This is a brief explanation of the worker’s compensation process. The first part of your case is the active or temporary part. Unless you paid for private disability insurance then you are only entitled to worker’s compensation and available public benefits if you are unable to work. Temporary disability is also paid if you could work with restrictions but your employer is unwilling to provide modified work. The benefit is non-taxable and is based on two thirds of your average weekly earnings on your date of injury. It is payable every two weeks. It stops under three scenarios. The first scenario is when your doctor, or a panel QME examiner, declares you permanent and stationary (as good as you are going to get). The second situation is after you have received temporary disability benefits for a two year period ( even for broken periods of time). It only lasts for a total of two years by statute. The third situation is if you return to work. In that case you don’t need it anymore.
Under all three of the above scenarios the temporary disability payments will stop. Thereafter unless we are ready to settle your case you will only receive advances from the insurance carrier based on their lowest estimate of permanent disability. These payments will come every two weeks and will stop when the estimate reached and are usually around $230 per week. Please refer to the notice from the insurance company for the actual amount.
It is a good idea to file a claim with EDD for state disability as a back up just in case. We carry the claim forms at our office. Although they will not pay you benefits while you are receiving workers compensation, when your temporary disability stops, you can reopen the claim. EDD will file a lien on your worker’s compensation claim just in case you later receive benefits from the workers compensation carrier for the same period. If that does occur you will have to pay EDD back out of it but the money will go back into your state disability account.
If you have been off of work for more than a year you may also be eligible for social security benefits. Please make an appointment to discuss a social security application with me if it looks like you will be off for a year or more.
The second part of your case is for permanent disability benefits. In a perfect world we could immediately settle those benefits when your temporary disability stops. Unfortunately, the calculation of these benefits can take longer, however. The delays are often out of our control and due to availability and schedules of Qualified Medical Doctors. Sometimes the insurance companies contest the opinions of the doctors and ask for further reports and depositions. If we disagree with a report or think a mistake was made we may do the same thing. In some cases the case will have to go to court for a judge to determine the amount of benefits when they are disputed.
As you can see from reading this letter the system is flawed and inadequate. Many people suffer, in addition to their physical injuries, great financial problems. I always encourage my clients to go back to work if they can at any opportunity. But make sure you let everyone know beforehand because it is fraudulent to collect money for being off work while you are actually working.
If you or a loved one has been injured at work it is important to protect your legal rights.