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How Long Do Workers' Comp Benefits Last?

Types of Workers’ Comp: An Overview

Workers’ compensation has been available to all Californians since the early 1900s. Adopted as a protection against dangerous workplaces, the system has stayed in place despite the obligation for workplaces to provide safe habitats for employees. If anyone is injured while on the job, workers’ comp provides benefits to help offset the costs of the injury. There are five different types of compensation, but workers may be eligible for more than one depending on the fallout of their injury.

Receiving Medical Care After an Accident

After an on-the-job injury, an employer has 30 days to arrange for necessary care. The doctor’s office will send bills straight to your employer’s workers’ comp insurance for review. If you want your existing doctor to treat you, you must inform your employer of the fact. Unlike your typical health insurance, workers’ comp covers dental injuries as well as other medical care.

When it comes to medical treatment, workers’ comp will cover treatment “for as long as it’s medically necessary” except in some specific cases. All treatment must be evidence-based, and state guidelines lay out recommendations for various injury treatments. Any treatment that goes beyond these guidelines must be presented to and reviewed by the insurance company.

For treatment that includes chiropractic, physical therapy, or occupational therapy, each patient is limited to 24 visits. Further treatment will not be covered unless authorized by the insurance company.

Temporary Disability

Work-related accidents that prevent the injured party from returning to work within 3 days are covered by benefits meant to replace lost wages. If you are completely unable to work during your recovery, you may receive total disability payments that cover as much as 2/3 of your pre-tax wage (up to a maximum of around $1,000 weekly, depending on your typical wages). For workers who can continue to fulfill some of their duties, and are offered the chance to, partial disability payments can help close the gap between your reduced wages and your usual wages.

Temporary disability benefits are time-limited, though the rules depend on the type of injury suffered. They may be stopped for one of three reasons:

  1. Your doctor attests that you are fully healed and/or you return to your job for full wages
  2. Your condition stabilizes (you are no longer healing or worsening)
  3. You have received up to 104 weeks of benefits in the past two years

In case of the stabilization that does not return you to your full capabilities, you may be eligible for permanent disability benefits or supplemental job displacement benefits.

Permanent Disability Benefits

When an injury results in lasting impairment, disability insurance kicks in with bi-monthly payments calculated to offset lost wages according to factors such as employee age, occupation, and severity of injury. If a doctor determines that you will be permanently disabled due to the accident, they will file a claim with the insurance provider on your behalf detailing the injuries and how they will continue to affect you. As with temporary disability benefits, you may receive either partial or total payments based on your ability to continue working.

Despite the name, these benefits aren’t always paid out on a lifelong scale. Here are some reasons you may stop receiving permanent disability benefits:

  • You have returned to the same employer and are making at least 85% of previous earnings & benefits
  • You have found another job that matches or exceeds the earnings and benefits paid by your previous job
  • You have settled your case with the insurance company and received a lump sum or agreed on terms for future payments and medical care.
  • You have reached the legal cap placed on permanent disability payments

Supplemental Job Displacement Benefits

For anyone who suffers a permanent disability and cannot continue at their job, the employer must offer up to $6,000 in support for job retraining, exams, licensing, or certifications. Employees in this situation may also be eligible for a return-to-work supplement program payment, which provides $5,000 to workers whose disability benefits failed to cover the full cost of lost wages.

The job displacement benefit comes in the form of a voucher, which lasts for the longer of five years post-injury or two years post-receipt. If the voucher is not used in full by this time, the remaining amount will be forfeited. If you wish to apply for a return-to-work supplement, you must do so within a year of being awarded a job displacement voucher.

Death Benefits

If an employee injury results in death, workers’ comp insurance will pay burial expenses of up to $10,000 and may also send support payments to dependents of the deceased. Each payment equals the total disability amount that would have been awarded to the deceased and the total payout is determined by number of dependents. The payments will continue:

  • Until reaching the full benefit amount (determined by number of dependents) when no dependents are under the age of 18
  • Until the youngest dependent turns 18, even if this requires payments that exceed the full benefit amount
  • In the case of a disabled minor dependent, the payments will continue for that individual’s life

Claiming Benefits After an Accident

Just like any type of insurance, workers’ comp requires you to submit a claim before you receive coverage. If you wait longer than 30 days to inform your employer of an injury sustained on the job, your claim will automatically be denied.

Your employer must provide you with a claim form to fill out after an injury has been reported. Typically, you will have one year to complete and submit the form. Be sure to tell your treatment provider that your injury was work-related when seeking treatment.

Do You Need Help with Workers’ Comp?

The Law Offices of Larry S. Buckley is experienced in helping Californians receive the benefits they are entitled to after a workplace accident. We are here to answer questions about your rights after a work-related injury.

Contact us online or call (530) 413-0245 to see if you’re getting the compensation you deserve.