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The Secret to Surviving a California Workers' Compensation Claim (Part 1)

The Secret to Surviving a California Workers’ Compensation Claim (Part 1)
“If you don't know where you are going, you might wind up someplace else.”
Yogi Berra

The Workers’ Compensation System has been around in California since the early part of the 19th century, originally enacted as the Worker’s Compensation Insurance and Safety Act of 1917.

To be brutally frank, the comp system is a down and dirty mechanism to prevent you from suing your employer for their negligence.  In return, your employer provides some significant benefits to help you get back in the saddle.  These benefits are nothing to scoff at; in some situations they can go into the hundreds of thousands of dollars.  No one gets rich; barely enough money is provided to help you squeeze by while you are recovering.  Medical treatment now is provided on an almost MediCal basis.  But, if approached intelligently, food can be on the table and a roof can remain over your head during the process.

Unfortunately, the modern Workers’ Compensation system has simply become a wilderness of red tape.  So you need a very sober understanding of where you are going, the system’s benefits (where they fall short), how to quickly obtain them, and where else to look for help.

You also need a plan.

The secret to surviving all of this is to plot an efficient course through this land of law, procedure and medical evidence the system is now driven by.  If you have never been down this way before you are at a distinct disadvantage. You need to educate yourself and have a good guide. 

These are your objectives:
• Make sure you have the maximum cash benefit coming in while you are recovering
• Make sure you get the maximum case benefit for your Permanent Disability (PD)
• Get the medical treatment you need to get back on your feet
• Settle your claim to provide for your future medical needs
• Make sure you are taking advantage of benefits from other governmental programs

These are the benefits mandated under the California Workers’ Compensation System that can help you achieve your objective.  Permanent Disability and Temporary Disability will be covered in this article (part 1).  Part 2 of this article The Secret to Surviving a California Workers’ Compensation Claim Part 2 will cover what you need to know about medical treatment to achieve your objectives:

Temporary disability       
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 limited to two years, so people with more serious injuries need to think about State Disability early on.
 TD will continue until you reach Maximum Medical Improvement (MMI) meaning that you have reached maximum medical improvement for a reasonable period of time.  Heads up if you are unable to go back to work when you get there!  Your TD will unceremoniously shut down.  If you get lucky, the insurance company will give you a heads up, and send you a notice (with your last check!).  Thereafter, they are required to start paying you advances on your permanent disability (Permanent Disability Advances --PDA’s) every two weeks.  

Permanent disability
Permanent disability (PD) is compensation for your diminished future earning capacity.  Through the enactment of SB-899 in 2004, PD was slashed by 40% to 70%, so a lot of attention is focused on making sure this benefit is fairly calculated.  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 here.  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. 

CONTINUE READING IN PART 2 OF THIS ARTICLE: The Secret to Surviving a Workers’ Compensation Claim (Part 2)


Thomas Ledgerwood
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Proprietor Ledgerwood Law Group