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As you will hear repeated many times from us, the workers’ compensation process moves slowly. Your case may take a long time to resolve. Below is a list of other benefits & resources for injured workers that may be able to provide financial and medical assistance while we pursue your claim. Our team of experts may be able to assist you in pursuing some of these so feel free to explore with us.

There is often a misconception that pursuing an injury or disability claim means that you cannot or should not work. This is simply not the case. You are encouraged to find and obtain employment that you are physically and mentally capable of performing during the pendency of your claims, even if it’s with a different employer. Your only obligation is to be honest about it. Inform your doctors, inform your lawyers, and inform the insurance company or governmental agency from which you are seeking benefits when and where you are working, what limitations or accommodations are made for this work, and how much you are being paid.

In the event that you are unable to obtain medical treatment for your injury or disability during the pendency of your claim, you may be entitled to use your regular health insurance or pay out of pocket. Please do not unnecessarily delay treatment that you need. Please make health care decisions based on your health care needs, not on how it might affect your claim. Not only is it detrimental to your health to delay treatment, but that delay may be interpreted to mean that your injury or disability was not that severe as you did not seek treatment.

Regardless of the type of claim that you are pursuing, there may be at least some contribution because of work. If your work is a contributing factor to your injuries, then you may be entitled to workers’ compensation benefits.  These include: 

TEMPORARY DISABILITY: Paid by a WC carrier whenever an injured worker is unable to work their full schedule and lose wages because of a work injury. Except in rare circumstances, Temporary Disability (TD) is paid every two weeks at the rate of 2/3 of your wage loss for a maximum period of 104 weeks. There is a maximum rate of TD that is paid based on your date of injury.   

MEDICAL TREATMENT: You are entitled to medical treatment that will help you get better or feel better from your work related injuries. However, there are some limitations on your right to receive medical treatment.   

  • You must treat with the WC carrier’s doctors identified on its Medical Provider Network List. 
  • The WC carrier is only required to provide you with 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits, for life. 
  • All treatment must conform to the Medical Treatment Utilization Schedule (MTUS) or other evidence based treatment guidelines.
  • All treatment requests must be submitted in writing to the WC carrier.  It will then send that request to Utilization Review (UR), which will either approve, modify, or deny the medical necessity of the treatment. 
  • UR uses the MTUS to determine medical necessity.  You and/or your doctor have the right to appeal any UR denial and you may appeal the UR denial to Independent Medical Review, which will also use the MTUS to determine if the treatment is medically necessary. 

REIMBURSEMENT OF OUT OF POCKET EXPENSES:  You may recover any expense incurred as a result of seeking WC benefits, including mileage, meals, and lodging to attend any appointment with a doctor, pharmacy or vendor relating to your work injuries.  You may also recover lost wages in the event you miss time from work attending any forensic evaluation such as an Agreed Medical Examiner, Panel Qualified Medical Examiner or Court Appointed Independent Medical Examiner. 

PERMANENT DISABILITY: In the event you suffer a permanent disability (PD) arising out of your work injury, the physician will determine your level of impairment, which we will ensure is a fair, accurate, and adequate measurement of your PD taking into consideration your age and occupation at the time of your injury. The WC carrier will pay you PD at the rate of $290 per week for several months to several years depending on the severity of your PD. This is NOT a lifetime benefit  

VOUCHER FOR RETRAINING – In the event the doctor determines that you cannot return to your usual and customary duties, you may be entitled to receive up to $6,000 in educational retraining to help you return to the workforce.  You may choose to work with a vocational counselor who can help you best use this benefit.  

If you are unable to work as a result of a medical condition (regardless of the cause), then you may be entitled to receive State Disability Insurance (SDI) from the Employment Development Department (EDD) for a maximum of 52 weeks. The EDD will not pay SDI benefits if you are receiving TD; however, it is imperative that you apply for SDI benefits as soon as possible because the EDD pays 2/3 of your highest quarter earnings in the last 18 months.

If your employment has terminated because of a variety of reasons, voluntarily or involuntarily, you may qualify for Unemployment Insurance with the EDD. It is paid a lower rate than SDI benefits and for a shorter period of time, however, it is a source of income while you are looking for another job.

SOCIAL SECURITY RETIREMENT:  Anyone who pays into the Social Security system is eligible to take retirement benefits as early as age 62 and as late as age 70. These benefits are for life. Be advised that the earlier you take these retirement benefits, the less the monthly benefit will be.  You may wish to speak with a financial advisor when making this decision. 

SOCIAL SECURITY DISABILITY INCOME: In the event that you are unable to work for more than 52 weeks, the Social Security Administration (SSA) may provide Social Security Disability Income if it determines that you are unable to engage in substantial gainful employment (regardless of the cause) until you are able to return to work or reach the age of 65 at which time you will begin receiving your SSA Retirement benefits. To determine your SSDI rate, you may contact the SSA and it will tell you the amount you may receive based on your contributions to the SSA system. You may receive SSDI in addition to TD or PD benefits described above.   

SOCIAL SECURITY SUPPLEMENTAL INCOME: This is another disability benefit available through the SSA whenever the individual is unable to engage in substantial gainful employment due to a medical condition and they have very few resources (less than $2,000 for an individual or $3,000 for a family). Past work is not taken into account for this benefit. 

Disability retirement benefits are available to any injured and disabled worker employed by a public entity who is permanently incapable of performing their usual duties regardless of the cause of that disability. If it is determined that your disability is work related, then the monthly pension allowance may be higher.

These benefits are controlled by the Board of Retirement for the public entity involved. Some of the Boards include CalPERS (which contracts with many cities), CalSTRS (for teachers), Santa Barbara County Employees Retirement System (SBCERS), Ventura County Employees Retirement Association (VCERA), Kern County Employees Retirement Association (KCERA), Los Angeles County Employee’s Retirement System (LACERA), and the University of California Office of the President (UCOP), among others.

You or your company may have purchased a long term disability (LTD) or short term disability (STD) plan as a resource for injured and disabled workers. Many employers, unions, and individuals procure these plans, often managed by companies like ING, Liberty Mutual, AFLAC, Voya, etc. These policies are designed to provide a source of money while recovering from a medical condition that prevents the worker from performing their usual and customary duties.

STD policies are of short duration, usually not more than a year and often much less, but pay much higher benefits. LTD policies generally start after you’ve been off work for a few months and may last until you’re 65 if you remain disabled. however, the criteria to qualify for an LTD policy after two years is the same as it is for an SSDI claim; i.e., the LTD carrier no longer looks at the job you used to perform, but rather considers your skill, education, knowledge and experience to determine if there are jobs in the labor market that you can perform.

There are many governmental programs that provide benefits to injured and disabled workers, who may be struggling financially due to their injuries, including the SNAP program, Medi-Cal, the State Dept. of Rehabilitation, as well as non-profit organizations that are specifically designed to help people who are, for lack of a better phrase, down on their luck. With a little effort, you may be able to locate a program that can help serve you while you are trying to recover from your medical condition. Feel free to explore our Help Through Hard Times page for links to just a few of these many resources.

WHAT OTHER BENEFITS CAN I RECIEVE?

If you’ve been injured at work, there are many other benefits you may be entitled to, but not aware of.