If you work in a risky environment, you face a high risk of sustaining an injury due to an accident at the workplace. Some of the high-risk work environments include the construction industry, utilities, maritime services, and a host of different industries. However, you may suffer injuries at any workplace.

Workplace injury results in a substantial financial burden. You can no longer work if the injury is severe. You also have to cater to the medical bills. In addition, the damage may lead to surgery, long periods of hospitalization, and missed workdays.

Due to these factors, California has several programs to ease your financial burden should you suffer an injury in or out of the workplace. These programs include workers’ compensation and disability benefits. Although workers’ compensation and disability benefits may seem to fulfill the same purpose, they are different. Therefore, understanding the difference between workers’ compensation and disability benefits is critical.

Have you suffered any work-related injuries or work unrelated injuries that prevent you from working? You need to contact a workers compensation lawyer to help you receive your benefits. At the Workers Compensation Lawyer Law Firm, we have over 20 years experience in representing workers who are seeking compensation benefits in Los Angeles, CA. Therefore, don’t hesitate to contact us today.

The Difference Between Workers Compensation And Disability Benefits

Workers Compensation Benefits

The workers’ compensation benefits aim to protect you and your employer from financial burdens after an injury. The law requires your employer to compensate you for injuries you sustain while working. Therefore, you are eligible for workers’ compensation only when you sustain an injury at work. 

Disability Benefits

Disability Benefits, on the other hand, caters for partial wage replacement if you can’t work due to injuries or illness unrelated to work. You may also claim the disability benefits if you can’t work due to a pregnancy. 

Understanding More About Workers Compensation In California

The law requires your employer to pay for workers’ compensation if you are injured at work. The injury could be a result of a single event. For example, you may hurt your back in a fall, suffer a chemical burn or sustain injuries while operating a machine at work. You may also suffer workplace injury due to repeated exposures at work. For example, you can hurt your back, hand, or foot due to repeating the same motion over and over again. You may also lose your hearing due to continued exposure to loud noises at your workplace.

Benefits You Will Receive Under Workers Compensation Plan In California

Medical Care

Your employer pays for your medical expenses as you seek treatment for the injury. Your employer will cater for your doctor’s visits, treatment services, any tests, medication, and any travel costs to seek treatment for your injuries.

However, in California, a doctor must treat you in a particular network known as the Medical Provider Network (MPN). As a result, all workers receive the same level of medical care. In addition, under workers’ compensation benefits, you will be treated under guidelines that govern all workers who suffer a workplace injury. The policies determine the duration, frequency, and appropriateness of the treatment.

The doctors under the MPN must follow these guidelines. They follow these guidelines under a process known as Utilization Review. An independent medical practitioner approves, modifies, or rejects the treatment request. Under the plan, your doctor will treat you until they believe you no longer need further treatment.

Mileage Reimbursement

Under California workers’ compensation, you are eligible for mileage allowance to and from your medical appointments. For example, you are a delivery driver who is injured as you deliver merchandise. You select a doctor in the MPN, and they send you for tests. Under workers’ comp, you will be reimbursed for the expenses you incur. Under the workers’ comp benefits, you don’t need to pay for the tests either. You will also be reimbursed for any travels to pick up your prescriptions.

Filing For Worker Compensation Benefits Is A Three-Step Process

You first have to report the injury to your employer, file the actual claim, and finally fill the “application for adjudication of claim,” which you submit to the Worker’s Compensation Appeals Board if your application is rejected.

However, you have to file the reports under specified time limits. It would help if you were careful that you don’t miss any deadline, as doing so may lead to complications in receiving your compensation claims.

  • Step I. Report The Injury To Your Employer Immediately

Reporting the injury is pretty straightforward if a one-time occurrence caused the injury. You will know the exact date the accident occurred. However, the matter becomes more complicated when you suffer an injury due to repetitive actions like losing your hearing due to continued exposure to loud noises. In such a case, you file the claim the first day you visit your doctor because of the injury caused by the repetitive action.

If you suffer an injury at work, you should immediately seek medical attention. If the injury is severe, you can seek treatment from any medical facility. However, if the injury isn’t as severe, you should visit a doctor in the MPN network. It would help if you also informed the doctor that you sustained the injury at your place. If you can’t inform your employer immediately after the injury, inform them about your injury within 30 days. Failure to do so can result in the employer or the insurance agency denying you the benefits. Therefore, the sooner you inform your employer, the better.

  • Step II. Filing The Workers’ Compensation Claim Form

Your employer should issue you the workers’ compensation form a day after you report the injury. They will also inform you of your rights and any benefits you can claim. The employer will also notify you of other details about the workers’ compensation benefits.

Making sure to fill the form correctly is critical. Therefore, it’s prudent to enlist the services of an attorney who will ensure you provide all the necessary information. You should state every part of your body that you injured during the accident. After you correctly fill in the form, you should submit it to your employer either by hand or using a certified postal service provider like the U.S Postal Service. Your employer will also fill in their potion and submit it to the insurance company. They will also give you a copy of the completed form.

  • Step III. Filling For An Appeal If Your Claim Is Denied

Once you submit the completed form, it’s the responsibility of the insurance company to authorize the payment for your medical expenses and other related costs like travel expenses. The insurance company will also investigate the claim to determine its legitimacy. According to the law, the insurance should cater to up to $10,000 in medical expenses before deciding the claim’s legitimacy. The insurer has ninety days from when you submit the form to deny the claim. If they fail to do so within the ninety days, the law presumes the insurer has no issue with the claim and has accepted your benefits claim.

You may think all is well when your employer starts to pay your medical bills. However, disagreements between you and your employer or the insurance company may arise. To resolve any issues, you have to file a case with the WCAB. You have to file an Application for Adjudication of Claim. You have to file this claim before the end of a year from when the claim was denied. You have to file your date of injury, the last day you received the benefits from your employer, and the day you stopped receiving the benefits in your appeal.

If you’re seeking death benefits for a dependent who died of a work-related injury, you have to file the adjudication claim before the end of a year from when your loved one died. It’s critical to fill the form correctly. If any information isn’t correct, your claim may be delayed.

Understanding Disability Benefits In California

In California, you qualify for disability benefits if you can’t work due to non-work-related injuries. The purpose of the disability benefits is to help you financially for the duration you are out of work. You can either qualify for temporary or permanent disability benefits. Below are the types of temporary disability benefits in more detail.

Temporary Disability Benefits

To qualify for temporary disability benefits, the doctor must ascertain that you can’t work due to your injury or are limited at the amount of work you can undertake due to the injury. You will have to see the doctor after every 45 days, and they will make recommendations on your ability to work.

  • Payment For Temporary Disability

Under temporary disability, you receive payment every two weeks, unlike workers’ compensation benefits, where the insurance pays for your medical bills. After fourteen days of submitting the medical report, the insurance company must pay you. The report states that you can’t work or work the hours you used to before the injury.

The temporary benefits will end when you return to work, when your condition stabilizes or if you become eligible for permanent disability benefits.

  • Calculations For Temporary Benefits

You will receive two-thirds of your average weekly wage (AWW). The amount of money you will receive depends on the current salary your job group in California is receiving at that particular time.

You are eligible for short-term disability benefits (SDI) or permanent disability benefits in California. It’s one of the few states with short-term disability insurance (SDI) for employees. The program is also referred to as temporary disability insurance (TDI).

In California, you fund the program through payroll deductions. You are eligible for short–term disability if you’ve received at least $30,000 in wages from which the funds are deducted, unlike workers’ compensation, where you receive the benefits no matter your contribution.

  • How To File For California Short-Term Disability

Before collecting the short-term benefits, you must file a claim with the California Employment Development Department (EDD). However, you should file the claim within seven weeks from the time of the injury. If you fail to do so, you may lose the benefits. You must also present a medical certificate of disability which a doctor must sign.

In California, you may also receive the benefits if you spend time off work taking care of a seriously ill family member.

You can also receive the benefits if you can’t work due to pregnancy and childbirth. The disability period under the program for standard delivery is four weeks before the delivery of the child. The disability benefits extend for six weeks after the child’s birth. If you undergo complicated pregnancies, the disability benefits may prolong if the doctor certifies the childbirth was difficult.

Under the law, it’s also your right for your employer to give you disability leave when you can’t work due to pregnancy, childbirth, or related issues resulting from delivery. According to the law, your employer should give you four months off due to pregnancy or childbirth.

California Permanent Disability

You qualify for permanent disability when you suffer injuries that prevent you from working again due to your injuries. You receive the permanent disability benefits after every two weeks. 

  • Permanent Partial Disability

The state considers you partially disabled if your disability rating is under 100%. However, you will still be entitled to weekly payments, set at a certain amount. You will receive money for more weeks if your rating is higher. Similarly, the higher your disability rating, the more benefit you will receive.

  • Permanent Total Disability

If you become 100% disabled, you are entitled to weekly payments for the rest of your life.

  • Life Pension

According to the law, if your disability is between 70% to 99%, you are entitled to a life pension. Life pension means you’ll receive money in addition to your disability benefits for the rest of your life.

Receiving Your Permanent Disability In California

The percentage of your disability will determine the amount of cash you’ll receive.

According to the law, you can’t receive temporary and permanent benefits simultaneously. You will receive permanent disability when you return to work, when your condition stabilizes, and when a judge makes the decision.

You should receive your permanent disability benefits fourteen days after you stop receiving your temporary disability benefits. The insurance company should pay you an estimate of the permanent disability even if they don’t know the exact amount. However, if you receive 85% of your former salary after going back to work, the insurance company will delay the permanent disability payment.

A judge can also determine your level of disability if you and the insurance agency can’t agree. The judge will review your medical reports and treatment records to determine your level of disability. It’s critical to employ the services of a well-experienced lawyer to represent you in court. 

  • The Amount You Will Receive For Disability Insurance In California

You will receive weekly disability benefits, ranging from $50 to $1,252. The benefits are calculated on the percentage of your disability. The higher the disability percentage, the higher the disability percentage you’ll receive.

Summary On The Difference Between Workers Comp And Disability Benefits

Although workers’ compensation and disability benefits may seem confusing, they do have various differences. The filling process, eligibility, benefits, and appeal are different for California’s two types of benefits. The primary purpose of disability insurance benefits is to help you financially when you can’t work due to a non-related injury. On the other hand, the state’s workers’ compensation benefits cater to the medical bills and additional treatment-related costs for injuries you sustain at work.

Below are notable differences between workers’ compensation and disability benefits in California:

  1. Eligibility

  • Eligibility For State Disability Insurance

You have to meet a specific criterion to be eligible for state disability benefits. Some of the conditions you have to meet include submitting the disability claim forty-nine days after your disability. You should also be unable to work for eight consecutive days.  You should also have earned at least $300 from which the state deducts the disability funds. You also have to have seen a qualified medical doctor in the first eight days of your disability. The physician must also issue you a medical certificate to validate your disability. You must also agree to an independent medical examination to determine the validity of your injuries.

  • Eligibility Requirements For Workers’ Compensation Benefits.

The injury must be work-related to qualify for workers’ compensation benefits.  If your claim has an issue, you should file for adjudication within one year. You should also seek medical treatment from the doctor in the MPN unless the injury is an emergency. You must also provide the medical treatment documentation, and the damage must be the result of a work-related accident.

  1. Claim Denial And Appeal Process

  • The Disability Benefits Claim Denial And Appeal Process

The state can deny your disability claim. If this happens, the state will send you a disqualification letter stating why they rejected the disability claim. However, you have to file an appeal within 20 days of receiving the denial letter.

You should fill the appeal form stating why you believe the state was wrong in denying you the disability claim. You also must include your address, phone number, claim identification number, and name in your appeal. Once the state receives your request, they will notify you of the hearing date and location. A judge will listen to your case and the state’s disability representative at the hearing on why they denied your disability claim. It’s critical to enlist the services of a qualified attorney to represent you in the case.

  • The Workers’ Benefits Claim Denial And Appeal Process

Your employer can also deny your compensation benefits claims. However, the rejection comes from the insurance company responsible for paying the claim. The insurance company may deny the claim citing insufficient evidence, they may state you didn’t sustain the injury at work, and the damage isn’t as severe as you claim. The process of filing for an appeal to workers’ benefits is also different from that of filing for disability benefits.

You must file a declaration of readiness for compensation benefits claims for the workers’ compensation claim to proceed. You file this document with the Workers’ Compensation Appeals Board (WCAB). You must also submit the appeal to your employer, who will pass it on to the insurance company after filing their part. The WCAB will schedule a hearing to determine if the insurance company will pay your benefits. As with disability benefits, you should enlist the services of a qualified lawyer to represent you in the hearing.

Enlisting The Service Of An Attorney To Help You Receive The Benefits

If the state or insurance company denies your benefits, it’s imperative to enlist the services of a California workers’ compensation lawyer. They will review the denial letter and guide you through the appeal process. The lawyer has a deep understanding of the law concerning compensation claims. They will represent you in the hearings and help you receive your much-needed benefits.

Call A Workers Compensation Lawyer Near Me

To qualify for workers’ compensation in California, you should have suffered an injury due to an accident in your workplace. To be eligible for disability benefits, you must suffer an injury that isn’t work-related. Disability benefits depend on your injury level, and the state determines the benefits on a scale of 0% to 100%. The higher the disability level, the higher the benefits and the longer you receive the benefits.

The insurance company may reject your worker’s compensation claim. In such a case, you need to employ the services of a highly experienced workers’ compensation attorney. At The Workers Compensation Lawyer Law Firm, we have highly experienced attorneys who have helped workers in Los Angeles, CA receive the compensation they deserve. If you or your loved one needs help with chasing worker’s compensation or disability benefits, don’t hesitate to contact us at 424-501-9228.