Benefits Mandated Under the California Workers' Compensation System That Can Help You Achieve Your Objectives.
If you are injured on the job and unable to work, you are entitled to temporary disability (TD). It will be paid at two-thirds of your normal salary subject to statutory maximums and minimums. TD is a non-taxable benefit. TD is now limited to two years, so people with more serious injuries are in deep trouble.
TD will continue until you reach Maximum Medical Improvement (MMI), meaning that your medical condition or injury has reached a plateau, where no improvement is expected in the foreseeable future. Heads up: if you are unable to go back to work when you reach MMI, your TD will be unceremoniously shut down regardless of your ability to return to work. If you get lucky, the insurance company will send you a notice (with your last check). Thereafter, they are required to start paying you advances on your permanent disability (PDAs) every two weeks.
Under the California workers’ compensation system, you are entitled to “all medical treatment necessary to cure or relieve the effects of your industrial injury” (LC Sections 4600-4603). This entitlement includes not only doctor bills but medicines, hospital costs, fees for lab tests, x-rays, MRIs, and other diagnostic procedures. You are also entitled to costs of mileage for going to and from medical appointments, the pharmacy, and med-legal evaluations.
However, being entitled to medical treatment under the system and getting it are two entirely different matters. The California legislature has given the insurance industry draconian powers to control their costs in this department such as:
• Medical Provider Networks (MPNs) (Think company doctor as your primary treating physician).
• Utilization Review (UR) (“No, you can’t have this needed medical treatment as it is not ‘evidenced based’ and it costs too much”).
• American College of Occupational and Environmental Medicine (ACOEM) Guides and the Medical Treatment Utilization Schedule (MTUS)--(Stingy, evidence-based treatment protocols that UR is based on assembled by a pack of conservative pro-insurance physicians).
• Independent Medical Review (IMR), (Medical treatment disputes will be resolved by a doctor who will never see you).
Rest assured, you can get the medical treatment you need in a workers’ compensation claim. You just have to know what you are doing. These benefits are all about saving money for big insurance companies.
Permanent disability (PD) is compensation for your diminished future earning capacity. By the enactment of SB-899 in 2004, PD was slashed by between 40% and 70%, so a lot of attention needs to be focused on making sure this benefit is calculated fairly. Fortunately, there have been some really cool cases that have come down from the Workers’ Compensation Appeals Board and Appellate Courts that put you in the position to fight back and get some meaningful numbers. Also, with the enactment of SB-863, there will be promising scheduled bumps in this benefit for those injured on or after 1/1/13.
Future Medical Treatment
If you settle your case on “stipulation,” you keep your rights to future medical treatment open. The grant is for life. That used to mean something before SB-899 and the Schwarzeneggerization of the comp system. Drastic cuts were imposed on so-called “palliative” treatment such as physical therapy, chiropractic treatment, and acupuncture.
Sadly, keeping your medical treatment rights open sometimes only gives you the right to fight for future medical treatment, as it is now subject to UR, MPNs, ACOEM Guidelines, MTUS and IMR. There are ways to make it work for you. Don’t get discouraged and give up. Read Chapter Three, “How to Get Effective Medical Treatment.” If you have had it with medical treatment under the comp system, Chapter Fifteen, “Settling out Future Medical Treatment Rights,” is required reading.
Supplemental Job Displacement Vouchers
Another cruel joke played on injured men and women in this state was the elimination of the Vocational Rehabilitation program in 2003. Back in “the good old days,” injured workers that could not return to their old jobs had a simple retraining program to help them get back into the work force. Now we have Supplemental Job Displacement vouchers. For injuries prior to 1/1/13, vouchers range from $4,000 to $10,000, depending on an applicant’s level of disability. Now it is a straight $6000 for all injuries. It is not all bad. There still is hope. The trick with vouchers is combining them with other governmental programs to help you get back on your feet.