Assisting Clients Across California Since 1993

Frequently Asked Questions

What am I entitled to? What are my rights? 

These are some of the benefits available for an injured worker in California.

Temporary Disability (TD): TD is paid for the period during which the employee is recovering and in the opinion of the treating doctor, is unable to work. TD ends when the injured worker is returned to work or when the disability becomes “permanent and stationary” (released by the doctor). The following qualify as being returned to work: light-duty, modified or full-duty positions.

There is a three day waiting period between the injury and the beginning of payments. If disability extends beyond fourteen days or the worker has been off for 14 days, the insurance company must either begin TD or send what is called a “delay letter” indicating that the claim is being investigated. TD payments equal two-thirds of the employee’s weekly gross income up to a maximum benefit rate. Note that other benefits and income can sometimes be included in gross income.

If your check is late, the insurance company may be liable for penalties, depending on the circumstances. Keep track of the number of your payments and the period of time for which the checks cover, to be sure you are receiving all of your benefits on a timely basis. If possible, keep either a copy of the check before it is cashed or the check stub for your records.

Benefits are limited to two years, with certain exceptions.

If you have questions about how this will affect your case, please call us at 916-800-1414.

Permanent Disability (PD): You are entitled to a PD rating if your injury leaves you with a disability. The amount will vary based on your disability level and income. This is not payable until your condition becomes permanent and stationary (P&S). You may receive weekly PD advances pending the conclusion or settlement of your case. These advances will be deducted (as a credit to the carrier) from any settlement or award. Depending on your date of injury, the procedure when you become P&S can vary.

Pre-1991 — Your doctor makes the initial determination as to your level of disability. You may also be seen by evaluating doctors.

1991-1993 — The amount of Permanent Disability is determined by a Qualified Medical Evaluator (QME). If you are not represented by an attorney, you will be sent a list of three QME’s, called a Panel QME List. You will select a doctor from this list, and his opinion will be binding unless you later hire an attorney, who will have the right to either send you to another QME or agree with the insurance company to send you to an Agreed Medical Examiner (AME).

Post 1/1/94 — Your treating doctor should evaluate your level of PD. If you or the insurance company disagree, and you are unrepresented, you will be sent a Panel QME List. However, once you have seen the Panel QME, you will not be able to select another evaluator, even if you later decide to hire an attorney. You will be bound by the Panel QME’s decision. Therefore, it is very important, if you think you may wish to have an attorney, to contact the attorney before you have selected the Panel QME.

If you have questions about how this will affect your case, please call us at 916-800-1414.

Medical Treatment: You have the right to select your own treating doctor as long as certain procedures are followed. Do not begin seeing a doctor on your own without first requesting a change of physicians from the insurance company, in writing. Your first such request should be granted, but after that additional changes may be challenged based on whether they are reasonable. The insurance company also has the right to send you for a consultation, but they cannot force you to change doctors without following certain procedures.

While injured workers may still choose their own treating doctor after 30 days post-injury, changes to the Labor Code now require that injured workers choose their doctors from a Medical Provider Network (MPN), if the insurance company has created one. This network consists of doctors that the insurance company has chosen to be part of their network. Additionally, injured workers who were treating with doctors outside of an MPN previously can be forced to change their treating doctor to a doctor inside the MPN. Some of the injured workers’ rights regarding doctors within an MPN can be complex, so please feel free to call Walters & Zinn, Attorneys at Law, at 916-800-1414 to discuss in more detail.

If you have questions about how this will affect your case, please call us at 916-800-1414.

Mileage And Related Expenses: You are entitled to be compensated for your travel expenses at up to 58 cents per mile for your round-trip mileage to health care providers for treatment, evaluation, physical therapy or picking up prescriptions related to your industrial injury. Therefore, keep track of your mileage to health care providers and any related expenses such as parking or toll fare. This money can be paid for the expenses you have already incurred.

If you have questions about how this will affect your case, please call us at 916-800-1414.

Future Medical Expenses: Workers’ compensation cases are concluded by Stipulation and Award, Compromise and Release or by trial. If a Compromise and Release is entered into, the worker is selling his right to future medical treatment. A Stipulation and Award or trial may entitle the employee to future medical treatment for the industrial injury at the employer’s workers’ compensation carrier’s expense. Any award following a Stipulation and Award or a trial may be reopened within five years of the date of injury to seek further benefits should your amount of disability increase.

If you have questions about how this will affect your case, please call us at 916-800-1414.

Vocational Rehabilitation: If your treating doctor or the doctors who evaluate you find that you are a Qualified Injured Worker (QIW), you may be entitled to Vocational Rehabilitation. A title of Qualified Injured Worker would mean that you are permanently unable, or likely to be unable, to engage in your usual and customary employment at the position in which you worked at the time of injury. Rehabilitation must be requested within five years of the date of injury or one year of any settlement, whichever is longer.

The insurance company will provide a Qualified Injured Worker who is not offered a modified position ‘school vouchers’ which are redeemable at select schools, generally post-secondary schools. Injured workers should call Walters & Zinn, Attorneys at Law, at 916-800-1414 to discuss in more detail.

If you have questions about how this will affect your case, please call us at 916-800-1414.

 Can I be fired, demoted or harassed for reporting an injury?

California law makes it illegal for an employer to harass, discriminate against or fire a worker for being injured or for filing a claim. California Labor Code Section 132a. This does not mean that this never happens. If you feel your employer has violated this rule, you can call us at 916-800-1414. Please note that a complaint under Section 132a must be filed within one year from the date of the violation.

If you have questions about how this will affect your case, please call us at 916-800-1414.

  Can I file a civil lawsuit against my employer?

With a few exceptions, the answer is no. Exceptions exist for when your employer is illegally uninsured, or if you were injured by a power press which had been modified or for certain intentional acts of the employer. Call us for more information at 916-800-1414.

If you have questions about how this will affect your case, please call us at 916-800-1414.

  Does the insurance company have to pay me right away? 

No. The law allows them to delay payment up to 90 days if they decide to investigate your claim. When you have been off work 14 days, the insurance company must either begin paying benefits, or send what is known as a “Delay Letter” indicating they are investigating the claim. A decision to accept or deny the claim must be made within 90 days, or the claim is admitted by law. Labor Code Section 5402. While your claim is delayed, you may be eligible for State Disability

While an insurance company is still required to send delay letters if benefits are not paid within 14 days, the insurance company is now liable for all reasonable medical treatment, per the new ACOEM guidelines, up to a maximum of $10,000 while the claim is in a delay until the claim is either accepted or denied.

If you have questions about how this will affect your case, please call us at 916-800-1414.

  What if my employer has no insurance?

It is against the law for an employer to not have workers’ compensation insurance. A state agency, the Uninsured Employers Benefit Trust Fund (UEBTF) exists to pay claims to workers injured at an uninsured job. Bringing the UEBTF into a claim is tricky, but feel free to call us for help. Please note that if your employer was illegally uninsured, you may be able to file a regular civil lawsuit in addition to pursuing workers’ compensation. Remember that the one-year time limit for civil lawsuits usually applies. Consult us for more information at 916-800-1414.

If you have questions about how this will affect your case, please call us at 916-800-1414.

 Can I collect a full salary while I am unable to work?

No, unless you have an employment contract or union agreement that provides for a full salary while you are off work. Most people are only eligible for Temporary Disability, which pays two-third of your preinjury earnings, up to a statutory maximum which varies for different dates of injury (see temporary/permanent disability rates).

If you have questions about how this will affect your case, please call us at 916-800-1414.

 What happens if the insurance company is late with a payment? 

The law requires insurance companies to make payments within specific time frames. If they are late they may have to pay you a penalty of up to 25% of the late payment. Call us at 916-800-1414, if you have questions.

The insurance company may avoid this 25% penalty by paying a self-imposed 10% penalty of the amount of the late payment within 90 days of realizing they were late. If you have questions about how this will affect your case, please call us at 916-800-1414.

 Can I collect State Disability for a work injury?

State Disability Insurance (SDI) is paid through the Employment Development Department (EDD) and is designed to provide payments to people who are medically unable to work for a short time, generally up to one year. It is similar to Temporary Disability. You cannot collect SDI and Temporary Disability at the same time. If you are hurt at work and your claim is put on delay, you can collect SDI during the delay. Make sure you tell EDD that your disability is because of a work injury but that you are not receiving benefits. If you start receiving Temporary Disability, you must notify EDD right away.

If you have questions about how this will affect your case, please call us at 916-800-1414.

 What if I can’t do my job anymore? 

Once you are Permanent and Stationary, if the doctor decides you can no longer do your old job, you may be eligible for a retraining voucher.

If you have questions about how this will affect your case, please call us at 916-800-1414.

  Does my employer have to continue my health benefits while I am unable to work?

No. The U.S. Supreme Court has ruled that federal law preempts state law, so if your health care plan is one formed under Federal ERISA rules (which most are) then so long as your employer complies with the requirements of ERISA the termination of your health coverage is probably legal. Call us for more information.

If you have questions about how this will affect your case, please call us at 916-800-1414.

  How can an attorney help me?

Attorneys help make sure you get all the benefits you are supposed to receive. They handle all contact with the insurance company, evaluate the disability reflected in the medical reports, can arrange medical evaluations and handle problems that may arise. An attorney will negotiate the best settlement possible (ideally), but it is then your decision whether to accept. If no informal settlement can be reached, the attorney will file for a hearing and represent you at the Workers’ Compensation Appeals Board (WCAB). Call us at 916-800-1414 for more information.

If you have questions about how this will affect your case, please call us at 916-800-1414.

 How much does an attorney cost?

Nothing upfront. Workers’ Compensation attorneys work on a contingency fee basis, taking a percentage (usually 12% to 15%) of your final settlement.

If you have questions about how this will affect your case, please call us at 916-800-1414.

 Can I select my own treating doctor? 

Maybe. If the insurance company has set up a Medical Provider Network, (MPN) they can force you to choose from within that network, even if you have made a written predesignation of a different doctor. There can be certain exceptions to this, call us for details. If they have not done so, then the old rules apply, and you can select your own doctor 30 days post-injury. There are additional aspects of this rule which are too complicated to note here, please call our office for further information.

While injured workers may still choose their own treating doctor, changes to the Labor Code now require that injured workers choose their doctors from a Medical Provider Network (MPN), if the insurance company has created one. This network consists of doctors that the insurance company has chosen to be part of their network. Additionally, injured workers who were treating with doctors outside of an MPN previously may be forced to change their treating doctor to a doctor inside the MPN. Some of the injured workers’ rights regarding doctors within an MPN can be complex, so please feel free to call Walters & Zinn, Attorneys at Law, at 916-800-1414 to discuss in more detail.

If you have questions about how this will affect your case, please call us at 916-800-1414.