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Workers’ compensation provides benefits for employees who suffer from work-related injuries. Some of those benefits are easy to calculate and others depend on factors that are open to interpretation. A California workers’ compensation lawyer can help injured employees understand the benefits to which they are entitled.

Medical Expenses

Medical expenses are the easiest benefit to calculate. The benefits are equal to the medical bills that are incurred because of a work-related injury. Injured employees should tell the treating physician that the injury is job-related so that the provider will bill the employer directly.

To be eligible for payment of medical expenses, employees must report the injury to their employer promptly and must be treated by a care provider selected by the employer (unless the employee has pre-designated a different care provider). A health condition that develops over time (such as repetitive stress syndrome) should be reported as soon as the employee becomes aware that the condition is work-related. The employer should then begin paying for treatment. If the employer disputes that the condition is job-related, the employee should get advice from a California worker’s compensation attorney.

Temporary Disability Benefits

Employees with work-related injuries are entitled to temporary disability benefits if the injury causes them to miss at least three days of work or to be hospitalized overnight. Temporary disability benefits are a form of income replacement.

The benefit continues until the employee is able to return to work or until the treating physician decides that the employee’s condition has reached “maximum medical improvement” (MMI). An employee reaches MMI when the injury is no longer healing but has not completely healed.

Temporary disability benefits are usually easy to calculate. In most cases, the benefit is two-thirds of the employee’s gross wage, subject to minimum and maximum payments. The 2017 maximum is $1,172.57 per week. The 2018 maximum will be $1,215.27 per week.

No payroll taxes are deducted from temporary total disability benefits. For that reason, the benefit is often similar to an employee’s take-home pay.

Benefits can be more difficult to calculate when an employee’s wages vary or when the employee works for more than one employer. Employees can get legal advice from a California workers’ compensation lawyer if they do not believe the workers’ compensation insurance company is paying the full temporary disability rate to which they are entitled.

Permanent Disability Benefits

Permanent disability benefits are paid after an injury reaches Maximum Medical Improvement. Permanent disability benefits are more difficult to calculate than other benefits. The workers’ compensation system uses a formula to calculate the benefit, but the employer and the employee often disagree about the variables that are included in the formula.

Permanent disability benefits are determined by three variables:

  • The date of injury
  • The employee’s average wages before the injury
  • The employee’s “rating”

The date of the injury determines the schedule of benefits that will be used to compute the permanent injury benefit. That variable is not usually disputed, although it is sometimes difficult to determine the onset date if a health condition developed over time.

The employee’s wages are not usually disputed. However, they can be more difficult to calculate if the employee was paid varying rates or had more than one employer.

Determining the Rating

The greatest room for disagreement involves the employee’s “rating.” Factors that affect a rating include:

  • The employee’s age when the injury occurred
  • The employee’s occupation
  • The employee’s medical condition, including any work limitations that will result from the injury
  • How much of the medical condition is work-related and how much is attributable to other causes

The rating is based in large part on the treating physician’s “permanent and stationary” (P&S) report. A P&S report describes the employee’s condition after the employee reaches MMI, including any work restrictions that limit the kind or duration of work that the employee can perform. Common work restrictions involve lifting, bending, standing, and climbing.

The information in the P&S report is used to assign a rating to the employee’s injury. A rating is roughly equivalent to the percentage by which the disability affects the employee’s ability to work, as compared to the employee’s pre-injury condition.

An employee with a disability of 100% is totally disabled. Total disability ratings are rare. The smallest possible disability rating is 0.025%. Most disability ratings fall between 5% and 30%, although serious injuries can produce significantly larger ratings.

Ratings can be determined by a disability rater. However, experienced California workers’ compensation attorneys will often determine a fair rating based on the P&S report. The claims administrator for the insurance company will also propose a rating. Negotiation resolves different rating estimates in most cases.

Permanent Disability Benefits Settlements

If a dispute is resolved in a contested hearing, a workers’ compensation judge will determine the benefit. That benefit will then be paid over a period of weeks, as determine by the appropriate benefits schedule.

When the employee and employer settle, they can reach an agreement (or stipulation) about the facts, including the appropriate rating. The workers’ compensation judge will then enter an order pursuant to that stipulation. The order will require the employer to pay any continuing injury-related medical expenses for a period of time.

In many cases, however, an employee will agree to give up the right to receive payment of future medical expenses in exchange for a lump sum settlement. The lump sum will typically be larger than the employee would otherwise receive to account for the fact that the employer will not be paying future medical expenses.

Lump sum settlements are often a good choice for employees who do not expect to have future medical expenses. Employees who are willing to take that risk are rewarded with larger settlements.

The exact settlement amount is determined by all the factors discussed above, in addition to the lawyer’s experience in negotiating workers’ compensation settlements. A thorough review of all the facts (which might include getting a second medical opinion) is necessary to maximize the benefits that the employee will receive.

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I have been working for a famous hotel in Los Angeles for more than 2.5 years when an accident happened inside the hotel and I had meniscus tear of my right knee and back pain. After I found out the management didn’t care of my situation I decided to get an attorney, so I researched on the computer and I found ODG Law Group. I met with Leanna and she explained how she can help me. Because she was very nice and honest person I signed a contract and she accepted my case. After few years I decided to settle my case and I was happy about it. I also want to thanks to Tina. She is very nice person and every time I contact her she helped me with good manner. Thank you ODG Law Group for your professional work.

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