Calculating the Value of a California Workers' Compensation Injury Claim
California workers' compensation makes available to the injured worker a bundle of insurance benefits. The purpose of those benefits is to help the hurt employee recover from their injury by providing medical care as well as financial benefits to offset temporary and permanent earning loss that results from a work related accident injury. This article outlines the different benefits that are potentially available to the injured worker under California law.
By understanding when each benefit is applicable and in potentially what amount, the layperson hopefully gains a better understanding of the value of a California work injury claim. Note however that each and every case of injury is unique and therefore calculating actual value prior to actually litigating a case out is highly speculative. In other words, predictions about claim value are necessar ily speculative because the litigation process is inherently uncertain and highly dependent on the facts of each individual case and how those facts evolve over time. Therefore, it is always necessary to consult and hire a workers' compensation attorney if you truly want to pursue all the benefits listed below. While injured employees can represent themselves without an attorney, it is not recommended due to the complex nature of the workers' compensation laws.
To determine the value of a claim, one must first know exactly what benefits are potentially available under workers' compensation in California. First note that pain and suffering is not a benefit under workers' compensation. Therefore, emotional frustration, financial frustration and the experience of physical and mental pain, are not compensated. Therefore, the value of a claim to the injured worker is quantifiable using more objective measures of disability and nothing else. The five main benefits are 1) Medical Care; 2) Temporary Disability Indemnity; 3) Permanent Disability Indemnity; 4) Mileage Reimbursement; and 5) Supplemental Job Displacement Voucher. To determine whether a particular benefit is available, we look at each individually. *Note that this is an analysis of the benefits potentially available and payable on an "admitted" claim and may not be applicable to denied cases. For information on understanding the value of a denied work injury claim, please see my website.
1) Temporary Disability Indemnity - This is a form of wage replacement that can last up to 104 weeks and is calculated at 2/3 of the injured workers' gross pay up to a defined maximum weekly amount depending on the year of original injury. It is intended to help the injured worker financially while they are temporarily unable to work due to job related accident injury. Whether it is collectible depends on whether modified work to accommodate work restrictions is available at the place of employment. If no modified work can accommodate doctor restrictions, the applicant is considered to have temporary total disability and is paid the appropriate amount depending on their average wage at the time of the injury. Note that there are disqualifying events that can occur, so consult an attorney as to whether you can collect this benefit.
2) Medical Care - Medical care to cure or relieve the effects of the industrial accident injury. A doctor within the insurance carrier's medical provider network treats the patient and requests authorization for treatments that he or she believes are necessary and reasonable to cure or relieve. The insurance carrier's utilization review department analyzes requests based upon the facts known to the carrier and determines whether the requested treatment meets medical necessity. If it does not, the insurance carrier denies payment on the treatment and the care is not provided. Note that there are disqualifying events that can occur, so consult a workers' compensation lawyer to fight for medical care you believe is necessary to get better.
3) Permanent Disability Indemnity - This is a form of wage replacement that is paid at the end of the claim where the injured employee is determined to have a permanent injury. In other words, medical care never got the claimant back to 100%. The purpose of the money is to compensate for lost earning capacity due to an injury that hinders the employees ability to compete in the open labor market. The amount is usually completely unknown at the onset of the case because it is highly dependent on the recovery of the claimant. Where the claimant experiences a positive recovery, there will be less permanent disability indemnity. While some injuries are known to be incurable with current medical science, others have varying degrees of recovery. The type of injury will inform the amount of permanent disability indemnity paid on a work injury case.
4) Mileage Reimbursement - This is money paid to drive back and forth between doctor appointments. It is paid at the rate of 57.5 cents per mile in 2015 and is usually slightly increased year by year to account for cost of transportation inflation. Mileage should be submitted to the insurance carrier on a periodic basis for payment.
5) Supplemental Job Displacement Voucher - The SJDV is a small amount of money ($6000.00 for injuries in 2015) that is provided to those who are displaced from their occupation due to an industrial/occupational injury. Where permanent work restrictions preclude a person from going back to their occupation, the worker is displaced and may be eligible for the SJDV. Entitlement depends on the permanent work restrictions placed on the applicant by the AME/PQME or PTP. There are disqualifying events that only a lawyer can help determine apply to a particular case after knowing the facts of the case.
All of the above are potential benefits available under a workers' compensation case in California. Whether each one is collectible and in what amount depends on the type of injury sustained and the length and success of the recovery process, as well as the type of occupation and earnings of the employee at the time of the injury. To calculate the total value of a California work injury claim, one must go through the process and add up all the benefits collected over the life of the claim and not look only at the money obtained at the end of the case. A benefits printout should be provided by the insurance company on demand. Simply add everything collected on the benefits printout to the amount paid at the end of the case and that is the dollar value of the workers' compensation case.
ABOUT THE AUTHOR: Alexander D. Napolin, Esq.
Alexander D. Napolin, Esq. is a California Injury Lawyer with offices throughout Southern California, serving Claremont, Pomona, Upland, Chino, Covina, La Verne and San Dimas. He represents injury victims of auto car truck bus motorcycle accidents, as well as work accidents resulting in workers' compensation claims.
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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer. For specific technical or legal advice on the information provided and related topics, please contact the author.