The Money Benefits Available For California Workers' Compensation Claims

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Practice Areas: Workers Compensation

Several different types of money benefits are potentially collectable by injured workers under their claim for workers compensation benefits. This article sets forth the benefits and how they work within the system. Remember, this is a general view of the benefits, and each unique injury and claim situation will dictate which apply to any particular case. For information on how they will apply to your case, you need to consult with a Upland workers compensation lawyer. General information should never be applied to a unique case without consulting directly with an attorney

Temporary Total Disability Money Benefit:

This type of benefit is available as a form of wage replacement while the worker is recovering from an injury. To qualify for this money, there must be a complete inability to perform any type of work for the employer within doctor's restrictions. The money is collectible for up to two years and is paid at the rate of two-thirds of the employees gross average weekly rate. For injuries occurring in 2014, the maximum weekly rate is $1,074.64. This means that $1,074.64 is the most anyone can collect in one week even for those whose two thirds gross average weekly rate is greater than $1,074.64. For those injuries which will occur in 2015, the maximum weekly rate will be $1,103.29.

The temporary disabilty benefit is paid directly from the insurance company or third party administrator to the employee where the doctor places the worker on restrictions that the employer cannot accommodate or where the doctor deems the work related condition cause the employee total temporary disability. The key word is temporary, meaning that the doctor expects the employee's condition to get better with further medical treatment.

Temporary disability benefits from the workers compensation carrier should not be confused with State Disability Insurance (S.D.I.) paid by the Employment Development Department. Although both S.D.I. and Temporary Disability Benefit are calculated in the same way and paid for similar reasons, S.D.I. is available whether or not the injury occurred at work or outside of work and is available so long as money has been appropriately withheld from the employees paycheck for S.D.I. In the event the insurance company refuses to pay the temporary disability money benefit, an employee may attempt to collect money from their S.D.I. account from the Employment Development Department. At the end of the workers' compensation claim, E.D.D. may require the insurance carrier to reimburse moneys paid to the injured worker under S.D.I. if it is found that the temporary disability benefit should have been paid by the insurance company, and the judge will refuse to allow the claim to close until the workers' compensation carrier fulfills its obligation of reimbursing the State.

Temporary Partial Disability Money Benefit:

In some instances, the doctor places the worker on restrictions that call for reduced hours but do not restrict the workers ability to perform their full duties on the hours that they are able to work. Where the partial employment (less hours) pays the employee less than the weekly maximum temporary total disability rate, the employee is paid two-thirds of the money that was lost by working less hours up until their average weekly rate of pay reaches the maximum temporary disability rate.

Permanent Disability Money Benefit:

Temporary disability is money paid as wage replacement to keep the injured employee financially afloat while they are out of work recovering from their injury. The money continues for two years or until the employee reaches maximum medical improvement (no more improvement can be had for the condition). At that point in time, the disability is no longer considered temporary as it has become a permanent condition. Where the permanent condition results in no limitations whatsoever (full recovery), no permanent disability money benefit is paid. However, where permanent limitations are present, the nature and extent of those limitations will define the amount of permanent disability money benefit is paid. The permanent disability money benefits function within the system is to compensate the employee for a loss of earning capacity in the future resulting from a lessened ability to compete in the open labor market due to their permanent injury.

Death Benefit:

In the event the employee dies from a work related injury or illness, benefits may be payable to dependents (spouse, children or other dependents) of the deceased. For injuries on or after January 1, 2013 the benefit provides: $10,000.00 burial expense; $250,000 (1 dependent); $290,000 (2 dependents); $320,000.00 (3 or more dependents).

Mileage Reimbursement Benefit:

The mileage reimbursement benefit is available to pay for the expense and travel to and from medical appointments  to treat the work related injury or illness. Reasonable expenses for transportation include mileage reimbursement (after 1/1/14 $0.56 per mile), parking, bridge tolls, and apply to any appointment with a doctor, hospital, therapist or to travel to pharmacy to pick up medications.

This is just a simple breakdown of the money benefits available in the system. The amount available for any specific case varies widely depending on the specific circumstances of the injured worker. For a better understanding of your particular situation, contanct our local Upland workers compensation lawyer office.

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