What Benefits Are Available for Injured Or Sick Workers?

November 17, 2021 | 6:00 am


California adopted workers’ compensation laws to help and protect workers if they become ill or injured as a direct result of their jobs. But many people don’t realize the different benefits available to them today.

Chain | Cohn | Stiles work injury lawyer Beatriz Trejo highlights in a new video the five basic benefits available to injured workers. These five benefits are spelled out below.

But first, it’s important to note that workers’ comp. is based on a no-fault system, which means that an injured or ill employee does not need to prove that the injury or illness was someone else’s fault in order to receive workers’ compensation benefits. And employers in California are required by law to pay for workers’ compensation benefits.

For more detailed information, please see the “Workers’ Compensation in California” guidebook, which is meant to help workers with job injuries understand their basic legal rights, the steps to take to request workers’ compensation benefits, and where to seek further information and help if necessary. And if you believe you have a case, please contact the work injury lawyers at Chain | Cohn | Stiles for a free consultation.

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1) Temporary Disability

Temporary disability benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering. It pays two-thirds of your pre-tax wages you lose while you are recovering from a job injury. These payments begin when your doctor says you can’t do your usual work for more than three days or you get hospitalized overnight. Generally, temporary disability stops when you return to work, or when the doctor releases you for work, or says your injury has improved as much as it’s going to. If you can do some work while recovering and your employer offers you this type of work, you can receive temporary partial disability payments if your wages while recovering are below a maximum limit set by law.

 

2) Medical Treatment

California workers’ compensation law requires claims administrators to authorize and pay for medical care that is reasonably required to cure or relieve the effects of the injury. The doctors who treat you must follow treatment guidelines referred to as the medical treatment utilization schedule. If it’s an emergency, your employer must make sure that you have access to emergency treatment right away. For non-emergency care, the claims administrator is required to authorize treatment within one working day after you file a claim form. While investigating your claim, he or she must authorize necessary treatment up to $10,000

 

3) Permanent Disability

Most workers recover from their job injuries, but some workers continue to have health problems. If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability, and this means that you may be eligible for permanent disability benefits. And you don’t have to lose your job to be eligible for these benefits. When you reach a point where your medical condition is not improving and not getting worse, your condition is called “permanent and stationary”. This is referred to as the point in time when you have reached maximal medical improvement. Click here to learn more about “P&S”.

 

4) Job Displacement Voucher

A claims administrator must offer you a supplemental job displacement benefit if your injury causes permanent partial disability, or your employer does not offer you regular, modified, or alternative work within 60 days after the claims administrator receives a voucher report. A supplemental job displacement benefit is a voucher that promises to help pay for educational retraining or skill enhancement, or both, at eligible schools. You can use the voucher to pay for tuition, fees, books, tools, or other expenses required by the school for retraining or skill enhancement, and for licensing or professional certification fees, related examination fees, and examination preparation course fees. Up to $600 of the voucher money may be used to pay for services of a licensed placement agency, a vocational or return-to-work counselor (a person who helps injured workers develop their goals and plans for returning to work), and resume preparation. Up to $1,000 may be used to purchase computer equipment. Up to $500 of the voucher money may be used upon request for miscellaneous expenses without receipts or other documentation. Learn more about the voucher system here.

 

5) Death Benefits

Death benefits are payments to a spouse, children or other dependents if an employee dies from a work-related injury or illness. This includes burial expenses. The amount of the death benefit depends on the number of total and/or partial dependents. In the case of one or more totally dependent minors, death benefits will continue until youngest minor’s 18th birthday. Learn more about death benefits, including amount limits, by clicking here.

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Worker deaths could trigger a workers’ compensation claim for surviving dependents

March 6, 2019 | 6:00 am


Armando Gallegos had been working as a correctional officer for 13 years when he was attacked by 12 inmates at Kern Valley State Prison in April 2018. He suffered a broken vertebrae, a broken nose and a concussion, and spent five months trying to recover from those injuries.

Tragically, Gallegos died in September 2018 at age 56. Just recently, the Kern County Coroner’s Office released his cause of death: “congestive heart failure due to hypertensive cardiovascular disease, with contributing of advanced conduction disease and history of assault by inmates.”

The Department of Corrections and Rehabilitation had recommended attempted homicide charges for inmates involved in the attack. The group said information on possible new charges was pending the results of the coroner’s autopsy.

The cause of death announcement brings to light legal issues that arise with the death of workers, and the compensation families can receive with a loved one’s passing.

Families do not often assume that a worker’s death could trigger a workers’ compensation claim on behalf of the surviving dependents. Death benefits may be due when death occurs through a single industrially-related event, or within 240 weeks of an industrial injury resulting in death. However, a new California Supreme Court case significantly broadened what can be determined an industrial death and lowers the standard of proof for such claims.

Learn more about workers’ compensation and work fatalities here:

 

The Standard of Proof 

South Coast Framing Inc. v. WCAB (Clark) completely changed burden of proof for families seeking survivor death benefits. In South Coast Framing, the Court rejected previous standards of proof, such as “significant factor” and “material factor.” Instead, the court determined that the correct standard is that “the employment be one of the contributing causes without which the injury would not have occurred.”

The court described the standard of contributing cause as little crumbs off the crust of a 12-inch pie. In other words, the contributing cause would be so miniscule that you would not notice it if were missing.

 

Mysterious Circumstances 

Oftentimes, even determining contributing cause can seem challenging to surviving dependents. Sometimes the circumstances involving the death are so inexplicable that courts have indicated that they will rely on the fundamental principal that all reasonable doubts as to whether an injury is compensable are to be resolved in favor of the employee. This standard is particularly beneficial in cases where no autopsy is performed.

 

Benefits

Death benefits are payments to a spouse, children or other dependents if an employee dies with employment being a contributing cause. This includes burial expenses of up to $10,000, and medical expenses incurred.

The amount of the death benefit depends on the number of dependents. In cases with a single adult dependent, the surviving dependent may be entitled to a benefit of $250,000. For three adult total dependents, that number goes up to $320,000. In the case of one or more totally dependent minors, payment of death benefits will continue at least until the youngest minor’s 18th birthday; disabled minors receive benefits for life. Death benefits are paid at the total temporary disability rate, which is two-thirds of the employee’s average weekly earnings.

The period within which to commence proceedings for the collection of death benefits is one year from death; or within 240 weeks of an industrial injury resulting in death.

 

Dependents

The law distinguishes between total and partial dependents of the decedent. Minor children and spouses who earn $30,000 or less are conclusively considered total dependents. The Labor Code allows for two more types of dependents; those who are good-faith members of the deceased employee’s family or household, and those with specified marital, blood or adopted relationships with the decedent. These include:

  • grandchild;.
  • father or mother;.
  • father-in-law or mother-in-law;.
  • grandfather or grandmother;.
  • brother or sister;.
  • uncle or aunt;.
  • brother-in-law or sister-in-law; and.
  • nephew or niece.

In these cases, the amount of dependency must still be proven.

 

Additional Benefits

Workers’ compensation laws allow for additional benefits to the defendants of specified employees. These employees include public safety officers, firefighters, public officials, and correctional officers. The benefits range from extending survivor benefits beyond the age of eighteen for a minor dependent to scholarships for surviving minors.

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If you or someone you know is injured in an accident at work, please call the attorneys at Chain | Cohn | Stiles at (661) 323-4000, or chat with us online at chainlaw.com.

Chain | Cohn | Stiles is home to two state certified workers’ compensation specialist attorneys, Beatriz Trejo and James Yoro. Mr. Yoro has also been recognized in the prestigious U.S. News & World Report’s “Best Lawyers” listings.

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*NOTICE: Making a false or fraudulent Workers’ Compensation claim is a felony subject to up to 5 years in a prison or a fine of up to $150,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.