Your Guide to Workers Compensation

Transcription

1 What isworkers compensation? Your Guide to Workers Compensation Workers compensation is insurance that the law requires your employer to have to cover on the jobinjuries.ifyou become injuredon the jobor contract an i lness due to your jobduties this insurance is designedto assist you in your recovery.your employer pays for the insurance.if you can t work,workers compensation pays your medicalbi ls andprovides moneyto replace lost wages. What typesofinjuriesor i lnessesare covered bythisinsurance? The injuries coveredbyyour employer s insurance are anythat occur while on the job,including physicalandmentalinjuries or i lnesses.this insurance wi la low you to receive help ifyou are injuredno matter who was at fault.workers compensation insurance covers everythingfrom one-time occurrences to multiple occurrences that cause an injury.everythingfrom first-aidtype injuries to more serious accidents can be covered.coverage is automatic andimmediate,so be sure to notifyyour supervisor as soon as possible. What are the differencesbetween State DisabilityInsurance and workers compensation insurance? The differences between State DisabilityInsurance (SDI)andworkers compensation insurance are simple.ifyou become injuredor i landit was not work relatedit wouldfa lunder SDI. This benefit is providedbythe Employment Development Department.Ifyour i lness or injury was work relatedit wouldfa lunder your employer s workers compensation insurance. How do Ireport an injuryor i lness? To file a workers compensation claim,you have 30days to report the injuryto a supervisor. Ifthe injuryis more than a first-aidsituation,your employer wi lgive you a claim form on which you needto describe your injuryincludingwhere,when,andhow.once you have returnedthe completedform to your employer it is their responsibilityto submit the form to their workers compensation insurance carrier.you wi lthen be notifiedofyour benefits and coverage bythe insurance carrier.as an employee you have a right to dispute anyaction ofthe employer or insurance carrier.the Workers Compensation Appeals Boardmust be properly notifiedwithin one year ofthe incident or within one year ofthe last medicalbenefit or indemnity.it is veryimportant that you report your claim immediately.benefits cannot start until your claim has been received.california state law requires employers to authorize medical treatment within one workingdayofreceivinga claim form.to insure your right to these benefits you must report everyinjury,no matter how slight,andbe sure to request a claim form if it is more than a basic first-aidinjury.the employee is entitledto up to $10,000in medicalcare within one dayoffilinga claim form up anduntilthe case is acceptedor denied. The role and function ofthe primaryphysician The primaryphysician wi ldecide on the type oftreatment for the injuredworker.the physician wi lhe responsible for when the employee wi lbe able to return to work andwhat type ofduties

2 the employee can perform. In addition, the physician may refer the injured worker to a specialist or write medical reports that may affect the benefits you receive. Employees are legally protected from Discrimination The Employer may not discriminate against you due to a disability. The Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA) exclude discrimination of the disabled. CA Labor Code l32a provides that an employer who fires, threatens to fire, or in any manner discriminates against any employee because he or she has filed or made known his or her intention to file a claim for workers compensation is guilty of a misdemeanor. The employee s compensation shall be increased by one half, but in no event more than ten thousand dollars $10, The employee is entitled to receive up to $ for costs and expenses associated with the issue. What are the benefits that I might receive? The California workers compensation law guarantees you sixbasic benefits: Medical care:all reasonable and necessary medical care for your injury or illness with no deductibles. Medical benefits may include treatment by a doctor, hospital services, lab tests, x-rays, and some medicines. For injuries on or after January 1, 2004there are limits on the number of occupational therapy, physical therapy, and chiropractic visits. Temporary disability benefits:tax-free payments to help reduce lost wages while you were temporarily disabled. Permanent disability benefits:these are payments if your injury causes a permanent disability. Supplemental job displacement benefits (Vocational rehabilitation):for injuries on or after January 1, 2004, if your illness or injury causes permanent disability, your employer doesn t offer appropriate modified or alternative work and you don t return to work for the employer within 60 days of when temporary disability ends, you may be eligible for a supplemental job displacement benefit. This is a nontransferable voucher for educationrelated retraining and/or skill enhancement at state approved schools. The amount can range from $4,000 to $10,000 in vouchers, depending on the level o permanent disability. Death benefits:these are benefits paid to dependents of a worker who dies from a workrelated injury or illness. What if I am temporarily disabled? Your temporary disability rate will be calculated as follows:the rate is two thirds of your average weekly earnings, subject to minimum and maximum amounts that the legislature determines. The minimum and maximum amounts depend on the date of your injury. TD Rates M inimum M aximum

3 If you are unable to work for more than 3 days you are eligible to receive temporary disability. Generally, temporary disability stops when you return to work or when you are released from a physician s care. For most injuries, there is a limit of 104 weeks of temporary disability within five years from the date of injury. Certain injuries that typically take longer to heal are exempt. These injuries are subject to a cap of 240 weeks within a five-year period. What if I am permanently disabled? If, according to your doctor you are permanently disabled because of the said injury or illness, you may qualify for permanent disability payments. The amount depends on the doctor s report, how much of the permanent disability was directly caused by your work, and factors such as your age, occupation, type of injury, and date of injury. In general, the rate paid to you is a weekly rate paid spread over a fixed number of weeks. This rate is calculated by determining your rate of disability and then taking a percentage (usually two-thirds) of your average weekly earnings at the time of you injury. Rating Up to 14.75% % to 24.75% % to 69.75% % to 99.75% Minimum per week Am I able to predesignate a personal physician? You can designate a personal physician to treat yourself in the event of a workers compensation injury. This can be accomplished by completing the pre-designation form included at the end of this notice and by having your pre-designated physician sign and date the form. The form must then be sent to your employer. The physician of your choice must meet the below requirements. Must be your regular physician Must be your primary care physician or your physician s integrated multispecialty medical group Must be licensed per Business & Professions Code Must have previously provided you treatment The physician of choice can be a chiropractor or acupuncturist. if you do not predesignate a physician, your employer will arrange initial treatment with a Medical Provider Network physician. You then will be able to select a physician within the MPN for ongoing treatment. What if my injury/illness causes death? If the injury/illness causes death, payments may be made to people who were financially dependent on you. State law sets these benefits and the amount depends on the number of surviving partial and total dependents at the time of injury or illness resulting in death. Workers Compensation also pays for burial expenses up to $5,000.

4 Death Benefit Maximums 07/01/96-12/31/ No total dependents and one or $125,000 $250,000 more partial dependents Single total dependent $125,000 $250,000 Single total dependent and one or $145,000 $290,000 more partial dependents Two total dependents $145,000 $290,000 Three or more total dependents $160,000 $ What happens if I can no longer perform my position s requirements due to my injury/accident? For injuries on or after January 1, 2004, if you receive temporary disability payments, within 30 days after that benefit ends, your claims administrator should send you a letter advising whether your employer has a modified job or alternative work available for you. and explaining your potential rights to a supplemental job displacement benefit. If your employer does not have a modified job or alternative work available for you, you don t return to work for the employer within 60 days after your temporary disability ends, and it is determined that you have permanent disability, you may choose to receive nontransferable vouchers to use at a state accredited school for education-related retraining or skill-enhancement. If you qualify for the supplemental job displacement benefit, your claims administrator will provide vouchers up to a maximum set by state law: Supplemental Job Displacement Benefits (SJDB) Permanent Disability Level SJDB Voucher Amount Less than 15% Up to $4,000 15% to 25% Up to $6,000 26% to 49% Up to $8,000 50% to 99% Up to $10,000 How can I receive emergency medical treatment? If your illness/injury is an emergency, call 911 or go directly to the hospital. Your employer may give you a recommendation as to where to go. When you are being treated be sure to mention that your injury/illness occurred while on the job and if available give the healthcare provider your employer s workers compensation information. Do I get to choose which doctor I see for treatment? The following factors have to be considered for you to be able to choose your treating physician: Health Care Organization or Medical Provider Network. If through your employer s workers compensation carrier they have selected an HCO or network, then the workers compensation insurance carrier will select the doctor.

5 Group Health Insurance. If you are covered under your employer s group health insurance plan, you may pre-designate your treating physician. The penalties for workers compensation fraud. The laws that govern workers compensation make it illegal to file or submit any false documents or statements. If convicted fraud, the individual will face up to 5 years in prison and/or a fine up to $150,000. Who can I call if I have questions? If you have questions, you may call your employer s workers compensation insurance carrier, or you may call the Division of Workers Compensation Insurance toll free at , or contact one of the following offices: Division of Workers Compensation Insurance Information & Assistance Officers Anaheim Riverside Bakersfield Sacramento Eureka Salinas Fresno San Bernardino Goleta San Diego Long Beach San Francisco Los Angeles San Jose Marina Del Rey San Luis Obispo Oakland Santa Ana Oxnard Santa Rosa Pomona Stockton Redding Van Nuys *Your employer is required to post the name, address, and telephone number of their workers compensation carrier at your workplace. This pamphlet was prepared and published by for its clients. This pamphlet has been approved by the Administrative Director of the Division of Workers Compensation

6 PREDESIGNATION OF PERSONAL PHYSICIAN In the event you sustain an injury or illness related to your employment, you may he treated for such injury or illness by your personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or medical group if: your employer offers group health coverage; the doctor is your regular physician, who shall be either a physician who has limited his or her practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner, and has previously directed your medical treatment, and retains your medical records; your personal physician may be a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group providing comprehensive medical services predominantly for nonoccupational illnesses and injuries; prior to the injury your doctor agrees to treat you for work injuries or illnesses; prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor s name and business address. You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteopathic medicine treat you for a work- related injury or illness and the above requirements are met. NOTICE OF PREDESIGNATION OF PERSONAL PHYSICIAN Employee:Complete this section. To: be treated by: (name of employer) If I have a work-related injury or illness, I choose to (name of doctor)(m.d., D.O., or medical group) (street address, city, state, ZIP) (telephone number) Employee Name (please print): Employee s Address: Employee s Signature Date: Physician:I agree to this Predesignation: Signature: Date: (Physician or Designated Employee of the Physician or Medical Group) The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, other documentation of the physician s agreement to be predesignated will he required pursuant to Title 8, California Code of Regulations, section (a)(3). Title 8, California Code of Regulations, section (Optional DWC Form 9783 March 1, 2007 )

7 NOTICE OF PERSONAL CHIROPRACTOR OR PERSONAL ACUPUNCTURIST If your employer or your employer s insurer does not have a Medical Provider Network, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness. Your claims administrator generally has the right to select your treating physician within the first 30 days after your employer knows of your injury or illness. After your claims administrator has initiated your treatment with another doctor during this period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist. You may use this form to notify your employer of your personal chiropractor or acupuncturist. Your Chiropractor or Acupuncturist s Information: (name of chiropractor or acupuncturist) (street address,city,state,zip code) (telephone number) Employee Name (please print): Employee s address: Employee s Signature Date: