Modesto Workers Compensation Lawyer Representing Injured Workers

After a work-related injury, many people aren’t sure what they’re actually entitled to under California’s workers’ compensation laws. The system is benefit-based, but what you receive depends on your medical condition, your employment status, and how your claim is handled.
Understanding how workers’ compensation benefits are reviewed under California law can help injured workers better understand the types of benefits that may apply to their claim.

Temporary Disability (TD) Benefits While You Recover

Temporary Disability (TD) benefits are designed to provide wage replacement when a worker is temporarily unable to work due to a job-related injury. These benefits generally begin after a physician determines that work restrictions apply or an overnight hospitalization occurs, and they continue until a return-to-work determination or a finding that the condition is permanent and stationary.

Key Facts:

• Payments are generally calculated at two-thirds of gross (pre-tax) wages, subject to a state-set maximum.
• TD benefits may be paid for up to 104 weeks within five years from the injury date.

Permanent Disability (PD) Compensation for Long-Term Impairment

Permanent Disability (PD) benefits apply when a work-related injury results in lasting physical or mental limitations after a physician determines the condition has reached maximum medical improvement (MMI).

Key Facts:

• A permanent disability rating is assigned based on Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) reports under Labor Code § 4660.
• The rating calculation considers factors such as age, occupation, and the extent of permanent impairment.
• PD benefits may be paid weekly or issued as a lump sum, depending on how the claim is resolved.

Medical Care Paid by Your Employer’s MPN or HCO

Under California workers’ compensation rules, medical treatment for a work-related injury is generally provided through an employer’s Medical Provider Network (MPN) or a certified Health Care Organization (HCO), subject to applicable guidelines and authorization requirements.

Key Facts:

• Covered care may include doctor visits, surgery, prescriptions, rehabilitation services, diagnostic imaging, and necessary medical equipment.
• Treatment requests are reviewed under the Medical Treatment Utilization Schedule (MTUS), and approval depends on whether the care meets MTUS guidelines.

Supplemental Job Displacement Vouchers (SJDB)

A  Supplemental Job Displacement Benefit (SJDB) voucher may be available when a work-related injury results in permanent impairment and the employer does not offer modified or alternative work within the required timeframes after a permanent disability evaluation.

Key Facts:

• The voucher may be used for education, retraining, certification programs, tools, books, and related expenses through state-approved providers, up to $5,000.
• Eligibility depends on factors such as permanent impairment status and whether suitable work is offered by the employer.
• Vouchers are non-transferable and generally expire two years from issuance or five years from the injury date, whichever occurs first.

Death Benefits for Families of Deceased Workers

When a worker dies as a result of a job-related injury or illness, California’s workers’ compensation system provides for death benefits that may be available to qualifying dependents.

Key Facts:

• Death benefit amounts range from $250,000 to $320,000, depending on the number of qualifying dependents, such as a spouse, children, or other eligible family members.
• A burial allowance of up to $10,000 may be available to help cover funeral expenses.
• Claims must generally be filed within one year of the worker’s death or within 240 weeks of the injury date, whichever occurs first.