When you’ve had a workplace injury or illness in California, the most pressing question on your mind is probably how much you’ll get in workers’ compensation benefits. After all, if you’ve had to take time off from work, you’re no doubt wondering how you’ll pay your bills. You may also be worried about medical bills and what will happen if you end up with permanent disability that hurts your future earning potential. This article explains the kinds of benefits you may receive and how those benefits are calculated in California.
In California, workers’ comp pays for all medical care that’s reasonable and necessary to treat your work injury. You will need to follow the rules for choosing your treating doctor, however, and your employer’s insurance company may require authorization for nonemergency treatment.
Your employer’s insurance company should start paying medical benefits as soon as you report your injury and file your workers’ comp claim. If the insurer eventually denies your claim, it will still have to pay for the medical care you received up to that point (limited to a $10,000 maximum).
In addition to payment for your medical treatment, you’re also entitled to reimbursement for mileage to and from medical appointments or the pharmacy. (Cal. Labor Code §§ 4600, 5100 (2019).)
If your doctor says that you can’t work at all while you’re recovering from your injury, you can receive temporary total disability benefits. In California, these benefits are calculated at two-thirds of your average weekly wages before the accident. However, there is a legal maximum and minimum that changes every year, depending on the statewide average wages. For 2019, the weekly maximum is $1,251.38, and the minimum is $187.71.
If you’re able to return to work, but you’re earning less than usual—for example, because the work is part time or light duty— you can receive temporary partial disability benefits. Generally, these benefits will amount to two-thirds of your lost earnings (subject to the legal maximum and minimum). For example, if you were earning $900 a week before the accident, and you now earn only $600 per week, you can receive $200 in weekly temporary disability benefits (two-thirds of the $300 difference in earnings).
You will continue to receive temporary disability benefits until:
(Cal. Labor Code §§ 4653, 4654, 4656 (2019).)
If your on-the-job injury or illness has left you with any permanent limitations (referred to as impairments) that affect your ability to earn a living, you should receive permanent disability benefits. When you reach MMI, your doctor will evaluate you and give an opinion about the level of any permanent impairment you have. Then you will be assigned a permanent disability (PD) rating (stated as a percentage from 1% to 100%) based on a formula that includes your age and occupation, as well as your impairment level.
Your PD rating will determine how much you’ll receive in permanent disability benefits, as well as how long those benefits will continue.
If you’re like the vast majority of injured employees with permanent disability, your PD rating will be below 100%. You’ll be entitled to permanent partial disability benefits for a number of weeks determined by the percentage of your rating. Although the weekly amount is based on two-thirds of your pre-injury wages, the maximum is much lower than for temporary disability ($290 per week in 2019). For example, if you have a 30% PD rating, you’ll receive 210 weeks’ worth of benefits, for a total of $60,900 (at the maximum rate).
If your PD rating is at least 70% (but less than 100%), you can also receive a “life pension” that starts once you’ve reached the weekly limit for regular permanent partial disability benefits. The payments are quite low, however. For example, the current maximum for someone with a 99% PD rating is a little over $300 per week. (Cal. Labor Code §§ 4658, 4659 (2019).)
A 100% disability rating means that you can’t work in any capacity and are entitled to permanent total disability benefits. In California, you can receive these benefits for the rest of your life, at the same rate as your temporary total disability benefits. (Cal. Labor Code § 4659 (2019).)
If you aren’t able to return to your previous job because of permanent partial disability, and your employer doesn't offer you other work that is compatible with your limitations (and meets other legal requirements), you’re entitled to what California calls a “supplemental job displacement benefit.” This benefit, which is a replacement for traditional vocational rehabilitation, comes in the form of a voucher (worth up to $6,000) that you can use to pay for certain expenses related to finding or retraining for other work, including tuition, training programs, related materials and tools, and professional certification or licensing fees. You may also use a portion of the funds to buy computer equipment and pay for vocational counseling or job placement services. (Cal. Labor Code § 4658.7 (2019).)
You usually won’t see any of the payments for medical benefits, because your health care providers will bill the insurance company directly. However, if you have to pay for medical treatment because the insurer refused to do so (without a good reason), you’re entitled to receive reimbursement for the cost. (Cal. Labor Code §4600(a)(2019).)
You should receive payments for temporary disability benefits every two weeks. If your doctor has said that you have any permanent impairment from your workplace injury, California law requires the insurance company to begin paying you permanent disability benefits within two weeks after your temporary benefits have ended (unless you’ve returned work at a certain level of earnings). Before your PD rating has been determined, these advance payments will be based on a reasonable estimate of what you’ll be owed. (Cal. Labor Code §4650 (2019).)
If you’re entitled to permanent disability benefits, your final settlement or award will provide for regular payment of those benefits or, more typically in cases of partial disability, a lump sum for the total amount (minus any advance permanent disability payments). Similarly, if you’ll continue to need medical care for your work injury, the settlement may either cover those future bills or include a lump sum for the anticipated cost. You should make sure you understand the consequences of each type of settlement in California, preferably by discussing them thoroughly with your workers’ comp lawyer.
