Familiarity with the language used by California’s workers compensation system helps injured workers understand the terms they might encounter
Pursuing a California worker’s compensation claim is easier when the injured employee understands the process. In the second article of this two-part series, we explain ten of the twenty most common terms used in California workers’ compensation law. A Santa Rosa workers’ comp lawyer can answer any additional questions that an injured worker might have.
Offer of Modified or Alternative Work. When an employee who is permanently disabled because of a work injury is unable to return to his or her former job because of work restrictions, an employer has two choices. The employer can allow the employee to return to work in an alternative or modified job that is consistent with the employee’s work restrictions, or the employer can offer supplemental job displacement benefits. When the employer offers a return to work, the employer makes a written Offer of Modified or Alternative Work. The employee then has 30 days to accept or reject the offer. Since rejecting the offer can result in a reduction in the value of permanent disability benefits, it is best for the injured employee to discuss his or her options with a workers’ compensation attorney.
Permanent and Stationary (P&S) Report. The injured worker’s physician will write a P&S report after determining that the injured worker has reached Maximum Medical Improvement. The report describes the employee’s injury, identifies limitations there may be in the ability to engage in activities, it may impose work restrictions, and it determines the percentage of the disability that was caused by the employee’s work. The P&S report may then be used to calculate a permanent disability rating.
Permanent Disability Benefits. An injured worker who’s condition does not completely heal from an injury will generally be entitled to permanent disability benefits. An injured worker who cannot engage in any kind of future employment will receive permanent and total disability (PTD) benefits. Total disability benefits are rare. Most people who suffer from a permanent impairment will receive a permanent partial disability (PPD) benefit which is based on their permanent disability rating.
Permanent Disability Rating. A permanent disability rating determines the value permanent disability benefits an injured worker will receive. The rating is calculated by considering several factors, including the injured worker’s age, the date of the injury, the nature of their job, their medical condition as described in the P&S report, the percentage of the injury that was caused directly by the worker injury, and the injured worker’s diminished earning capacity.
Qualified Medical Evaluator. When an injured worker disagrees with a P&S report, one option is to obtain an independent evaluation from a Qualified Medical Evaluator (QME). A QME has been trained to evaluate injured workers and to make the kind of medical assessments that should be included in a P&S report. A QME is chosen from a list supplied for that purpose by the Division of Workers’ Compensation. Alternatively, the claims administrator and the injured workers’ attorney can agree on a particular medical evaluator. The claims administrator is generally required to pay the cost of one independent evaluation.
Serious and Willful Misconduct. In some cases, an employer must pay a penalty if the injured worker’s injury was caused by the employer’s serious and willful misconduct. The penalty can amount to an increase of up to 50% of the value of all benefits paid by the insurance company during the life of the claim. Serious and willful misconduct usually requires proof that an employer knew of a condition that was likely to cause an injury and deliberately failed to correct it. Ordinary negligence does not satisfy that standard. An employer that removes a safety shield from a tool and then orders an employee to use the tool in violation of workplace safety laws might be committing serious and willful misconduct.
Workers Compensation Settlement. A settlement is a resolution of a workers’ compensation claim that the parties agree upon. The parties enter into an agreement to settle for a sum certain rather than having benefits decided by a judge at a contested hearing. The most common form of settlement is a compromise and release. The injured worker is paid a lump sum of money and gives up the right to have their future medical care paid for by the insurance company. The other form of settlement is a stipulated award. Here the injured worker receives agreed upon benefits over a period of time and the future medical expenses related to the work injury continue to be paid by the employer.
Supplemental Job Displacement Benefit. Injured workers receive a supplemental job displacement benefit if they have a permanent partial disability, cannot return to their old job due to work restrictions, and are not offered modified or alternative employment by their employer. The benefit is a voucher that the employee uses to pay for vocational retraining or skills enhancement at state-approved schools.
Temporary Disability Benefits. After missing three days of work or spending the night in a hospital due to a work-related injury, employees are entitled to temporary disability benefits. The benefits last until the injured worker is able to return to work or reaches maximum medical improvement. The benefit is two-thirds of the gross wages, subject to a minimum and maximum weekly payment.
Work Restrictions. Work restrictions are imposed by a treating physician and define the activities an injured worker cannot perform after returning to work. These may include restrictions on the amount of weight which can be lifted, the amount of time an injured worker can stand, a prohibition against climbing stairs, and similar restrictions.
Get Help with Workers’ Comp Claims
To learn more about how California’s workers’ compensation system works, call Kneisler & Schondel at (707) 542-5132. You can also ask a question by submitting our online contact form.