Who Pays for Workers’ Compensation Benefits?

Workers’ Compensation is insurance that employers get for themselves and their employees to protect both parties. Through this insurance, the employees get access to compensation and other benefits if they get injured while on the job. However, they cannot sue their employer if they accept those benefits.

In California, for example, workers’ compensation includes medical treatment for work-related injuries, wage loss or temporary disability benefits, retraining or job displacement benefits, and permanent loss of function or permanent disability benefits. For an injured worker to become eligible in California, they need to file a workers’ compensation claim form. 

Workers’ Compensation in California

In 49 of the 50 states, workers’ compensation insurance is mandatory for companies and businesses with a minimum number of employees, but the minimum number is different in each state. Before the benefits are paid, the insurance company must determine if it will accept that the work injury is valid, then send forms to the worker with its decision. 

Suppose an injured worker is not entitled to benefits after filing a workers compensation claim. In that case, they can file an Application for Adjudication of Claim, ask for a Mandatory Settlement Conference, and then request a trial for the denial of benefits.

California workers’ compensation benefits include medical treatment for work-related injuries. However, if you have been injured at your workplace and are eligible for this insurance, you must first be treated by a doctor in the Medical Provider Network (MPN).

You will receive a standardized level of care and medical treatment that will help determine the duration and frequency of the compensation you are entitled to. The doctor will treat you until your condition cannot improve further. At this point, the doctor will write a Permanent and Stationary Report.

Payment of Workers Compensation

Regardless of the state where you live, employers always pay for workers’ compensation insurance. Your cost for workers’ compensation is a percentage of your payroll. Unlike health insurance, there are no employee payroll deductions for workers’ compensation insurance. There are three ways you can be paid: directly by the insurer, from the insurer through the employer, or by the workers’ compensation regulator.

Payments for Temporary Disability Benefits

Temporary disability benefits are payments for lost wages due to a work-related injury. Simply put, it is a substitute for the wages you would have earned if you weren’t injured. These benefits are only paid if the insurance company agrees that the injury occurred during work or is work-related. If your claim is denied, you will not be entitled to any benefits the insurance company provides. 

To be eligible for temporary disability benefits, a doctor must confirm that you can no longer work while you are injured. The doctor will see you every 45 days and make further recommendations about your work restrictions and ability to work. 

The payments for temporary disability are usually made every two weeks, with the insurance company making the first payment within 14 days of receiving the medical report. Temporary disability payments automatically end when you get back to work, a doctor advises that you can return to work or your condition stabilizes. You become eligible for permanent disability benefits.

Payments for Permanent Disability Benefits

If you are eligible to receive permanent disability benefits, you will be paid for the loss of future earning capacity due to the permanent effects of the work injury. Usually, permanent disability is rated on a scale from 0 to 100%. If your rating is under 100%, you will be considered partially disabled and entitled to weekly payments for a certain period. If your rating is between 70% and 99%, you are entitled to a lifetime pension.

If you are 100% disabled, you will receive weekly payments for the rest of your life. The California permanent disability rate is determined by calculating two-thirds of the worker’s average weekly wage. Since 2014, the maximum permanent disability rate has been $290 per week.

If your injury has caused permanent disability, you will receive the first permanent disability payment within 14 days after the last payment of your temporary disability. Then the payments will be made every two weeks. 

If any of the temporary or permanent disability benefits are not paid on time, you may get an additional penalty payment from the insurance company.

Should I Hire a Workers Compensation Attorney?

All employees are entitled to workers’ compensation benefits in the United States. These benefits cover treatment for physical injuries, lost wages, health care, medical treatment, therapy services rehabilitation, disability benefits, and even death benefits. Whether you’re in Los Angeles, San Diego, or Fresno, employers and their workers’ compensation insurers may try to deny the benefits you are entitled to, so it is recommended you seek legal representation. Localities might differ in their approaches so, for example, if you’re in Fresno, CA, you should seek advice from a Fresno workers compensation attorney.