Workers' compensation is a state-mandated insurance program that provides benefits to employees who suffer work-related injuries and illnesses. In California, the workers' compensation system is designed to provide injured workers with benefits such as medical treatment, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits, and death benefits.
In this informative blog, we will explore how to properly calculate your Workers' Compensation benefits in California.
Determining Average Weekly Wage
The first step in calculating workers' compensation benefits is determining an injured employee's average weekly wage (AWW). The AWW is used as the basis for calculating many of the benefits available to injured workers.
To determine AWW, an employee's gross wages for the 52 weeks prior to the injury should be totaled and divided by 52. If the employee has not worked for the same employer for at least 52 weeks, the AWW can be calculated using the wages earned during the time the employee has been working for the employer.
Seasonal, temporary, or part-time workers may have their AWW computed differently based on their work situation, so it is important to consult with a qualified workers' compensation attorney for specific advice.
Calculating Temporary Disability Benefits
Temporary disability benefits are designed to help injured workers recover their lost wages during the period they are unable to work due to their injury. In California, temporary disability benefits are calculated as two-thirds (66.67%) of the injured worker's AWW, subject to weekly minimum and maximum amounts established by law.
Temporary disability benefits are paid every two weeks until the injured worker has reached maximum medical improvement, returned to work, or received benefits for the maximum allowable period, which is generally up to 104 weeks within a 5-year period. These benefits are non-taxable and are not subject to deductions for taxes or Social Security.
Calculating Permanent Disability Benefits
If an injured worker is unable to fully recover from their injury, they may be eligible for permanent disability benefits. Calculating these benefits can be complex and generally involves the following steps:
Rating the disability: A doctor will evaluate the injured worker's level of disability using the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment. The doctor will then assign a percentage disability rating, which represents the worker's loss of bodily function due to the injury.
Using the disability rating schedule: California uses a schedule to establish the compensation for different levels of disability, based on the injured worker's disability rating. This schedule sets the number of weeks an injured worker is entitled to receive benefits and the weekly benefit amount. The worker's disability rating is multiplied by the number of weeks listed in the schedule to determine the total benefit amount.
Factoring in age and occupation: The total benefit amount may be adjusted based on the injured worker's age and occupation at the time of the injury. In general, younger workers and those with higher-paying jobs may receive higher permanent disability benefits.
Calculating Vocational Rehabilitation Benefits
Injured workers who are unable to return to their previous job due to their injury may qualify for vocational rehabilitation benefits. These benefits provide financial assistance for the injured worker to receive training, education, or skills development to help them return to the workforce in a different capacity.
The amount of vocational rehabilitation benefits an injured worker may receive will depend on the individual's specific circumstances, including their AWW, education level, and local labor market conditions.
Calculating Death Benefits and Burial Expenses
When a worker dies as a result of a work-related injury or illness, their dependents may be eligible for workers' compensation death benefits. These benefits are calculated as a percentage of the deceased worker's AWW, with the total amount varying depending on the number of dependents and their dependency status.
In addition to death benefits, California workers' compensation law provides for the payment of reasonable burial expenses, up to a maximum amount established by law. These expenses can include funeral and burial or cremation costs, as well as other customary and reasonable expenses related to the death of the worker.
Maximizing and Protecting Workers' Compensation Benefits
Workers' compensation is a form of insurance that provides benefits to employees who get injured or become ill due to the course of their employment. The benefits typically include medical treatment, wage replacement, and rehabilitation services.
However, to make sure you receive the maximum amount of benefits and protect your rights, it is essential to take certain steps after getting injured at work.
1. Seeking Appropriate Medical Treatment
One of the critical aspects of maximizing workers' compensation benefits is obtaining appropriate medical treatment as soon as possible after the injury. Prompt medical attention not only aids in early recovery, but it also establishes a medical record of the injury, which can prove vital in the claims process.
It is essential to inform the medical professional treating you about the specifics of your injury and how it occurred at work. This will allow them to provide accurate documentation and establish a link between your job and the injury. Ensure that you follow the prescribed treatment plan, attend all follow-up appointments, and adhere to any work restrictions specified by the medical professional. Ignoring medical advice may jeopardize your benefits and hinder your recovery.
2. Documenting All Relevant Information
To protect and maximize your workers' compensation benefits, it is crucial to document all relevant information about your injury and the incident surrounding it. Collect information such as the date and time of the injury in question, names of any witnesses, the location of the accident, and any other circumstances contributing to the incident.
Keep detailed records of all medical treatment received, including doctor's visits, hospital stays, medications, physical therapy sessions, and any other pertinent medical information.
Additionally, maintain records of any missed work time and lost wages resulting from your injury. This robust documentation is vital in supporting your workers' compensation claim and ensuring your maximum entitlement is met.
3. Ensuring Timely Communication With the Employer
To protect your workers' compensation benefits, it is crucial to notify your employer about your injury or work-related illness promptly. Most states have strict deadlines for reporting injuries, and failing to meet these deadlines may result in a denial of benefits.
Provide your employer with written notice detailing the specifics of your injury, including the date, time, and circumstances surrounding the incident. Furthermore, keep your employer updated on your medical treatment and recovery progress, and promptly inform them about any changes in your work restriction or availability.
4. Working With a Qualified Workers’ Compensation Attorney
Navigating the workers' compensation system can be challenging, especially while recovering from an injury. Hiring an experienced workers' compensation attorney can help protect your rights, maximize your benefits, and streamline the claims process. An attorney will assist you in gathering adequate documentation, representing you at hearings or appeals, and negotiating potential settlements.
Additionally, a workers' compensation attorney can recognize any unique issues in your case that may impact your benefits. They ensure that you receive the right medical treatment, and that your employer or insurance company complies with all legal obligations.
Understanding how workers' compensation benefits are calculated in California is crucial for anyone who has suffered a work-related injury or illness. By grasping the factors that influence benefit amounts and the various types of benefits available, you can navigate the workers' compensation process with confidence and ensure that you receive the support you deserve.
To learn about the benefits of Workers’ Compensation, check out Disability Help’s comprehensive guide.