatment guidelines, is allowed while the claim is being investigated.
- An increase will be added to your disability payments if they are issued late.
A way to resolve disagreements that may come up between the injured employee and the employer or insurance carrier, such as whether the injury or illness is a result of the employment, issues with the medical treatment or disputes over permanent disability benefits.
Some employers provide plans that pay all of an injured worker's wages while on TTD. These plans are called salary continuation. There are different types of salary continuation plans; some use an employee's vacation or sick-time to supplement the TTD benefits required by law so that an injured worker is receiving his or her full wages while on disability. Other employers do not offer salary continuation plans and the injured worker is paid 2/3rds of their salary (with a maximum set by law). Check with your employer to find out if you are covered by a salary continuation plan.
A worker injured between the period of April 19, 2004 through and including December 31, 2007 is not entitled to more than 104 weeks of temporary disability, from the date of the first payment. Employees injured on or after January 1, 2008 are eligible to receive 104 weeks of temporary disability payments within a five-year period. The five-year period is calculated from the date of injury. Temporary disability payments for a few long-term injuries, such as severe burns or chronic lung disease, may go longer than 104 weeks and can continue for up to 240 weeks of payment within a five-year period.
You may also file a state disability insurance (SDI) claim with the Employment Development Department, even if your workers' compensation claim is accepted. This will allow you to receive SDI payments after the 104 weeks of temporary disability payments if you are still too sick or hurt to return to work. When you file, be sure to advise the Employment Development Department of your industrial accident and the status of payments.
An injured worker is also entitled to receive the following benefits while receiving temporary disability benefits: medical treatment; reimbursement for transportation costs, including mileage, parking and tolls for trips to and from the doctor's office or from physical therapy visits; payment for all prescriptions, physical therapy visits and other medical costs.
If you have any questions or are experiencing a problem, contact the claims administrator handling your claim. If the problems are not resolved or you are not satisfied with the answers provided, you can contact your local State Division of Workers' Compensation and speak to an Information and Assistance (I&A) officer. They can provide you with information and/or forms to aid in resolving problems with your claim.
If you continue to experience problems, you may wish to consult with an Attorney who specializes in Workers' Compensation.
*The information contained in this article is general and not intended as a substitute for legal advice. Changes in the law or specific facts of a case may result in legal interpretations different than those presented here.
For additional information on California Worker's Compensation, see the following articles;