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WORKERS PENSION CALIFORNIA

Almost every employed Californian is protected by workers' compensation for job related injuries or illness. Therefore it's important that both employer and employees understand workers' compensation insurance.

This guide provides general information on workers' compensation insurance and offers suggestions on where to seek help with a question or problem (see listings of exhibits I, II and III).

MOST FREQUENTLY ASKED QUESTIONS ABOUT WORKERS COMPENSATION

Q. What is covered under a workers' compensation insurance policy?

A. The workers' compensation insurance policy includes two separate coverages: workers' compensation and employers liability. The workers' compensation coverage applies to injury or disease to the employee resulting from employment. The insurance company will pay benefits to the employee specified under the law. Employers liability coverage protects the employer for employee work-related bodily injury which is not compensable under workers' compensation coverage.

Q. What are workers' compensation benefits?

A. Depending on the circumstances of the accident and/or the injury, employees may be entitled to one or more of the following benefits:

Medical Care: All medical treatment necessary to cure or relieve the effects of a work-related injury or illness will be paid either by the employer or the insurance company providing coverage. This includes physician services, hospitalization, physical restoration, dental care, prescriptions, X-rays, laboratory services, and all other necessary/reasonable care ordered by the treating doctor(s).

Temporary Disability (TD) Paid if a physician verifies that an injured employee cannot work because of a work-related illness or injury. TD benefits are not paid for the first 3 days of work missed unless the employee is off more than fourteen days or hospitalized. The amount of TD compensation is determined by law and is two thirds of the employee's wages with a minimum of $126.00 per week (or the actual weekly wage if that is less than $126.00) and a maximum of $490.00 per week. Payments must be made every two weeks, for as long as the employee is eligible. TD benefits stop when the employee returns to work or the treating physician releases the employee for work or says that the injury has reached a point of maximum improvement.

Permanent Disability (PD) Paid if an injury or illness results in a permanent impairment that reduces the injured workers ability to compete in the open labor market. The amount he employee will receive depends on the extent of the disability. Other factors that are considered when calculating PD include the date of injury, the age when injured, and occupation. PD benefit amounts are set by law. PD benefits are paid every two weeks until the benefit is completely paid or when the employee settles the case and receives a lump sum (See exhibit III for maximum benefit rates.)

Vocational Rehabilitation (VR) Paid if it is unlikely a worker will be able to return to the usual job prior to his/her injury and the employer does not offer other work. Vocational Rehabilitation Maintenance Allowance benefits (VRMA) are paid while the employee is participating in vocational rehabilitation. VRMA is paid every two weeks for as long as the employee is eligible. The Division of Workers' Compensation, Rehabilitation Unit, must approve the rehabilitation plan. The right to rehabilitation is voluntary; injured workers may accept or reject this benefit. For injuries occurring on or after January 1, 1994, there is a $16,000.00 limit on all rehabilitation benefits.

Transportation Reimbursement Paid by the insurance carrier or employer for the reasonable cost of transportation incurred while obtaining medical care and rehabilitation. The injured worker is entitled to mileage from their home to place of treatment, examination or rehabilitation and back at the rate of 31 cents per mile.

Death Benefits Paid to qualified surviving dependents of a worker who dies from a work-related illness or injury. These benefits are paid usually at the same weekly rate as the maximum TD benefit in effect at the time of injury/illness. The maximum benefit will vary depending on the number of total and/or partial dependents.