Working in certain fields such as construction or healthcare may make you more susceptible to occupational hazards. What happens if you get hurt? Fortunately, workers’ compensation covers you if you sustain illness and injury on the job.
California has some of the strongest workers’ compensation systems in the country. The state requires mandatory coverage for nearly every employee and includes several types of benefits. You may receive long-term medical care as part of workers’ compensation.
Benefits for long-term injury or illness
Under California law, you are entitled to all necessary and reasonable medical care needed to cure work-related illness or injury. If a doctor determines you need to miss work while healing, you may receive Temporary Total Disability (TTD) wage replacement benefits.
Long-term medical care and permanent disabilities may entitle you to PD (permanent disability) payments. If your injury permanently limits your ability to work, PD benefits can help you maintain your quality of life. Payouts can scale up the more severe your injury is.
Calculating PD amount and rating
When your doctor determines you have a permanent work-related injury, your PD benefits will depend on several factors. California calculates your payment using a Whole-Person Impairment (WPI) rating to assign a percentage based on your level of impairment.
The state adjusts WPI based on occupation and age. The rating determines your payout duration and amount. For permanent partial disabilities, PD benefits cap out at $290 per week, but are usually two-thirds of your average weekly wage.
High PD percentages in California start at 70%. Above this threshold, you may receive a lifetime pension in addition to regular permanent disability payouts. California classifies a 100% rating as Permanent Total Disability (PTD) and entitles you to uncapped lifetime wage replacement payouts tied to maximum temporary disability rates.
How to claim your benefits
To file a claim for permanent or long-term illness or injury, a suitable physician must formally evaluate you. Any of the three may determine if you are eligible for benefits:
- Qualified medical evaluator
- Agreed medical evaluator
- Your treating doctor
You have a strict 30-day deadline to inform your employer in writing about your injury or illness. To seek workers’ comp, you must file a DWC-1 Claim form. You have one year from the date of injury or last received workers’ compensation payout.
You must be ready to provide proof for your PD claim. The insurance company may still deny your claims but you may still appeal. You may enhance your chances for receiving your fair benefits if you seek competent legal counsel to assist you.
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