California Workers' Compensation

 

Introduction

 

Employer's Responsibilities

 

Medical Care

 

Temporary Disability Benefits

 

Permanent Disability Benefits

 

Going Back To Work

 

Navigating The System

Workers' Compensation Lawyer

Permanent Disability

Q. What are permanent disability benefits?

A. Permanent disability (PD) is any long-term disability that results in a your inability to earn the same after medical treatment. If your injury in permanent disability you are entitled to permanent disability benefits, even if return to work.

Permanent disability benefits are limited and they may not cover all the income lost as a result of your work injury.

Q. How is permanent disability determined?

A. A doctor will decide if your injury caused permanent disability. After your doctor determines your injury has been treated and no change is likely, permanent disability is considered. At that time, your condition has become permanent and stationary (P&S). Your doctor might come to the conclusion that  maximal medical improvement has been reached (MMI) instead of P&S.

 

At that point your doctor will preparare a report to the workers compensation administrator notifying them you have permanent disability. The doctor also must assess if any of your disability was partially caused by something other than your work injury. For example, a previous medical condition. Assigning a percentage of your permanent disability to factors other than your work related injury is known as "apportionment".

Q. What happens after the doctor writes and submits the report ?

A. The letter will be used to calculate your permanent disability rating. Your workers' compensation lawyer will make sure the rating done  fairly by either the DEU or a private rater.

You also have the right to have the doctor's report  (PTP) rated.. You must request a rating of the PTP's report by submitting a request for Summary Rating Determination of your doctor's report and submitting it to the DEU.

The permanent disability rating is used in a formula that determines the benefits you'll be granted.

Your workers compensation lawyer will make sure you receive a copy of the QME's report as well as the reports from your doctor. If you feel there are errors in the QME's report, you can formally request a correction of the report within 30 day of receipt of the report.

Q. What can I do if I don't agree with the doctor's findings?

A. If you don't agree with your doctor's report you can be seen by a doctor called a QME. The claims administrator will forward the to your workers compensation lawyer to request a QME.

 

Your employer will pay for the cost associated with the QME exam. You have ten (10) days from the date the administrator tells you to begin the QME process. If you do not submit the form within 10 days, the claims administrator will choose the kind of doctor you'll see.

There are other specific timelines you must meet in filing your QME forms or you will lose important rights. It's important that you work closely with your workers compensation lawyer to meet all these deadlines. 

Q. Can I get more detail about the PD rating and how it is calculated?

A. After your medical examination the  doctor will prepare a medical report about your injury. The report includes whether any portion of your disability was caused by something other than your work injury and it also includes "impairment score".

Next, the impairment score is put into a formula that's used to calculate your percentage of disability. Disability means how the impairment affects your ability to function in every day duties at work. Your occupation and age at the time of your work related injury and your future earning capacity are all taken into consideration in the formula.

Any percentage of your disability caused by something other than your work injury is taken out.

Your percentage of disability equals a specific amount, depending on the date of your injury and your average weekly earnings at the time of injury. 

If your injury occurred between Jan. 1, 2005 and Dec. 31, 2012 your permanent disability benefit may be increased or decreased by 15 percent, this is determined based on the number of employees in your company. 

Q. What can I do if I don't agree with the disability score?

A. Your workers compensation lawyer can request the state DWC to review the rating. The DWC will review your claim to see  if mistakes were made in the rating or medical evaluation process.

 

This is called reconsideration of your rating. You can also present your case to a workers' compensation administrative law judge. Your workers compensation lawyer can present your case to a judge for further consideration.

Q. How much will I be paid?

A. Permanent disability benefits are set by the State of California. The workers compensation claims administrator will determine how much you'll get based on three factors:

  • Your disability score

  • Date of your injury

  • Your wages before you were injured.

 

Q. How and when are permanent disability benefits paid?

A. The claims administrator must begin paying your permanent disability payments within 14 days after temporary disability ends. The claims administrator will continue to make payments every two weeks thereafter.

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