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How Workers’ Compensation Works – A FAQ for Sacramento Employees

In almost all cases when someone is injured on the job, the worker will get the best possible outcome by hiring an experienced workers’ compensation lawyer.

Attorney Alice A. Strömbom focuses exclusively on Workers’ Compensation Law. She is very familiar with the tactics insurance companies use to avoid providing the medical treatment and disability benefits injured workers deserve, and has a recognized track record in combating such issues.

Contact us today for a free, confidential consultation and case evaluation.

What is Workers’ Compensation?

Workers’ compensation pays benefits to someone injured at work. The policies of WC are governed by state law, but the benefits are paid by a private insurance company that covers the employees. The employer pays an insurance premium to the insurance company who then pays the employee when he or she gets hurt at work.

Who is Covered?

Every employee in the state of California is covered. All business operating in California that have even one employee must have workers compensation insurance. The amount of coverage is dictated by state law, and the same law determines under what conditions the payments will be made.

Exception: If the company is large enough, it can be self-insured meaning it has to set aside certain funds to pay out in case of injuries. A self-insured company has to follow the same rules as the private insurance companies.

Who is Not Covered?

To recover benefits, the injured must be an employee. This means that the worker must be hired as an employee and not an independent contractor. So what’s the difference?

  • An employee is hired for an indefinite period of time and has an established pay, hours of work, time (shift) and is told how to do their work. Taxes such as Medicare, IRS withholdings, unemployment insurance are all taken from the paycheck.
  • An independent contractor is hired for a particular job, pay is determined by agreement, the ICs are responsible for own taxes. They delegate the job to others and work whenever they wish meeting certain deadlines set by the company.

The main consideration is whether the worker is operating as a freelance/owner of their own business or is he or she showing up to work for their shift and works doing whatever the boss wants them to do.

What Injuries are covered?

The benefits are paid for injuries by an employee hurt at work. The activities of the worker at the time of injury is important. Generally speaking, just about any behavior or activity while at work should be covered so long as they “arise out of and in the normal course of business.” This means that the person must be on the work site doing work in the normal course of business.

However, this law doesn’t require that every moment a person is to be only doing work things like lifting something etc. This also includes activities like taking a break, running an errand for the boss, and even non-work conduct while at work.

This is so the insurance carrier can’t deny benefits because, for example, someone was carrying a cake for a birthday surprise and fell and was injured.

Read more about which injuries are covered.

What Benefits are Paid?

Once an employee is injured in a work-related incident, then the insurance company must pay for certain benefits. These are:

  • Medical Bills: All bills related to the injury from diagnosis to rehabilitation.
  • Temporary disability benefits: This pays your wages while you are out of work if the reason you are out is related to your work injury. The amount is two-thirds of your gross pay up to $1,215.27
  • Permanent disability benefits: If you’re are permanently disabled, you will receive payments based on the severity of the disability and for either life (if 100% disabled) or for a number of weeks.
  • Supplemental job displacement benefits: This pays for in injured employee to gain a new skill or go to school to learn a trade if they are now unable to do their previous work.
  • Death benefits:Payments to your spouse, children or other dependents if you die from a job injury or illness.

How do I Start a Claim?

If you are injured at work, then you must fill out a claim (DWC1) and give it to your employer who then has 24 hours to submit it to the company’s WC insurance. Once this is done, the insurance company will open a case and start to provide benefits according to California’s workers’ compensation rules.

What if I Can’t Work?

If you are injured so that you can’t return to work, then you will receive temporary disability benefits while you heal up and go through rehabilitation, if necessary. During this time, all of your medical bills will continue to be paid, and your employer has to keep your job for you when you are ready to go back to work.

You can return to work once a doctor clears you saying that you are able to resume your pre-injury duties. If the doctor clears you to return to work but with restrictions that do not allow you to do your old job, then the employer can put you on modified duty while you heal up.

What Happens if My Injuries are Permanent?

Once your medical treatment and physical rehabilitation has finished, your doctor will determine if you have any permanent disability. If you do, you can be compensated for that disability. To qualify for this, the doctor must state that you your medical condition is permanent and stationary. This means that you have reached maximum medical improvement and will not get any better even if treated for the next year.

Then the doctor determines your disability rating. This is a percentage of disability based on your injury. A 100% disability means that you have reached maximum medical improvement and are unable to work. When that happens, WC insurer will pay you two-thirds of your pre-injury wage for the rest of your life. However, after 2014, the maximum amount you can receive per week is $290.

If you have a disability rating of something less than 100%, then the weekly amount will be paid out for a number of weeks. For example, a 50% disability rating will pay someone their weekly rate times 400 weeks which is $116,000. The same injury at a 20% rating would be paid for 100 weeks, which would be $29,000.

Can I get Payments for Job Training?

If you are able to go back to work, but your employer does not have a position for you that meets the limitations of your disability, then you can receive payments (in the form of vouchers) for retraining. The total benefits cap at $6,000 and can be spent on any of the following:

  • Tuition, books, administration fees and other required expenses for classes or training skills courses at a eligible educational institution.
  • Any occupational licensing or fees for professional certification, exams and prep courses.
  • Any required tools needed for the training course.
  • $1,000 for computer equipment for training.
  • Up to $600 for job hunting agency.
  • Up to $500 for other educational expenses, like transportation and uniforms.

Do I Need an Attorney?

In almost all cases when someone is injured on the job, the worker will get the best possible outcome by hiring an experienced workers’ compensation lawyer.

Attorney Alice A. Strömbom focuses exclusively on Workers’ Compensation Law. She is very familiar with the tactics insurance companies use to avoid providing the medical treatment and disability benefits injured workers deserve, and has a recognized track record in combating such issues.

The insurance agent who will administer your WC benefits is not employed by you or your employer. Rather they work for the insurance company, and like any company, they want to pay out as little as possible, under the law.

The law is often left to interpretation, and you might want to at least talk to an attorney who understands California Workers’ Compensation laws an rules. You don’t have to hire the attorney, but it is best to be armed with information provided by someone who is on your side.

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