Under the California workers compensation system, a worker injured on the job is entitled to benefits including:
- medical care - treatment for the injury
- temporary disability - payment for loss of wages
- permanent disability - payment for permanent loss of function
- job displacement benefits - payment for job retraining
Medical treatment is directed by a treating doctor that is part of a Medical Provider Network. Medical care must go through Utilization Review, a review of appropriate treatment for each type of injury.
An injured worker is entitled to mileage reimbursement for medical care travel.
Temporary disability benefits are payments for an injured worker's inability to work due to an injury. The rate is two-thirds of the injured worker's average weekly wage.
Temporary disability benefits are limited to 104 weeks within five years of the date of injury.
Permanent disability benefits are calculated based on the permanent loss of function on a 0 to 100% scale.
Permanent disability is paid on a weekly basis for a set period of time depending on the level of disability. The maximum weekly rate is $290 a week.
Job Displacement Benefits
Supplemental job displacement benefits are for an injured worker who cannot return to work after his or her condition has stabilized and is permanent and stationary. The injured worker receives a voucher for $6,000 for retraining.
The injured worker can receive additional benefits in the form of a penalty that the insurance company must pay for any benefit that is paid late based on Labor Code sections 4650 and 5814. The penalty can be up to 25% of the amount it is late in paying.
In this article, our California personal injury attorneys will explain:
- 1. Workers' compensation benefits in California
- 2. Medical Treatment
- 3. Temporary Disability Benefits
- 3.1. Payment of temporary disability
- 3.2. Calculation of temporary disability
- 3.3. Disputes of temporary disability
- 4. Permanent Disability
- 4.1. Permanent disability ratings
- 4.2. Permanent disability rate
- 4.3. Permanent disability payments
- 4.4. Disputes of permanent disability
- 5. Supplemental Job Displacement Benefits
- 6. Late payment of benefits
California workers' compensation benefits include:
- medical treatment for the injury
- wage loss or temporary disability benefits
- permanent loss of function or permanent disability benefits
- retraining or job displacement benefits
An injured worker becomes eligible for California workers' compensation benefits by filing a workers compensation claim for a work injury.
Before benefits are paid, the insurance company must decide if it is going accept that there is a work injury. The injured worker will receive forms from the insurance company with its decision.
California workers' compensation benefits include medical treatment for the work injury.1 However, an injured worker must be treated by a doctor in a special network, called a Medical Provider Network (MPN).2
Injured workers receive a standardized level of care. All treatment in workers' compensation is based on medical treatment guidelines that determine the frequency, duration, and appropriateness of all treatment commonly performed in workers' compensation cases.3
All the MPN doctors must follow the medical treatment guidelines through a process called Utilization Review (UR).4 Medical treatment requests are sent to an independent physician that can
- modify, or
- deny the treatment request.5
The treating doctor will treat the injured worker until he or she believes that further treatment will not be effective. At this point, the treating doctor will write a report called a Permanent and Stationary Report.6
An injured worker is entitled to mileage reimbursement for travel to and from all medical appointments. This includes travel to pick up prescriptions.
Example: Candice is involved in an automobile accident while working as a delivery driver.
She selects a treating doctor that is in the MPN. In addition to office visits, her doctor sends her for an MRI of her neck and for physical therapy. All the medical treatment is approved by Utilization Review.
Candice does not have to pay for any of the treatment.
She also submits mileage reimbursement requests totaling $170 to the insurance company for travel to and from her doctor's office, physical therapy, the MRI appointment, and to pick up prescriptions.
Temporary disability benefits are payments for lost wages due to a work injury.
Temporary disability is a substitute for lost wages, replacing what the employee would have earned if he or she was not injured. 7
Temporary disability benefits are only paid once the insurance company agrees that the injury is work-related. If the injury is denied, no benefits will be provided by the insurance company.
To get California temporary disability benefits, a doctor must state that an injured worker cannot work due to his or her injury or is limited in the kind or amount of work, and the employer does not have modified work or light duty to offer the worker as an alternate.8 9
The treating physician will see the injured worker every 45 days and make recommendations about his or her work restrictions and ability to work.10
Payments of temporary disability are made every two weeks.11 The first payment should be made by the insurance company within 14 days of receipt of the medical report stating the injured worker cannot work at all or cannot work the number of hours he or she previously did.12
Temporary disability will end when:
- the injured worker returns to work
- a doctor advises that the injured worker can return to work, or
- the injured worker's condition stabilizes, and he or she become eligible for permanent disability benefits.13
California temporary disability benefits are limited to 104 weeks within a five-year period from the date of injury.14
The amount of temporary total disability an injured worker receives is two-thirds of his or her average weekly wage (AWW).15
After calculating the temporary disability rate, the insurance company will check to see if it is below the minimum or above the maximum level set by the state.
The maximum and minimum amount of temporary disability an injured worker can receive changes each year based on a calculation of what California employers are paying their employees.16
Example: Alice suffers a fall at work and injures her hip. She goes to the doctor, and she is taken off work.
Alice made $1,000 a week at her job. Her temporary disability rate is two-thirds of this, or $667.
Within 14 days of Alice going off work, the insurance company sends Alice a check for $1,334, which is for two weeks of temporary disability.
It will continue to send Alice temporary disability checks every two weeks until she goes back to work or is declared permanent and stationary.
An injured worker may believe that he or she can't work or that the doctor's restrictions are incorrect. If that happens, the injured worker can request that a different doctor evaluate him or her and determine temporary disability status.17
Permanent disability benefits pay an injured worker for loss of future earning capacity due to the permanent effects of the work injury.18 19
Permanent disability is rated on a scale from 0 to 100%. If an injured worker's disability rating is under 100%, he or she is considered partially disabled.20 The injured worker will be entitled to weekly payments for a set period of time.
If an injured worker is 100% disabled, he or she is regarded as permanently totally disabled.21 In this case, the injured worker is entitled to weekly payments at the temporary disability rate for the rest of his or her life.22
If an injured worker's disability rating is between 70% and 99%, he or she is entitled to a life pension.23 After the weekly partial disability payments end, the injured worker will get an additional amount for the rest of his or her life due to the higher level of disability.
At some point, the treating doctor will state that the injured worker has reached permanent and stationary status. This means that the injured worker's medical condition will not improve.
Since the injured worker's condition has stabilized, the doctor can determine the level of permanent disability.
A permanent disability rating begins with a doctor determining a rating for each part of the body that was injured at work.
Once a doctor gives the injured worker an impairment percentage, it is converted into a permanent disability value. This is done using the California Permanent Disability Rating Schedule (PDRS).
Once there is a rating, it must be converted into a dollar value using a formula in the Labor Code.24
The California permanent disability rate is determined by calculating two-thirds of the worker's average weekly wage.25 But the maximum amount is much lower than most workers' calculated rate.
Since 2014, the maximum permanent disability rate is $290 per week. 26
If an injury causes permanent disability, the injured worker should receive the first permanent disability payment within 14 days after the last payment of temporary disability.
Permanent disability cannot be paid while an injured worker is receiving temporary disability.
Even if the insurance company does not know the amount of permanent disability that the injured worker will ultimately receive, they should estimate it and make payments on that amount.27
Payments of permanent disability are made every two weeks.28
Example: Jesse has been off work for his back injury for 6 months. Jesse's condition has not yet stabilized, but his doctor says he can go back to work.
The insurance company sends Jesse a form letter saying that it is ending temporary disability payments and estimates Jesse's permanent disability at 5%.
Jesse begins receiving permanent disability payments of $290 a week.
An injured worker who believes that the treating doctor did not provide the correct permanent disability can request that a different doctor evaluate him or her to determine his or her permanent disability status.29 This is called a med-legal examination.
If there are two competing medical reports on the level of permanent disability, there is the option of having a trial on the issue.
The injured worker can testify about the injury, and the judge will review medical reports and records, and decide the level of disability.
Injured workers that are not able to return to work are eligible for a $6,000 supplemental job displacement voucher.30
To avoid a voucher, the employer must offer the employee regular, modified, or alternate work. The work must be:
- at least 85% the salary of the prior job
- a reasonable commuting distance from the injured worker's home31
- lasting at least 12 months
The offer has to be sent within 60 days of receiving a medical report that the injured worker is permanent and stationary. 32
The voucher can be used for:
- licensing and examination fees
- placement and resume services
- tools for training program
- computer equipment
Example: Bryan is a warehouse worker and he injures his shoulder at work. When his condition stabilizes, his doctor says Bryan is restricted in the activities he can do. He can only lift up to 15 pounds.
The employer doesn't have any positions it can offer within those restrictions. Bryan cannot continue working with the employer but will get a $6,000 voucher to help him get a new job.
If any of the above benefits are not paid on time, an injured worker may get an additional penalty payment from the insurance company.
Penalties exist to:
- make any delayed payment costly to an insurance company
- avoid economic hardship for the injured worker by ensuring prompt payments33
Section 4650 penalty
California Labor Code section 4650 applies to late payments of temporary disability benefits and permanent disability benefits.
If an insurance company does not make temporary or permanent disability payments timely:
- the payment shall be increased by 10%34
The payment is considered late if:
- it is not made within 14 days of the start of the payments35
- if subsequent payments are not made every two weeks after that
Section 5814 penalty
Labor Code section 5814 applies to any payment of benefits.
If a payment to an injured worker has been unreasonably delayed or refused:
- it shall be increased by up to 25% of the amount delayed, or $10,000, whichever is less36
If an injured worker's permanent disability payment is late, he or she will receive an additional 10%.37
Example: Tara has a work injury to her back. Her doctor says she cannot work for six weeks.
She should have received temporary disability payments of $700 per week for her lost wages. The insurance company did not make the payments until the end of the six weeks.
When the insurance company finally sent the payment for the six weeks of lost wages totaling $4,200, it also sent a check for a 10% penalty of $420.
The California workers' compensation system is set up to provide benefits to injured workers.
Insurance companies that provide benefits are set up as profitable companies first and providers of benefits second.
If an injured worker is not receiving benefits, it may not be because he or she does not have a valid claim, but because the insurance company is putting profits above all else.
Anytime benefits are delayed or denied, an injured worker must make every effort to claim the benefits he or she deserves.
Call us for help...
For help with filing a workers compensation claim in California, completing workers comp forms or appealing a denial of benefits, contact us at (855) LAW-FIRM. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries in California.
Cal. Lab. Code §4616(a)(1).
Cal. Lab. Code § 5307.27(a).
Cal. Lab. Code § 4616(e).
Cal. Lab. Code § 4616(f).
Cal. Code Regs., tit. 8 § 9785.3.
Signature Fruit Co. v. Workers' Comp. Appeals Bd., 142 Cal. App. 4th 790, 801.
Cal. Lab. Code § 4658.7.
Cal. Lab. Code § 6409.
Cal. Code Regs., tit. 8, § 9785(f).
Cal. Lab. Code § 4650(c).
Cal. Lab. Code § 4650(a).
Signature Fruit Co. supra, at p. 801.
Cal. Lab. Code § 4656.
Cal. Lab. Code § 4653.
Cal. Lab. Code § 4453(a)(10).
Cal. Lab. Code § 4062.
Signature Fruit Co. supra, at p. 802.
Russell v. Bankers Life Co. (1975) 46 Cal. App. 3d 405, 419.
Cal. Lab. Code § 4452.5(b).
Cal. Lab. Code § 4452.5(a).
Cal. Lab. Code § 4659(b).
Cal. Lab. Code § 4659.
Cal. Lab. Code § 4658.
Cal. Lab. Code § 4658.
Cal. Lab. Code § 4650(b)(1).
Cal. Lab. Code § 4650(c).
Cal. Lab. Code § 4061.
Cal. Lab. Code § 4658.7(d).
Cal. Lab. Code § 4658.1.
Cal. Lab. Code § 4658.7(b)(1).
State Compensation Insurance Fund v. WCAB (1998) 63 Cal. Comp. Cases 916, 921.
Cal. Lab. Code § 4650(d).
Cal. Lab. Code § 4650(d).
Cal. Lab. Code § 5814(a).
Cal. Lab. Code § 4650(d).