When you are hurt while on the job or are unable to work due to job-related injuries, California law entitles you to various benefits. The benefits include workers’ compensation benefits, disability benefits, and social security disability insurance. You may find it challenging to understand the benefits that suit your situation the best due to variations in eligibility criteria and the scope of each benefit. If you are in Orange County, CA, and find yourself in this situation, consider consulting with an accomplished workers’ compensation lawyer who will guide you in the right direction. The Workers’ Compensation Attorney Group is a law firm with excellent lawyers ready to help workers receive their just compensation.
Workers’ Compensation Basics
Workers' compensation is a form of insurance that employers purchase to provide coverage for employees who suffer work-related injuries or illnesses. In California, you are entitled to workers’ compensation benefits while you are recovering if you are hurt or injured while on the job. Generally, the process and the procedures for claiming the benefits are supposed to be straightforward, but there are important guidelines that must be adhered to when determining your eligibility for the claims. Understanding the basics of the workers’ compensation will help you know how and when to begin claiming for your benefits. You also get to know the injuries that are covered by the program and those that are not.
Injuries Covered by The Workers’ Compensation Insurance
The workers’ compensation covers injuries and illnesses that are caused by the employer's or employee's carelessness. They may include;
- Diseases like cancer which are caused by prolonged exposure to toxic or carcinogenic substances at the workplace,
- Pre Existing medical conditions or injuries which were hastened or aggravated by the conditions in the workplace, for example, a back injury,
- Workplace injuries caused by facilities or equipment in the working environment like chairs or any other working tools and equipment,
- Damages resulting from activities sponsored by the employer such as field trips, picnics, luncheons or breaks,
- Injuries caused by physical or mental stress resulting from increased duties and demanding conditions at work. These injuries may also stem from constant harassment from the supervisors.
Types of Expenses Covered by The Workers’ Compensation Insurance
If you are eligible for workers' compensation, the insurance provider will provide coverage for the following expenses:
- Replacement income - This payment is usually disbursed a few days after you missed work due to the injuries. The amount paid is typically two-thirds of the wage you used to earn before the injury
- Medical expenses for the injuries or illnesses
- Retraining costs, especially if the injuries led to your transfer to another type of job or if you are expected to use aids like wheelchairs
- Compensation for long-lasting injuries.
It is worth noting that:
✔ Once you have collected workers’ compensation, you cannot sue your employer. This is because the workers’ compensation acts as a substitute for giving up your right to sue your employer for injuries suffered at work.
✔ The program does not cover pain and suffering.
People Covered by Workers’ Compensation
The workers’ compensation insurance covers various types of employees. In the state of California, the workers’ compensation does not cover the following employees;
Volunteers, business owners, independent contractors, private house employees, maritime employees, casual workers, railroads employees, farmers, and farm workers. These special groups are covered under different laws; for instance, maritime employees are covered under the Jones Act while railroad employees are covered under the Federal Employers Liability Act (FELA). We invite you to get in touch with our attorneys if you want to receive compensation under federal laws such as FELA so that we can advise and help you. If you do not fall under any of these categories, you are eligible for workers' compensation coverage.
What Should I Do After Getting Injured or if I Become Ill at Work?
If you suffer injuries at work, consider applying for workers’ compensation. To succeed in the process, or increase your likelihood of receiving compensation, you should follow the steps below;
- Notify your employer as soon as you are injured. You can report directly to your employer or through your work supervisor. You should do this in writing and ensure to keep copies of the report for future reference and personal records.
- Complete a compensation claim form. Upon notification, your employer must supply you with a claim form. They must issue you with the form regardless of how they learn of your injuries. Unless you complete the claim form, your employer will have no responsibility to make compensation benefits available for you. While completing the form, ensure that it is fully and accurately filled. Also, ensure to keep copies of the claim form for your use.
- After receiving the claim form, your employer should notify the workers’ compensation insurance company as soon as possible. The employer should also arrange for your medication.
- File the claim form as soon as possible. If you delay filing it, you risk delaying your benefits as well. By playing your part as quickly as possible, you increase the likelihood of your benefits being disbursed faster. Filing early also makes it possible for you to seek help from legal experts or workers’ compensation officials, should any disputes arise.
Does The Workers' Compensation Cover Permanent Injuries?
The workers’ compensation insurance does not limit the extent of injuries covered, so long as you are eligible. Thus, short term, long term, and permanent injuries are covered. The program also covers illnesses or any problems that result from long-term exposure to dangerous activities such as back problems and the Carpal Tunnel Syndrome.
Can I Be Fired for Filing for Workers’ Compensation Benefits?
Your employer should not fire you for filling for the workers’ compensation claims. The law makes it unlawful and allows you to report their actions to the workers’ compensation office in your area as soon as possible if they threaten to or do fire you.
The Difference Between Workers’ Compensation and Disability Benefits
There are many distinctions between the workers’ compensation and disability benefits in California. Precisely, the procedures followed while filing for claims, the eligibility criteria, the amount payable, and appeals, all differ. You are entitled to workers' compensation if the injuries you suffer are related to your work. On the contrary, you receive disability benefits if your injuries are not related to work but affect your capability to work. The variations are discussed below in detail.
You are eligible for State Disability Benefits in California if:
- You have been unable to engage in your regular work for not less than eight (8) days consecutively,
- You submit your claim for the benefits forty-nine (49) days from the day you developed the disability,
- You have been employed or were actively seeking employment during the time you became disabled,
- You have lost wages as a result of the disability; or if you are not employed, you have been actively looking for work,
- You agree to submit to an independent medical assessment aimed at determining the extent of your disability,
- You have been under the treatment and medical care of a licensed doctor for the last eight (8) days,
- You have a medical certificate stating your disability from a licensed physician,
- You have earned not less than three hundred ($300) dollars, and from the amount, a percentage had been deducted and withheld by the State Disability insurance for payment of the benefits.
To be eligible for the workers’ compensation benefits:
- The cause of your injuries should be directly related to your employment,
- You should file your claims within one (1) year of suffering a work-related injury,
- You should only receive medication from an authorized doctor, unless where there was an emergency,
- You should provide documentation for the medical treatments you received.
The State Disability Insurance typically pays you between 60-70% of your wages for a maximum of fifty-two (52) weeks of disability. The amount is based on what you used to earn within the past one (1) year. The 12 months are divided into four (4) quarters to ensure that you receive the maximum amount. The amount of benefits is then determined using the quarter in which your wages were highest.
For the workers’ compensation, you are entitled to two-thirds of your gross wages for the temporary disabilities suffered. Public entities and companies that insure themselves often compensate you for the salary difference so that you may receive your payment as usual after you have sustained injuries related to work. The law does not necessitate the program, and therefore, the program is not offered by all companies or public entities except a few. If you have been partially, permanently injured, the workers’ compensation law entitles you to permanent disability benefits. The amount you will receive will be calculated based on the percentage of the impairment you suffer.
Denial of Claim and Appeal
In both workers’ compensation and state disability insurance benefits, your claim may be denied. The reasons for the refusal and the procedure for appeal differ.
If you are disqualified from state disability benefits, an appeal form together with a letter for your disqualification is sent to you. The law allows you to appeal for the decision made within twenty (20) days from the day you receive the mail notifying you of the disqualification. When completing the appeal form, you will be expected to give reasons why you think that you should not be denied access to the benefits. Other details you will have to include in the appeal form are your contact information, identification number, name, signature, and your address.
The Employment Development Department of California will then review the information you presented in the appeal form, find out the truth, and notify you of their findings. Your claims may also be forwarded to the California Unemployment Insurance Appeals Boards’ local office and other relevant authorities. The concerned authorities, including you, will be notified about the date scheduled for a hearing. During the hearing process, a judge will listen to your claims as well as those presented by the disability insurance representative and reach a verdict.
The workers’ compensation may also deny your claims for benefits. The reasons for the denial are different from those of disability benefits. They include:
Injuries not related to work. If the insurance company or your employer does not believe that your injuries are related to the job, they may deny you compensation benefits. Typically, the Workers’ Compensation covers you only if:
✔ You were injured while working on something that benefits your employer and,
✔ The cause of your illness or injuries was your work.
The workers’ compensation insurance may claim that the cause of your injuries was not related to your job even if you were injured at your workplace. The California Workers’ Compensation is a no-fault system. Thus, you can be eligible for benefits regardless of whether you or your employer was to blame for the injuries. However, the insurance company may deny you the benefits if it finds out that the cause of your injuries was your misconduct such as alcohol and drug abuse. You can also be denied access to benefits if you hurt yourself purposely to get compensation.
Pre Existing conditions. The presence of preexisting conditions has a significant impact on workers’ compensation benefits. On a positive note, the workers’ compensation does not reject your coverage simply because the specific part you are injured was affected by a previous injury. You can argue that although you had a preexisting injury, the current or most recent injury intensified the condition. The insurance may claim that the prior conditions primarily caused your need for medication and deny you the claims on this ground.
Cases of minor injuries. If your injury was minor and did not require time off the job or any medical care, the insurance company may deny you access to workers’ compensation claims. If you want to combat this form of denial, you should seek medical treatment for the injuries immediately they occur and let the doctor know that the injuries are related to work. If you attempt to persevere the pains and convince the insurance providers without evidence of a medical report, they may not accept, leaving you with suffering as you claim for the benefits. In most cases, you will end up losing the benefits altogether.
Missed deadlines. To receive workers’ compensation claims, you must report the injuries to your employer within the set time limits. In California, you are expected to notify your employer within thirty (30) days from the day you were injured or got ill. It is advisable to report these incidences as soon as they occur. If you report your injury close to the deadline, your employer, as well as the insurance company, will doubt the facts of your case and may delay or deny you access to the benefits.
If you want to appeal the denial, the procedure is different from that followed in disability benefits claim. That is; you will have to file a Declaration of Readiness to Proceed (DOR or DR) with the Workers’ Compensation Appeal Board (WCAB). While filing a DOR, ensure to supply a copy of the form to the employer's insurance company. The Workers' Compensation Appeal Board will then plan for the hearing during which they will reach a verdict on whether to uphold your appeal or not.
Disability insurance is part of the state disability program. The program receives funding from the California workers who contribute to it through deductions from their payrolls. Workers’ compensation program, on the other hand, is paid for by the employers.
The Time Frame for Receiving Benefits
For disability insurance, you will receive benefits for a maximum of fifty-two (52) weeks only. On the contrary, the benefits for the workers’ compensation total temporary disability are provided for two (2) to five (5) years. The duration typically depends on the part of the body that was injured.
Can I Receive Disability Benefits If I Have Filed for Workers’ Compensation Claim?
Yes. There are situations in which you can be allowed to collect disability benefits even if you have filed for a workers’ compensation claim. You can receive state disability benefits if the workers’ compensation has denied your claim or when they have delayed in disbursing the benefits. Also, if your weekly benefits from the workers’ compensation are lower than that of disability insurance benefits, the state disability insurance will pay the difference in the weekly amounts. In case the state disability insurance had paid your benefits while the processing of the workers’ compensation was underway, it will file a lien to recover the benefits with your workers’ compensation insurer.
What Are the Roles of the State Disability and Workers’ Compensation Program Administrators?
The administrators help in ensuring that the payment from the disability insurance programs and the workers’ compensation programs do not overlap. An overlap in benefits received is considered an overpayment. If an overlap occurs, either you (the injured worker) or the administrator in charge of the claims is held accountable for the payment of the state disability insurance. Therefore, the claims administrators need to be highly cautious.
Which Program Offers Better Benefits?
Whenever you suffer injuries in the course of the job, your employer will try to convince or even force you to seek state disability benefits or unemployment insurance. By doing so, the employer will have shifted the burdens brought by your injuries to the government. Employers have been known to consider options that best suit them and not their employees. Thus, if you are injured on the job or in a situation that relates to the job, the best benefits you should consider are the workers’ compensation. Always ensure to apply for workers' compensation benefits first even if you intend to apply for other benefits. Workers’ compensation is the best in this case because:
- Through workers’ compensation, you will receive varied financial benefits compared to other benefits.
- The benefits from the workers’ compensation are not subjected to taxes while benefits from other sources, including the state disability and unemployment programs, are subject to taxes.
- The benefits from workers’ compensation are available for an extended period ranging from two (2) to three (3) years. Other benefits, precisely state disability benefits, and unemployment benefits are available to you for a short time of fifty-two (52) weeks and twenty-six (26) weeks respectively.
- In the workers' compensation program, if you decide to return to work before making a complete recovery, your employer may opt to put you in another job but with low earnings. During this time, you will continue earning the workers' compensation benefits, though on a partial rate. Other benefits like the state disability benefits most often do not provide any additional pay to compensate for the difference. Once you resume working, whether wholly or partially healed, all the benefits you used to receive end.
- Workers’ compensation also covers all the necessary medical expenses resulting from your injuries without limiting the final costs. Also, nothing will be deducted from your pay to make up for the expenses. No other benefits will cover all those expenses. In most cases, they have limitations as well as deducting from you in the long run.
Find a Skilled Workers’ Compensation Attorney Near Me
Workers’ compensation benefits and disability benefits are both meant to help you when you are unable to perform duties due to injuries. The eligibility criteria, injuries covered, processes followed to obtain the benefits, and many other aspects differ. To gain the most out of your injuries, you need to know the differences between the two benefit programs.
If you are in Orange County, CA, we invite you to contact The Workers’ Compensation Attorney Group at 562-485-9694. We will help you understand the facts and the basics of the benefits, and help you file a claim. Call us today for professional help.