In theory, workers’ compensation is in place to provide the medical treatment that injured employees need to heal from their injury and return to work. Unfortunately, some types of injuries result in permanent physical disabilities, rendering the employee unable to perform the tasks required for their job. In fact, some injuries can even result in the inability for the sufferer to perform the tasks required for any job.
Because long-term injuries can and do occur as a result of workplace accidents, permanent disability benefits are available to provide ongoing treatment and replace the wages that the worker can no longer earn as the result of their injury. Here is a look at the permanent disability payments that are available through California’s workers’ compensation program, and how an attorney can help you to obtain the benefits you need.
Workers’ compensation is a form of no-fault insurance policy that nearly all private employers in California are required to have on behalf of their employees. When a worker is injured on-the-job, this policy provides coverage of medical treatment for the injury, as well as disability payments, which are wage replacement for the time that the worker misses from their job as a result of the injury.
There are several types of disability payments available through California workers’ compensation, including temporary total disability, which provides a portion of the worker’s regular weekly wage while they are out of work due to their injury. Once they are deemed healthy enough to return to work, the payments stop. However, if the worker’s injuries are determined by their physician to be permanent in nature and limit their ability to work, they may be eligible for continued payments.
When an individual is injured as a result of a work-related accident, they will continue treatment until they reach maximum medical improvement (MMI). This is a point when the physician determines that the worker has made all of the meaningful progress in their recovery and that their condition is unlikely to improve further, even if treatments continue. At this time, the doctor will provide to the insurance provider who services the policy with medical reports describing permanent injuries that the worker has and how they prevent the worker from normal use of the affected body part.
Once the report is submitted, a qualified medical evaluator (QME) will provide a disability rating for the insurance company to use to determine the amount of wage loss payments that the injured worker is qualified to receive as well as how long those payments will last. This rating is based on factors such as the nature of the injury, the occupation of the injured employee, and how old the employee was at the time of the injury. If the worker is determined to be 100 percent permanently disabled by the injury, they will be given weekly payments equaling the same amount they received for temporary total disability (usually 2/3 of their pre-injury wage) for life.
If the injured worker is given a disability rating of less than 100 percent, they will be eligible for permanent partial disability payments. The amount of these payments and the length of time that the claimant is eligible to receive them will depend on their disability rating. If the disability rating is over 70 percent, the injured worker still qualifies for lifetime payments.
While California’s workers’ compensation laws were designed with the notion that the injured worker could complete the process on their own. However, the process can be quite complex, particularly when the worker’s injuries present serious limitations. Permanent disabilities are a major source of expenses for insurance companies, and they frequently attempt to limit those expenses by giving low disability ratings. They will particularly fight to keep disability payments below 70 percent, which would trigger the receipt of permanent benefits. A workers’ compensation lawyer understands the medical documentation that is needed to prove that the injury that was suffered is not only permanently disabling, but that it warrants a higher permanent disability payment.
An attorney can also assist with issues affecting your claim, such as ensuring that a lump settlement offered by the insurance company for your long-term injury is fair compensation for the limitations that your disability will permanently place on your ability to earn an income. They can help you challenge a permanent disability rating by requesting a reconsideration of a summary rating within 30 days and can help you understand what your rating means and how it was calculated.
There are only a few reasons why a summary disability rating can be disputed, such as the disability schedules being based on an error of fact, the injury impairs the worker’s ability to rehabilitate from the injury, impacting their loss of future earning capacity in a greater way than what is reflected by their scheduled rating, or the nature of the worker’s disability was not properly reflected in the adjustment factors when calculating their rating.
Long-term injuries can leave a worker unable to perform the tasks of their job, and in many cases unable to perform the tasks of any job. The amount of wage replacement benefits that the injured worker is able to receive for these injuries is based on a complex process of evaluations and calculations that leave many workers with less compensation than they’re entitled to receive. The experienced legal team at KCNS has the knowledge to understand how permanent disability payments are calculated, the tactics that insurance companies use to limit these payments, and the type of evidence needed to stand up to the insurance company and fight for the full value of the claim.
Our lawyers have decades of experience with all types of workers’ compensation claims in California. For your free case evaluation, contact us by calling (818) 937-9255 or using our contact form.
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