Benefits for Worker's Compensation
There is often confusion about what to expect when you suffer an injury on the job and don't have a full injury recovery. This guide is meant to help you consider the very basic benefits provided.
Benefit 1 OF 4 for Workers' Compensation: MEDICAL BENEFITSMedical Benefits: workers' compensation is designed to treat an injured worker, in order to help them return to work. If your case is denied, then typically treatment takes place with a doctor on a lien basis until the litigation yields an acceptance or settlement. In other cases, where a claim is accepted, then treatment is rendered within the insurance carrier's network. Under current law, insurance carriers are allowed to customize their own medical provider network (MPN) within a statutory framework. The first step toward getting treatment is for the MPN doctor to request authorization. The insurance carrier will then pass the request through a utilization review (UR) to either certify/approve, modify, or non-certify/deny the request treatment. As it turns out, most treatment requests are non-certified. When treatment is denied, the only recourse is appealing to an anonymous independent medical reviewing doctor (IMR), who never sees you or reveals their identity. Rather, the IMR consider the treating doctor's request, the reviewing doctor's denial, and then makes a final decision regarding the treatment. The decision from the IMR is final, and not subject to judicial review.
Benefit 2 OF 4 for Workers' Compensation: TEMPORARY DISABILITY (OFF WORK CHECKS)Temporary Disability Benefits: When a primary treating doctor certifies an injured worker to be temporarily totally disabled (TTD), they can apply for financial benefits equal to two-thirds (2/3) of their average weekly wages (AWW). The maximum TTD benefit injured workers can apply for is 104 weeks (2 years) within 5 years of the date of injury, unless an exception applies, subject to a doctor's report. However, with essentially one out of two claims file being denied, many injured workers are left seeking state disability through EDD, which pays a similar amount, but only up to 52 weeks (1 year), assuming an injured worker has that much in their state account. Typically, EDD seeks reimbursement at the conclusion of an injured worker's claim from the party found liable for the period paid. Temporary disability payments can also be provided when the doctor provides work restrictions which the employer cannot accommodate, or when their is a temporary partial disability.
Benefit 3 OF 4 for Workers' Compensation: PERMANENT DISABILITY (SETTLEMENT MONEY)Permanent Disability Benefits: After treatment for a period of time, a primary treating doctor (PTP), and also an independent evaluating doctor (AME or QME), declare an injured worker's condition to be permanent and stationary / stable. This happens when looking ahead, they don't see a major change in condition over the next 12 months barring some major change like surgery. This is also referred to as maximum medical improvement. At that time, the doctors assign a percentage of impairment associated with each part of the body applicable, which is then transferred to a percentage of permanent disability (PD) based on the injured workers age and occupation. Permanent disability is a dollar figure on a scale from 1-100 within a minimum and maximum, dependent on an injured workers average weekly earnings. It is payable at a certain rate per week for a certain number of weeks, and is combined with each additionally affected body part. Payments in a lump sum are reserved for a request for commutation (up-front payments) based on the discretion of the judge, when the benefit is accrued, or when the parties settle any/all issues related to the benefit by compromise and release.
Benefit 4 OF 4 for Workers' Compensation: SCHOOLING VOUCHERSupplemental Job Displacement Benefit Voucher: In some case, where it is determined that an injured worker cannot return to work in their usual and customary duties, they may be entitled to a schooling voucher of $6,000, plus an additional possible $5,000 state stipend. An injured worker has 1 year from the proof of service of the voucher (AD FORM 10133.32) to activate it. The $5,000 state stipend is on a first come/ first serve basis until the allotted pool of money is exhausted.