Workers Compensation and FMLA

If you sustain a work-related injury, you might need some time off work to allow for proper medical care and healing. Unfortunately, the time you are away from work can be challenging for you and the family. Other times, a family matter might cause you to take some time off work. During this time you are away from your job, you might be at risk of missing your salary or losing the job, making it even harder. Luckily, workers’ compensation laws are available to protect your employment or wages when you are on medical or short-term leave.

You must know that California has statutes that protect employees injured at work through the California Family Rights Act, which plays the role of the federal Family and Medical Leave Act (FMLA) if you are in Los Angeles, CA. However, to qualify for the job-protected leave, you must have been employed for over twelve months.

Some employers violate these laws and the rights of employees, and the effects are brutal. Fortunately, with the help of a workers comp lawyer, you can obtain compensation for the losses you have incurred due to the loss of income. At The Workers Compensation Lawyer Law Firm, we are here to eliminate the confusion of workers' compensation and FMLA to understand your rights during your claim.

Understanding FMLA

The federal government Department of Labor (DLO) has several regulations that protect covered employees. One of these regulations is the FMLA, whose reason for enactment was to ensure job safety for qualified workers who go for unpaid leave for no more than twelve weeks a year. Therefore, if you need to be away from work for a prolonged duration after a work-related illness or deal with a family matter involving an immediate family member like spouse, parent, or children, FMLA is the right leave.

It’s worth understanding that unlike workers comp that only compensates workers for injuries stemming from the job and protects them for the duration they are away from work, the cause of the injury for FMLA is irrelevant. It may be work-related or not. The bottom line is that it protects your job for the leave duration, and at the end of the period, you will return to your initial position, or it’s equal. Besides, even if the leave is unpaid, you will still be eligible for other work benefits like medical care.

FMLA applies to both private and public entities with a minimum of 50 employees within a radius of seventy-five miles.

There are multiple reasons why you can take leave through FMLA. These are:

• A serious health condition that hinders you from performing your work duties
• Adopting or fostering a child and caring for a newly adopted child within the first twelve months
• The birth of a child or caring for a newborn within that first twelve months
• Taking care of a seriously ill parent, spouse, or child

Note that not every health condition you or an immediate family member is suffering from is eligible for leave under FMLA. A serious health condition must meet the following criteria:

• It involves a duration of incapacity requiring you to stay away from work for three days and continue medical care.
• Consist of a term of disability or treatment associated with inpatient care
• Consist of a duration of injury or treatment stemming from a chronic medical condition
• Involves a period of inability due to pregnancy or prenatal care
• Involves a long-term or permanent incapacity due to a need for which treatment is ineffective.

The Basics of Workers Comp

Workers' compensation doesn’t focus much on job protection. Instead, the insurance program is designed to provide you with partial income replacement when you are unable to return to work due to a condition or injury that is work-related. Besides, the insurance program provides health care benefits for treating your injury or illness connected to your work. Therefore, if your condition requires medical treatment, worker’s compensation will pay for all the expenses involved.

Unlike FMLA, which limits the duration you should go for leave, workers comp has no limit on the period you can be off work, but there is no guarantee your original job position will be waiting for you.

Many employers violate the rights of employees provided under the worker’s compensation program. However, a system is available through this program that enables employees to sue employers to obtain compensation for work-related illnesses or injuries. The settlement would cover medical bills, partial salary, and training costs if the injuries forced you to switch your line of work or new position.

Note that you relinquish your right to sue the employer for your injuries if they provide these forms of compensation. Usually, there is a trade-off between you and the employer. They offer you compensation benefits even when you are at fault for your work-related illness or injury in exchange for not suing them. Therefore, it’s crucial to work with a workers comp lawyer because you cannot go back and sue your boss if you fail to obtain maximum compensation for your losses under the program.

If you are hurt at work in Los Angeles, you are eligible for the following benefits:

1. Medical Care

The medical treatment is provided when recovering from the effects of an injury or condition stemming from work, which is one of the benefits you enjoy under the workers’ compensation insurance coverage. However, you cannot seek treatment from any doctor or physician when it comes to work-related injuries. Your doctor should be from the Medical Provider Network (MPN) to ensure you obtain standardized treatment and one that meets the medical guidelines provided under workers comp law.

Your medical treatment request must go to an independent doctor for approval, amendment, or denial of the request. The doctor handling your case will provide treatment until the point where they believe further medical care will be ineffective. At this point, they jot down a permanent and fixed status report.

Your medical care benefits include mileage compensation for the distance covered when going to doctor’s appointments. Also, these benefits include the cost of medication and other medical tools or equipment needed for your recovery.

2. Temporary Disability Benefits

Some of the injuries sustained at work can prevent you from working for a long time. However, the question is, will your employer pay wages during this time you are away from work to protect your family from financial hardship? Yes. The workers' comp provides temporary disability benefits that compensate you for lost income to replace your income had you not been hurt at work.

You will obtain these benefits only after your employer’s insurer decides that the condition or injury is linked to work. If it cannot be directly connected to your line of duty, they will turn down your request for these benefits.

To obtain temporary disability benefits, the physician handling your case must state that you cannot work due to an injury. Further, if the harm sustained wasn’t severe but limits the duties you can perform, and the employer cannot modify the work or offer light duty as an alternative, you will be eligible for temporary disability benefits. During the recovery period, you will be required to report to your physician after every forty-five days. After these medical evaluations, the doctor will suggest your capacity to resume work or restrict your duties on the job.

Even if the first doctor disagrees that your injuries are work-related or believe you could still work, you can dispute their opinion and seek advice from another physician to determine your temporary disability status.

Note that the payments for your temporary disability benefits are made every two weeks or twice a month and can go on for up to 104 weeks within five years. The costs will stop when your injuries heal, and you can resume work, or the physician recommends that you are fit to continue work. Also, your benefits will be stopped if your illness stabilizes and you qualify for permanent disability benefits.

The total temporary disability payments are estimated at two-thirds of your average weekly wages. However, this payment varies based on the prevailing minimum and maximum wages employers pay workers that year.

3. Permanent Disability Benefits

You are entitled to permanent disability benefits if the on-the-job injuries cause loss of future earnings capabilities. These benefits reimburse you based on one to ninety-nine percent loss of body function. If your disability is rated below 100%, you are deemed as partially disabled, which makes you qualify for weekly disbursements for a particular duration.

However, when you are classified as 100 percent disabled, you will be in a permanent disability status which qualifies you for weekly payments of two-thirds of your average weekly pay for the remainder of your life. If your disability is rated ranging from seventy to ninety-nine percent, you will be qualified for a life pension. After your weekly wage payment, you will obtain additional compensation for the rest of your life because of the high disability level.

You will obtain permanent disability benefits if the doctor rules that your medical condition or injury has reached a permanent status, meaning no treatment can effectively change your state. And because you are in a stable condition, the doctor will establish the permanent disability level for each body part. If you are awarded an impairment ratio, you will translate it into permanent disability value utilizing the Permanent Disability Rating Schedule (PDRS). The rating is then put in dollar value, which becomes the compensation you obtain for your injuries.

Note that you will obtain the permanent disability payment two weeks after your last temporary disability payment. You cannot receive both benefits at the same time.

Even under permanent disability benefits, you can dispute your doctor’s assessment and recommendation regarding your status if you feel it’s incorrect. You can request a different medical expert to conduct a med-legal examination. If the other doctor gives a different opinion regarding your permanent disability status, a trial will be set to determine the matter. During the trial, you will be given your chance to testify, and the court will evaluate the medical report from both doctors to assess the disability level.

4. Supplemental Job Placement Benefits

If you are ready and willing to return to work, but your employer fails to offer you a job, you will be eligible for a $6,000 supplemental job voucher. However, your employer can avoid making the payment by providing modified, steady, and alternate work that pays a minimum of 85% of your wage before the job and a reasonable traveling distance from your home. Additionally, the job should last for at least a year.

You should obtain the offer for the job sixty days after the employer has obtained a medical statement that you are permanent or temporary. Once you receive the voucher, you may use it for:

• Payment of licensing
• Certification or testing
• Equipment for Training
• Computer equipment

5. Return to Work Money

You are entitled to return to work funds if your permanent disability ratings are unduly low compared to wage loss. The money is used for loan repayment or payment of past-due bills.

All the workers' compensation benefits are intended for hurt workers, but insurance companies have set the system up to benefit themselves. Therefore, whenever you are denied benefits, or they are delayed, it’s your insurer putting profits above your claim, which is why you need to contact a workers' compensation lawyer right away for legal guidance.

Overlap of Workers Compensation and FMLA

Workers comp and FMLA differ in terms of the cause of injury or illness. If your illness or injury occurs in the line of work and for the employer's benefit, you should file a worker’s compensation claim. However, these two programs can overlap when your work-related injury or illness becomes a serious health condition.

Recall, FMLA protects job positions for employees who take unpaid leave due to serious health conditions. Therefore, if the work-related injury is classified as a serious health condition, you may be eligible for protection under workers’ compensation and FMLA, meaning the two programs can run concurrently. Contrary to the common belief, your job could be protected and obtain healthcare benefits under FMLA, consequently obtaining a partial salary under the worker’s compensation insurance program.

It means that you could be away from work receiving worker’s compensation benefits, and at the same time, your period off work is tallied against the twelve-week voluntary job-protected FMLA leave. In any of these situations where the laws for the two programs overlap, your employer must provide time away from work under the program that allows you to obtain maximum benefits and greater rights.

So, your employer cannot compel you to take leave under FMLA in place of workers comp when your injuries or illness are eligible for benefits under the workers' compensation. You, as the employee, benefits a lot from this law because:

• Your employer must continue the medical care coverage while you are away from work.
• Your job position will be secured until the time you return to work. Also, your employer can’t force you to come back to light-duty tasks at work because the workers' comp regulations have restrictions for returning to work and reasonable accommodation the employer must provide if you need more time off work.

However, if you are off work on the workers’ comp program, the time could count against the twelve weeks provided under FMLA, which is why your employer must notify you in writing that you are going for an FMLA leave. If they fail to inform you about this, you are still eligible for FMLA leave after your time off under the workers' compensation program.

It’s worth noting that you can take extra workers' compensation leave after completing the FMLA leave. Here, where reasonable accommodation is required, California’s Fair Employment and Housing Act comes into play, meaning your employer can extend your stay off work even if your medical leave has lapsed.

Can Your Employer Force You to Take an FMLA Leave for an Illness or Injury Stemming From Work?

Technically, it’s within the law for your employer to require you to take an FMLA leave for a work-related injury. The FMLA statutes allow your employer to count your time off work as family and health care leave even while enjoying workers’ comp benefits as long as the reason for being away from work meets the FMLA criteria.

Sometimes, your employer might opt to use FMLA when you want or are eligible for workers comp benefits to reduce expenses without committing any illegality. Recall, your employer cannot pay a partial salary while on FMLA leave, although you are entitled to obtain benefits like medical care. 

If you file a workers comp claim, your employer’s insurance policy will be utilized to cover the benefits stemming from your claim. And because of the suit filed, the insurance premiums your employer pays to the insurer increase, consequently leading to increased expenses.  As a result, your employer will direct you to take an FMLA leave in place of filing a workers comp claim. However, this shouldn’t be a reason for you to exhaust all your benefits trying to avoid workers comp laws, which is why your employer should do the due diligence.

Employer Breach of FMLA and Workers Compensation Statutes

The worker’s compensation code sec 132(a) protects you against unfair dismissal due to an injury or illness resulting from work. Even if you are out of work on FMLA leave, you are still in your own right to worker’s compensation benefits. However, if the employer does any of the following, they are in violation of FMLA and workers’ comp statutes:

• Change your role or position after returning to work from leave
• Sack you for filing a compensation claim against the employer and being away from work due to a medical condition.
• Sacking you for complaining that the employer violates your FMLA and workers comp rights
• End your job because of taking time off work to care for an immediate family member with a serious medical or health condition.

The law is clear that no employer should interfere with your rights to obtain workers' compensation benefits or take FMLA leave. Further, employers are discouraged from discriminating or hitting back against workers who utilize their FMLA leave. Additionally, your employer shouldn’t hire, discipline, or promote employees based on their decision to use FMLA leave. Even under workers' compensation benefits, your employer cannot withdraw your right to take the FMLA leave.

There are no stipulated federal guidelines on how employers should integrate workers comp and FMLA leave. However, the DOL has confirmed that it is within the law for the two programs to overlap or run concurrently if a serious health condition or injury is the cause of being away from work. The other reason is if your company has notified you that you are using the FMLA leave.

When you are away from work recovering from work-related injuries, you are simultaneously eligible for FMLA protection. If your employer fails to notify you in writing that you are on FMLA leave, you are entitled to job protection for the duration of your leave and an additional period for your workers' compensation leave. Therefore, your employer is advised to kick start your FMLA leave simultaneously with the approval of your workers' comp leave.

Keep in mind that if you return from a workers’ compensation leave that was not labeled as FMLA leave, your employer can violate your FMLA rights, including not reinstating you to your original position or an equivalent, although this should be unintentional. Additionally, your situation becomes more arduous if the injury or disease sustained from work causes a disability that requires you to keep off work for an extended duration other than the one provided under the law.

Whenever you suffer injuries or develop a condition in the line of duty, it is the right of your employer to notify you of the company policy that allows your FMLA and workers comp leave to overlap.

Find an Experienced Workers Comp Lawyer Near Me

Your employer is required by law to carry enough workers' compensation insurance coverage if you sustain work-related injuries that result in medical leave, hospital bills, and other losses. Your situation will be challenging if your illness or injuries are classified as serious health conditions because FMLA laws can still apply in your case. This can be confusing, which is why you must hire an experienced worker’s comp lawyer.

The Workers Compensation Lawyer Law Firm is here to offer legal assistance and protect you from violations of your rights by the employer. Also, our lawyers can help with your workers' comp claim in Los Angeles, CA. Call us today at 424-501-9228 for a zero-obligation consultation.