Workers' Compensation Benefits
Victorville Workers’ Compensation Benefits Lawyer
Work-related injuries affect millions of Americans every year, but thankfully the workers’ compensation system provides a process for recovering expenses incurred as a result of their injuries. In 2018, injured workers throughout the U.S. receivedU.S..8 billion in workers’ compensation benefits, with each claim generating an average compensation amount of $41,003. A valid workers’ compensation claim can allow injured workers to obtain a reasonable settlement to cover their damages, meaning they can focus on healing during this challenging time rather than struggling to maintain financial security for their families.
The only way to successfully navigate this difficult process is to hire the services of an experienced Victorville workers’ compensation attorney. At Kampf, Schiavone & Associates, our expert team approaches every claim with compassion, care, and dedication. Employing comprehensive legal knowledge and decades of litigation experience, we provide clients with first-rate legal representation throughout the claims process and work diligently to deliver you the best possible results in your workers’ compensation benefits package.
Eligibility for Workers’ Compensation
In California, workers’ compensation operates according to a no-fault system if the injured worker demonstrates they suffered injuries and incurred expenses as a direct result of their employment. An injured worker does not need to hire a lawyer to make a workers’ compensation claim. However, experienced legal representation can make a significant difference in the outcome of your claim. They can guide you through the process, ensure you complete all necessary steps within the proper statute of limitations, and coordinate an aggressive defense against your employer’s insurance company. If a claim is denied or becomes excessively complicated, a lawyer knows how to handle these issues, so they do not prevent you from receiving benefits.
Requirements to Apply for Workers’ Compensation
Workers’ compensation in California includes specific requirements for submitting a valid claim, such as time limits for reporting your injury. However, eligibility for workers’ compensation benefits does not require the victim to suffer from specific injuries, diseases, illnesses, or debilitating conditions. An injured worker is entitled to collect temporary disability benefits while actively under the care of an MPN physician, equal to two thirds of the average weekly wages. In cases where the injury results in the victim’s death, dependents of the victim may seek death benefits as well.
Types of Workers’ Compensation Insurance Benefits
Benefits available to applicant’s of workers’ compensation claims consist of proper medical treatment, temporary disability benefits, permanent disability benefits, your job back, once your treatment has ended, or the Supplemental Job Displacement Voucher and your rights to apply for the Supplemental Fund through the State of California.
- Medical Benefits
When an employee suffers an occupational injury, they likely require a variety of medical expenses for current treatment and continuing care into the future. Medical benefits are defined as any medical or hospital costs deemed reasonably necessary to either fix the injury or provide relief from its effects. This includes reimbursement for medical treatment, procedures, surgeries, medication, travel to and from doctor appointments, and any additional out-of-pocket medical costs required to ensure the worker recovers fully and may reenter the workforce. By submitting a valid claim within the specified statute of limitations, injured workers can recover 100% of their medical expenses. Nearly two-thirds of workers’ compensation claims are filed to exclusively cover medical benefits.
The employer typically reserves the right to enforce limitations on the doctor or healthcare facility the employee visits during the 30-day period following the injury. The patient may receive as much care as necessary to encourage total recovery, but such care involves completion of a Utilization Review. During this review, another doctor who has not examined you is hired to assess the attending physician’s recommendations. They will employ their own medical knowledge and experience to decide whether the treatment process falls within predetermined guidelines and is needed to facilitate full recovery after the injury.
If the employer/carrier delays this UR process an injured worker may file for a hearing at the Workers’ Compensation Appeals Board and have a judge order the medical treatment.
In denied cases the injured worker is entitled to $10,000.00 in medical treatment initially, until the case is picked up and accepted by the insurance carrier through avenues of the WCAB.
- Medical Benefits
- Temporary Disability Benefits
California’s workers’ compensation program defines temporary disability as any injury or condition resulting from occupational duties that cause the injured employee to miss at least three days of work while seeking treatment or any injury or condition that requires hospitalization. Temporary disability benefits provide up to two-thirds of the amount they would have earned in a typical week if they were not restricted from working due to their injury, referred to as average weekly earnings (AWE). As the AWE increases, so does the temporary disability rate.
Medical documentation is needed to support the assertion that the employee cannot physically return to work, and temporary benefits are available for a maximum of two years or at which time the employee has recovered enough to resume the essential duties of their job, whichever occurs first.
The injured worker is entitled to receive bi-weekly benefits, determined using average weekly wage information and minimum disability rates. Temporary Disability is normally paid for a two- year period. However, in catastrophic cases, this may be extended, or in the event of an additional injury another two -year period of benefits may become available.
Temporary disabilities may be partial or total. A partial temporary disability prevents an injured worker from performing certain occupational tasks and is based on the presumption that they will eventually recover fully and return to their previous work capacity. In these cases, the worker may return to their workplace before achieving total recovery, often with limited responsibilities and a reduced salary. If an injured worker suffers from a total temporary disability, they are temporarily prohibited from continuing the job they performed before sustaining their injury or any other job they were capable of performing before the injury. However, they are expected to heal, and the majority of workers receiving these benefits end up recovering fully and returning to their job, leading to termination of benefits.
- Temporary Disability Benefits
- Permanent Disability Benefits
An injured worker may recover permanent disability benefits if the initial injury they sustain results in a long-term or significantly life-altering impairment even after recovery. These benefits are calculated into a percentage based on the health and disability of the worker, then adjusted higher or lower depending on age and occupation. Permanent disability benefits vary due to the extent of harm suffered and range from under $1,000 for one percent disability to more than $260,000 for 99 percent disability.
An individual with a 100% disability is considered totally permanently disabled and may no longer complete the work tasks they performed before sustaining the injury. They will receive disability benefits throughout their lifetime. Very few workers’ compensation claims involve permanent total disabilities. An injured worker deemed over 70% disabled may receive a life pension that pays a variable rate comparable with disability benefits. Permanent partial disabilities are typically limited to a certain duration of time or a total dollar amount.
Similar to temporary disability, benefits are paid biweekly until the injured worker receives the total compensation amount. Even workers affected by permanent disabilities may ultimately return to the company they worked for previously and perform a modified version of their job with a limited number of occupational tasks. A workers’ compensation physician must inform the employer of accommodation requirements that must be made at the workplace to allow disabled employees to continue working.
- Permanent Disability Benefits
- Supplemental Job Displacement Voucher
When temporary and permanent disabilities prevent an injured worker from returning to the same industry or job they performed before becoming injured, Supplemental Job Displacement Vouchers are available which provides up to $6,000.00 for retraining plus additional miscellaneous expenses up to $500.00 and $1,000.00 for a computer, ten percent of which may be used to hire a counselor to assist in your job search. Some benefits are offered in the form of cash rather than training. If the previous employer does not offer employment within a 60-day period after the worker has reached maximum medical improvement, vouchers may be provided. These vouchers assist the worker in seeking employment at a different workplace.
- Supplemental Job Displacement Voucher
- Right-to-Work Fund
If an injured worker is eligible for Supplemental Job Displacement Benefits, they are also eligible for the right-to-work fund, depending on their date of injury. This offers extra assistance to injured workers unable to return to their previous jobs. The maximum available right-to-work fund benefit equals $5,000.00 per injury. The state of California covers this benefit, not your employer or workers’ compensation insurance.
- Right-to-Work Fund
- Compensable Consequences Benefits
An injured worker suffering occupational injuries that cause additional health problems may be able to pursue compensable consequences benefits as well. Examples of compensable consequences include wrists broken during a fall caused by a work-related knee injury, back injuries developing from a limp caused by occupational knee or ankle injuries, injuries sustained in an automobile accident while traveling to the doctor for treatment of your occupational injury, or injuries caused by medical malpractice during treatment.
Subsequent Injury Trust Fund/SIBTF Benefits
Once the case in chief resolves you may be entitled to benefits through the State of California’s Subsequent Injuries Trust Fund.
What is Subsequent Injuries Benefit Trusts Fund (SIBTF)?
The SIBTF, or Subsequent Injuries Benefits Trust Fund, is a fund established and administered by the California Division of Workers Compensation. The purpose of the fund is two-fold:
To encourage employers to offer employment to workers with pre-existing disabilities.
To encourage workers with pre-existing disabilities to seek employment.
SIBTF accomplishes these two goals by providing benefits to qualified injured workers. In some cases, employers are insulated from liability for pre-existing disabilities by way of the SIBTF.
What are SIBTF benefits?
SIBTF benefits are payments made by the State of California to the injured worker to compensate the injured worker for their pre-existing disability.
Who qualifies for SIBTF benefits?
Injured workers qualify for SIBTF benefits if they fall under the requirements of Labor Code 4751. This requires that the injured worker have a pre-existing disability which predates the compensable industrial injury. The pre-existing disability needs to be labor-disabling or ratable. The pre-existing disability can be industrial or non-industrial. The combined effects of the pre-existing disability and the subsequent injury must be greater than or equal to 70% and the combination of both disabilities must be greater than just the effect of the subsequent injury alone. Finally, the condition must meet one of two thresholds:
The 35% requirement: Permanent disability from the subsequent injury is 35% or higher
The opposite and corresponding requirement: The pre-existing disability affects an extremity (hand or arm or foot or leg) or an eye AND the permanent disability from the subsequent injury BOTH 1) affects the opposite and corresponding member and 2) is 5% or higher
Here is a quick and easy numbered list summarizing the above:
The employee must have a prior partial disability and a subsequent compensable injury;
The degree of disability caused by the combination of both disabilities must be greater than that which would have resulted from the subsequent injury alone;
The combined effect of the pre-existing disability and subsequent injury must be equal to or more than 70 percent; and
The employee’s condition meets one of the following:
The previous disability or impairment affected a hand, an arm, a foot, a leg or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member, and the disability from the subsequent injury, when considered alone and without regard to or adjustment for the occupation or age of the employee, is equal to 5 percent or more of the total; or
The permanent disability resulting from the subsequent injury, when considered alone and without regard to or adjustment for the occupation or the age of the employee, is equal to 35 percent or more of the total.
The term “Subsequent Injury” is confusing to many people. The Subsequent Injury must be an industrial injury whereas the “Pre-existing disability” can be either industrial or non-industrial. The injury is deemed “Subsequent” because the injured must have a disability which pre-exists the “subsequent injury.” Some stakeholders have posited that a more accurate and descriptive term would be “Pre-existing Disability” Benefits Trust Fund rather than Subsequent Injury Benefits Trust Fund.
How much are SIBTF benefits?
SIBTF benefits are intended to provide compensation “for the remainder of the combined permanent disability existing after the last injury.” This amount is often reduced by the amount of compensation that the injured worker has received for the pre-existing disability (with some exceptions).
Schedule Your Free Consultation Today
If you or a loved one sustained an injury in a work-related accident, you may be entitled to receive benefits through the workers’ compensation system in California. For over three decades, the team of workers’ compensation specialists from Kampf, Schiavone & Associates has assisted thousands of California families in navigating this process with confidence and convenience. We are proud to be recognized as the largest workers’ compensation law firm in the San Bernardino area and have recovered more than $250 million for our clients.
We offer free consultations for prospective clients and never charge until we win your case. To discuss your legal options with our team, call (866) 583-8796 or contact us online.