Your Guide to Workers Compensation

Your Guide to Workers’ Compensation

Workers’ compensation is insurance that the law requires your employer to have to cover on the job injuries. Ifyou become injured on the job or contract an illness due to your job duties this insurance is designed to assist you in your recovery. Your employer pays for the insurance. If you can’t work, workers’ compensation pays your medical bills and provides money to replace lost wages.

What types of injuries or illnesses are covered by this insurance?

The injuries covered by your employer’s insurance are any that occur while on the job, including physical and mental injuries or illnesses. This insurance will allow you to receive help if you are injured no matter who was at fault. Workers’ compensation insurance covers everything from one-time occurrences to multiple occurrences that cause an injury. Everything from first-aid type injuries to more serious accidents can be covered. Coverage is automatic and immediate, so be sure to notify your supervisor as soon as possible.

What are the differences between State Disability Insurance and workers’ compensation insurance?

The differences between State Disability Insurance (SDI) and workers’ compensation insurance are simple. If you become injured or ill and it was not work related it would fall under SDI. This benefit is provided by the Employment Development Department. If your illness or injury was work related it would fall under your employer’s workers’ compensation insurance. How do I report an injury or illness?

To file a workers’ compensation claim, you have 30 days to report the injury to a supervisor. If the injury is more than a first-aid situation, your employer will give you a claim form on which you need to describe your injury including where, when, and how. Once you have

returned the completed form to your employer it is their responsibility to submit the form to their workers’ compensation insurance carrier. You will then be notified of your benefits and coverage by the insurance carrier. As an employee you have a right to dispute any action of the employer or insurance carrier. The Workers Compensation Appeals Board must be properly notified within one year of the incident or within one year of the last medical benefit or

indemnity. It is very important that you report your claim immediately. Benefits cannot start until your claim has been received. California state law requires employers to authorize medical treatment within one working day of receiving a claim form. To insure your right to these benefits you must report every injury, no matter how slight, and be sure to request a claim form if it is more than a basic first-aid injury. The employee is entitled to up to $10,000 in medical care within one day of filing a claim form up and until the case is accepted or denied.

The role and function of the primary physician

The primary physician will decide on the type of treatment for the injured worker. The physician will he responsible for when the employee will be able to return to work and what type of duties

the employee can perform. In addition, the physician may refer the injured worker to a specialist or write medical reports that may affect the benefits you receive.

Employees are legally protected from Discrimination

The Employer may not discriminate against you due to a disability. The Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA) exclude

discrimination of the disabled. CA Labor Code §l32a provides that an employer who fires, threatens to fire, or in any manner discriminates against any employee because he or she has filed or made known his or her intention to file a claim for workers’ compensation is guilty of a misdemeanor. The employee’s compensation shall be increased by one half, but in no event more than ten thousand dollars $10,000.00.

The employee is entitled to receive up to $250.00 for costs and expenses associated with the issue.

What are the benefits that I might receive?

The California workers’ compensation law guarantees you six basic benefits:

x M edical care: All reasonable and necessary medical care for your injury or illness with no deductibles. M edical benefits may include treatment by a doctor, hospital services, lab tests, x-rays, and some medicines. For injuries on or after January 1, 2004 there are limits on the number of occupational therapy, physical therapy, and chiropractic visits.

x Temporary disability benefits: Tax-free payments to help reduce lost wages while you were temporarily disabled.

x Permanent disability benefits: These are payments if your injury causes a permanent disability.

x Supplemental job displacement benefits (Vocational rehabilitation): For injuries on or after January 1, 2004, if your illness or injury causes permanent disability, your employer doesn’t offer appropriate modified or alternative work and you don’t return to work for the employer within 60 days of when temporary disability ends, you may be eligible for a supplemental job displacement benefit. This is a nontransferable voucher for education-related retraining and/or skill enhancement at state approved schools. The amount can range from $4,000 to $10,000 in vouchers, depending on the level o permanent disability.

x Death benefits: These are benefits paid to dependents of a worker who dies from a work-related injury or illness.

What if I am temporarily disabled?

Your temporary disability rate will be calculated as follows: the rate is two thirds of your average weekly earnings, subject to minimum and maximum amounts that the legislature determines. The minimum and maximum amounts depend on the date of your injury.

TD Rates 2005 2006 2007 2008 2009 2010-11

M inimum 126 126 132.25 137.45 143.70 148.00

If you are unable to work for more than 3 days you are eligible to receive temporary disability. Generally, temporary disability stops when you return to work or when you are released from a physician’s care. For most injuries, there is a limit of 104 weeks of temporary disability within five years from the date of injury. Certain injuries that typically take longer to heal are exempt. These injuries are subject to a cap of 240 weeks within a five-year period.

What if I am permanently disabled?

If, according to your doctor you are permanently disabled because of the said injury or illness, you may qualify for permanent disability payments. The amount depends on the doctor’s report, how much of the permanent disability was directly caused by your work, and factors such as your age, occupation, type of injury, and date of injury. In general, the rate paid to you is a weekly rate paid spread over a fixed number of weeks. This rate is calculated by determining your rate of disability and then taking a percentage (usually two-thirds) of your average weekly earnings at the time of you injury.

Rating 2003 2004 2005 2006-2010

Up to 14.75% 185 200 220 230

15% to 24.75% 185 200 220 230

25% to 69.75% 185 200 220 230

70% to 99.75% 230 250 270 270

Minimum per week 100 105 105 130

Am I able to predesignate a personal physician?

You can designate a personal physician to treat yourself in the event of a workers’ compensation injury. This can be accomplished by completing the pre-designation form included at the end of this notice and by having your pre-designated physician sign and date the form. The form must then be sent to your employer. The physician of your choice must meet the below

requirements.

Must be your regular physician

Must be your primary care physician or your physician’s integrated multispecialty medical group

Must be licensed per Business & Professions Code Must have previously provided you treatment

The physician of choice can be a chiropractor or acupuncturist. if you do not predesignate a physician, your employer will arrange initial treatment with a Medical Provider Network physician. You then will be able to select a physician within the MPN for ongoing treatment. What if my injury/illness causes death?

If the injury/illness causes death, payments may be made to people who were financially dependent on you. State law sets these benefits and the amount depends on the number of surviving partial and total dependents at the time of injury or illness resulting in death. Workers’

Death Benefit Maximums 07/01/96-12/31/05 2006 — 2010 No total dependents and one or

more partial dependents

$125,000 $250,000

Single total dependent $125,000 $250,000

Single total dependent and one or more partial dependents

$145,000 $290,000

Two total dependents $145,000 $290,000

Three or more total dependents $160,000 $320.000

What happens if I can no longer perform my position’s requirements due to my injury/accident?

For injuries on or after January 1, 2004, if you receive temporary disability payments, within 30 days after that benefit ends, your claims administrator should send you a letter advising whether your employer has a modified job or alternative work available for you. and explaining your potential rights to a supplemental job displacement benefit. If your employer does not have a modified job or alternative work available for you, you don’t return to work for the employer within 60 days after your temporary disability ends, and it is determined that you have

permanent disability, you may choose to receive nontransferable vouchers to use at a state accredited school for education-related retraining or skill-enhancement. If you qualify for the supplemental job displacement benefit, your claims administrator will provide vouchers up to a maximum set by state law:

Supplemental Job Displacement Benefits

(SJDB)

Permanent Disability Level SJDB Voucher Amount

Less than 15% Up to $4,000

15% to 25% Up to $6,000

26% to 49% Up to $8,000

50% to 99% Up to $10,000

How can I receive emergency medical treatment?

If your illness/injury is an emergency, call 911 or go directly to the hospital. Your employer may give you a recommendation as to where to go. When you are being treated be sure to mention that your injury/illness occurred while on the job and if available give the healthcare provider your employer’s workers’ compensation information.

Do I get to choose which doctor I see for treatment?

The following factors have to be considered for you to be able to choose your treating physician:

x Health Care Organization or Medical Provider Network. If through your employer’s workers’ compensation carrier they have selected an HCO or network, then the workers’ compensation insurance carrier will select the doctor.

x Group Health Insurance. If you are covered under your employer’s group health insurance plan, you may pre-designate your treating physician.

The penalties for workers’ compensation fraud.

The laws that govern workers’ compensation make it illegal to file or submit any false documents or statements. If convicted fraud, the individual will face up to 5 years in prison and/or a fine up to $150,000.

Who can I call if I have questions?

If you have questions, you may call your employer’s workers’ compensation insurance carrier, or you may call the Division of Workers’ Compensation Insurance toll free at 1-800-736-7401, or contact one of the following offices:

Division of Workers’ Compensation Insurance Information & Assistance Officers

Anaheim 714-414-1800 Riverside 951-782-4269

Bakersfield 661-395-2733 Sacramento 916-928-3101

Eureka 707-445-6518 Salinas 831-443-3060

Fresno 559-445-5051 San Bernardino 909-383-4341

Goleta 805-968-0258 San Diego 619-767-2083

Long Beach 562-590-5001 San Francisco 415-703-5011

Los Angeles 213-576-7335 San Jose 408-277-1246

Marina Del Rey. _{310-482-3820 San Luis Obispo 805-596-4153}

Oakland 510-622-2866 Santa Ana 714-558-4121

Oxnard 805-485-2533

Santa Rosa

Pomona 909-623-4301 Stockton 209-948-7759

Redding 530-225-2845 Van Nuys 818-901-5367

*Your employer is required to post the name, address, and telephone number of their workers’ compensation carrier at your workplace.

This pamphlet was prepared and published by for its clients.

This pamphlet has been approved by the Administrative Director of the Division of Workers’ Compensation

PREDESIGNATION OF PERSONAL PHYSICIAN

In the event you sustain an injury or illness related to your employment, you may he treated for such injury or illness by your personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or medical group if:

x your employer offers group health coverage;

x the doctor is your regular physician, who shall be either a physician who has limited his or her

practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner, and has previously directed your medical treatment, and retains your medical records;

x your “personal physician” may be a medical group if it is a single corporation or partnership

composed of licensed doctors of medicine or osteopathy, which operates an integrated multi-specialty medical group providing comprehensive medical services predominantly for nonoccupational illnesses and injuries;

x prior to the injury your doctor agrees to treat you for work injuries or illnesses;

x prior to the injury you provided your employer the following in writing: (1) notice that you want

your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor’s name and business address.

You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteopathic medicine treat you for a work- related injury or illness and the above requirements are met.

NOTICE OF PREDESIGNATION OF PERSONAL PHYSICIAN

Employee: Complete this section.

To: (name of employer) If I have a work-related injury or illness, I choose to

be treated by:

(name of doctor)(M.D., D.O., or medical group)

(street address, city, state, ZIP) (telephone number)

Employee Name (please print):

Employee’s Address:

Employee’s

Signature Date:

Physician: I agree to this Predesignation:

Signature: ________________________________________________Date: (Physician or Designated Employee of the Physician or Medical Group)

The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, other documentation of the physician’s agreement to be predesignated will he required pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3). Title 8, California Code of Regulations, section 9783.

NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If your employer or your employer’s insurer does not have a Medical Provider Network, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your claims administrator generally has the right to select your treating physician within the first 30 days after your employer knows of your injury or illness. After your claims administrator has initiated your treatment with another doctor during this period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist.

You may use this form to notify your employer of your personal chiropractor or acupuncturist. Your Chiropractor or Acupuncturist’s Information:

(name of chiropractor or acupuncturist)

(street address, city, state, zip code)

(telephone number)

Employee Name (please print):

Employee’s address:

Employee’s