A: Workers’ compensation is a form of insurance that provides benefits to employees who suffer work-related injuries or illnesses. It typically covers medical treatment, rehabilitation costs, and lost wages during the recovery period.  After the recovery period, it typically provides additional benefits such as compensation for lasting impairment and help to transition to a new job, if necessary.

A: Most employees are eligible for workers’ compensation benefits, including full-time and part-time workers. However, independent contractors and most volunteers are generally not covered, although in a few situations, volunteers may be covered according to California law.  The specific eligibility criteria vary by jurisdiction and employment status, so it’s important to consult with a local attorney.

A: Workers’ compensation generally covers injuries and illnesses that occur in the course of employment. This can include physical injuries such as sprains and fractures as well as occupational diseases like respiratory conditions or hearing loss caused by workplace exposure.  Psychological injuries may be covered.  In addition, injuries due to repetitive work may be covered.  The types of injuries covered vary depending on the law of the state.  California law recognizes all of the above types of injuries or conditions. 

A: It’s important to report your work-related injury or illness to your employer as soon as possible. Each company may have its own reporting process, but generally, you should notify your foreperson, supervisor or human resources department. Failing to report in a timely manner could affect your ability to claim workers’ compensation benefits.

A: If your claim is denied, you usually have the right to challenge the decision. The type of challenge varies by jurisdiction, but it usually involves submitting a formal written request to the state workers’ compensation agency.  You should consult with a workers’ compensation attorney to navigate this process. 

In California, the process for nearly all claims. especially for all relatively recent injuries, is to file an Application for Adjudication with the appropriate District Office of the Division of Workers’ Compensation.    

A: The rules regarding choosing a doctor depend on the jurisdiction. In some cases, employers may have a specific network of healthcare providers that employees must use for initial treatment. However, in other instances, you may have the freedom to select your own doctor once you have reported the injury or illness.

In California, this question can be complex.  Generally, most insurance companies who administer claims for work injuries in California have a Medical Provider Network (MPN) which you need to use.  If the insurance company (claims administrator) for your claim has an MPN, you generally need to pick a doctor in the MPN network, which you can do after your first visit by submitting a request to change your treating physician. However, if there are not enough doctors in the MPN close to you, you may be able to select a doctor outside the MPN. In addition, if the claims administrator does not have an MPN (which is unusual), you are of course not confined to treating within an MPN.  There are more complexities with this question that simply cannot be covered here. For more information on Medical Treatment, click here. 

A: Workers’ compensation benefits typically replace a portion of your lost wages while you are unable to work due to a work-related injury or illness. The amount you receive is usually a percentage of your regular salary, subject to maximum limits set by the workers’ compensation laws in your jurisdiction.

In California, this benefit is known as Temporary Disability.  If you are unable to perform your normal job and suffer wage loss as a result of your work injury, you are supposed to receive two-thirds (2/3) of your gross wages (before taxes) for Temporary Total Disability, or two-thirds (2/3) of your weekly loss in wages for Temporary Partial Disability.  These amounts are subject to statutory limits and are based on your gross (pre-tax) average weekly wages.  For more information on Temporary Disability, click here. 

A: The duration of workers’ compensation benefits can vary depending on the severity of the injury and the jurisdiction. In general, benefits continue until you have recovered and can return to work, or until you reach maximum medical improvement, which means your condition is unlikely to improve significantly with further treatment.

In California, temporary disability benefits for most injuries usually cease upon the earliest of the following: (1) when you do not continue to be disabled from working, (2) when you no longer are suffering wage loss due to the injury, (3) when the condition becomes permanent and stationary, (4) when you have received the maximum of 104 weeks of benefits, or (5) five years from the date of injury. While the above timeframes usually apply to most injuries occurring after 2007, these timeframes can vary for certain severe injuries or conditions based on the date of injury. Retirement or other life events can also potentially interfere with your right to receive temporary disability benefits. If you continue to be unable to work due to your injury, it is usually helpful to continue seeing your treating physician and obtaining status reports to show that you remain unable to work. 

A workers’ compensation attorney may be able to help extend the period of your temporary disability payments if they were cut off prematurely. An attorney can evaluate your right to receive temporary disability benefits, based on the medical record, and can ask the doctors involved relevant questions to determine whether or not your condition has actually become permanent and stationary.  It is of course much better to get an attorney involved in the process sooner rather than later, and it is best to have an attorney involved in your claim from the very beginning.

Additionally, in California, you may be eligible for compensation for Permanent Disability after temporary disability ends and your condition becomes stable, or “permanent and stationary.”  “Permanent disability” does not mean payments are permanent or last forever.  Permanent disability is meant to compensate the injured worker for lasting impairment, which can run the range from being a very slight impairment to being a very severe impairment.  If the permanent disability is slight, payments may be for as little as a few weeks, and if it is severe, they can last for years.  In rare situations for extremely severe impairment, permanent disability can last for life.  Again, permanent disability may be additional compensation AFTER and in addition to temporary disability.  For more information on Permanent Disability, click here.