Hurt On The Job?

That can be a terrible experience. But fortunately, the California workers' compensation system takes away a lot of the worry about job injuries and illnesses. It's no-fault insurance, paid for by employers and supervised by the state. This website explains this valuable benefit.

What's Workers' Compensation?

California's workers' compensation law, passed by the state Legislature more than 90 years ago, guarantees prompt, automatic benefits to workers injured on the job.

Before workers' compensation, injured workers had to sue their employers to recover medical costs and lost wages. Lawsuits took months and sometimes years. Juries and judges had to decide who was at fault and how much, if anything, would be paid. Too often, the injured worker got nothing. It was costly, time consuming and unfair.

Today, workers' compensation is faster and fairer. If you can't work because of a job injury or job illness, workers' compensation pays your medical bills and provides money to help replace your lost income until you can return to work.

Who's Covered?

Nearly every working Californian is protected by workers' compensation, but there are a few exceptions. People in business for themselves and unpaid volunteers may not be covered. Maritime workers and federal employees are covered by federal laws.

What's Covered?

Any injury arising out of and in the course of one's employment is covered. Job-related illnesses are covered too. (For example. common colds and flu aren't covered, but if you catch tuberculosis while working at a TB hospital, that's covered) The key is whether the injury or illness is caused by your job.

When Am I Covered?

Coverage begins the first minute you're on the job and continues anytime you're working. You don't have to work a certain amount of time or earn a certain amount before you're protected. Coverage is automatic and immediate.

How Do I Get Benefits?

Report the injury to your employer or supervisor immediately and complete a simple claim form if more than first aid is required. The claim form will ask what, where, when and how it happened. Your employer or supervisor will see that you get medical help right away and file the necessary reports.

Prompt reporting is the key Your medical bills and any other workers' compensation benefits can't be paid until your workers' compensation claims administrator knows about the injury. Failing to report your injury in a timely manner can result in a delay of receiving your workers' compensation benefits In some circumstances, a significant delay could result un a complete loss of your potential workers' compensation benefits. Insure your right to benefits by reporting every injury, no matter how slight. Even a cut finger can lead to disability if an infection develops.

What Are The Benefits?

Workers' compensation payments are tax free. There are no deductions for state or federal taxes, Social Security, union or retirement fund contributions, etc. For some workers the compensation check will be close to regular take-home pay. California law guarantees five kinds of workers' compensation benefits:

All reasonable and necessary medical care to cure or relieve the effects of the injury or illness

Not just doctor bills, but also medicines, hospital costs. fees for lab tests, x-rays, crutches-even travel expenses for required medical treatment For injuries on or after January 1, 2004 there are limits on some medical services ~ for example the number of visits for chiropractic care, occupational therapy, and physical therapy are subject to caps set by state law. In workers' compensation, there are no deductibles. and all medical costs are paid directly by the claims administrator, so you should never see a bill.

Cash payments to help replace lost wages

Most injuries only keep you from working temporarily, and you'll receive "temporary disability" payments until the doctor says you're able to return to work. Under state law, for injuries on or after April 19, 2004, temporary disability may continue for no more than two years from the date of the first payment, or no more than five years from the date of injury for a few very serious types of injuries such as severe burns or chronic lung disease. Temporary Total Disability is paid at 2/3 of your average weekly wage, subject to minimum and maximum amounts that are set by State law and which vary depending on your date of injury. Compensation is not paid for the first three days you are unable to work, unless you are hospitalized as an in-patient or unable to work for more than 14 days. In these instances, even the "waiting period" will be paid. If you report the injury promptly, your first temporary disability check should be mailed within 14 days. After that, you will receive a check every two weeks until the doctor says you can go back to work or the time limit set by the state is reached.

Permanent Disability

If the work injury or illness results in a permanent impairment of your ability to compete in the open labor market, you will be entitled to additional payments in the form of permanent disability. Permanent disability is determined based on medical reports from treating physicians, Qualified Medical Examiners, or Agreed Medical Examiners. Similar to temporary disability, permanent disability payments are subject to minimum and maximum amounts that are set by State law and which vary depending on your date of injury.

Rehabilitation services necessary to return to work

If the injury keeps you from returning to your regular work, your employer will advise you if your regular job can be modified or if another position can be provided to accommodate your permanent disability. Many employers are subject to laws governed by the Americans with Disabilities Act or the Fair Employment and Housing Act An employer subject to these laws must provide reasonable accommodation -- if possible -- to qualified disabled individuals who can perform all the essential job functions. If you are not able to return to your regular job because of a disability, you may have rights under these laws. For more information call the Equal Employment Opportunity Commission at 1-800-669-4000.

If your injury or illness occurred before January 1, 2004, and it results in your inability to return to your usual and customary job duties, you may be entitled to vocational rehabilitation. Vocational rehabilitation can be in the form of a bona fide offer of modified or alternate work. If your employing department does not have modified or alternate work available for you, then a trained counselor will work with you to develop a plan to retrain you and return you to the workforce in a different job and/or career. Workers' compensation pays for all costs related to such a plan up to a maximum of $16,000.

If your injury or illness occurred after January 1, 2004, you are unable to return to your usual and customary job duties, and your employing department is unable to offer you modified or alternate work, you may be entitled to a supplemental job displacement voucher. These vouchers can only be used for education related retraining and/or skill enhancement at State approved schools. The amount of the voucher you may receive ranges from $4,000-$10,000, depending on your level of permanent disability.

Death Benefits

If your work related injury or illness results in your death, death benefits will be paid to your surviving dependents. These benefits are subject to limitations as set by State law. Workers' Compensation also pays for burial expenses.

What If There's A Problem

Fortunately most claims are handled routinely. After all, Workers' Compensation benefits are automatic and the amounts are set by the Legislature.

But, mistakes and misunderstandings do happen. If you think you haven't received all your benefits, start by calling your employer or Workers' Compensation claims administrator. Many questions can be cleared up with a phone call.

If you still have questions. contact the nearest office of the State Division of Workers' Compensation. Information & Assistance Officers are employed by the state to protect your rights, review your claim, and let you know what steps you can take. For example, they can tell you about the procedures for resolving medical disputes and direct you on how to proceed. Information and Assistance Officers also can provide you with free written materials about workers' compensation. Information and Assistance services are free. For the nearest office check the State Government Offices section of the phone book under Industrial Relations Department." call 1-800-736-7401 for recorded information and the location of a local office, or visit the State Division of Workers' Compensation website at http://www.dir.ca.gov/dwc.

Some problems may need to be resolved by the Workers' Compensation Appeals Board, the state agency responsible for handling disputes. The Appeals Board is a court of law. You can represent yourself or you can hire an attorney. Most attorneys who represent injured workers do son on a contingency fee basis. This means that they are only paid if you recover workers' compensation benefits. Attorneys who represent injured workers are usually paid 12-15% of your total recovery or settlement. If your attorney assists you with the vocational rehabilitation process, they are usually entitled to attorney's fees for their services in that regard. The adjuster handling your claim will typically withhold 12-15% of your vocational rehabilitation maintenance allowance payments to pay for your attorney's fees in connection with your vocational rehabilitation services.

You also need to be aware that if you hire an attorney other people involved in your case-including your claims administrator-may no longer be allowed to speak directly to you about important matters. and the Division of Workers' Compensation Information & Assistance Officers may be unable to advise or assist you. If you choose to stop having an attorney represent you, or you want to change lawyers, your original lawyer can still claim a portion of your benefits as attorney fees.

Keep in mind, it's illegal for an employer to fire or discriminate against employees just because they file, intend to file or settle a Workers' Compensation claim. It is similarly illegal for an employer to terminate, retaliate, or discriminate against an employee for reporting a workplace injury or illness. It is also illegal for an employer to terminate, retaliate, or discriminate against an employee who testified on behalf of a co-worker who establishes that they sustained an injury or illness arising out of and in the course of their employment. State law imposes significant penalties against employers who engage in such conduct.

Other Benefits

If your injury or illness prevents you from working for a year, and you are unable to return to any form of gainful employment, you may be eligible for Social Security Disability Benefits. For information, contact the nearest office of the Social Security Administration (listed in the white pages of the phone book under "United States Government ) or discuss it with your employer or claim administrator.

Workers' Compensation sometimes is confused with another state program. State Disability Insurance (SDI). They seem similar, but there are important differences. Workers' Compensation takes care of on-the-job injuries and illnesses, and is paid for by your employer. On the other hand, SDI covers off-the-job injuries or sickness and is paid for by deductions from your paycheck. If you are not receiving Workers' Compensation benefits, you may be able to get State Disability benefits. For information, call the local office of the state Employment Development Department listed in the government pages of your phone book.

Where Can I Get More Information?

Always start by asking your employer or the Workers Compensation claims administrator (the name, address and phone number are posted at your workplace). Many times problems can be solved and questions answered with a simple phone call. In addition, you can get recorded information or order free written materials about Workers' Compensation by calling the State Division of Workers' Compensation at 1-800-736-7401, or by visiting the Division of Workers' Compensation web site at http://www.dir.ca.gov/dwc. If you would like a State Information & Assistance Officer to explain your rights, solve problems, or provide other information, you can call and leave a message at the nearest local office of the Division of Workers' Compensation. The address and phone number are posted at your workplace and are listed in the State Government section of the phone book under "Industrial Relations Department" The state's information and assistance services are free.

More About Medical Care

Good medical care is important-to you, your family and your employer. Quality medical treatment is the quickest way to recovery.

If there's a first-aid facility at your workplace, get immediate treatment and report where, when and how the accident happened. (If it's an emergency, call for help immediately, get the best treatment available, then report the injury to your employer as soon as possible.)

If it's more than a first-aid injury, your employer will give you a claim form. To make sure you get all your benefits, complete the form and return it to your employer as soon as possible. Within one working day of receiving the claim form your employer should return a signed and dated copy to you, send a copy to the claims administrator, and authorize medical treatment.

If additional treatment is necessary, the claims administrator will arrange for medical care. If you have not pre-designated a personal physician in writing, prior to your injury, you will need to select a primary treating physician from the County's Medical Provider Network. Often, the doctor is a specialist for the specific injury. In addition, the doctor will be familiar with Workers' Compensation requirements and will report promptly so your benefits will he paid. If you want to change doctors for any reason ask your employer or claims administrator.

The doctor with overall responsibility for treating your injury or illness is your primary treating physician (PTP). The PTP decides what kind of medical care you need and when you can return to work. If necessary he or she will review your job description with you and your employer to define any limitations or restrictions that you may have when you go back to work. This doctor also is responsible for coordinating care between other medical providers, and if it is a serious injury, will write reports about any permanent disability, the need for future medical care, or if it is a pre-2004 injury, the need for vocational rehabilitation.

You can be treated right away by your personal doctor (either a medical doctor or doctor of osteopathy who has treated you in the past and maintains your medical records) if your employer offers group health coverage, the doctor agreed in advance to treat you for any work injuries or illnesses and you gave your employer the doctors name and address in writing before the injury.

Above all, don't treat yourself. Even minor injuries need expert care. Prompt, quality medical treatment is the best investment you and your employer can make.