Medical treatment is the first and most essential benefit of a California work comp claim. Your employer provides medical treatment to help you recover from an injury or illness caused in the course of your employment. Doctors in California's workers' compensation system are required to provide treatments proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.

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Medical treatment is to comply with the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain, and therapy after surgery. Under SB 863, a doctor must request all treatment on a Request for Authorization (RFA) form. Upon receiving this request, the carrier will send it to Utilization Review (UR) to make a determination whether to approve or deny based on the requests conformity to the ACOEM Guidelines. Should UR deny the doctor's request, you have 30 days to appeal through an Independent Medical Review (IMR). This is also a good time to get a workers' comp lawyer involved in your claim.

Temporary disability (TD) payments help to make up for lost wages while receiving medical treatments. If you are unable to work due to your medical condition or are losing wages because your injury prevents you from doing your usual job while recovering you are entitled to temporary disability. As a general rule, if not working, TD pays two-thirds of the gross (pre-tax) wages you are losing while recovering from your work-related injury. Your wages are figured out by using all forms of income you receive from work: wages, food, lodging, tips, commissions, overtime, and bonuses. Generally, employers will go back a 12 month period to determine your Average Weekly Wage (AWW).  Give proof of these earnings to the claims administrator. The claims administrator will consider all forms of income when calculating your TD benefits. 

Once you have received all available medical treatment, as outlined by the ACOEM Guidelines, a doctor, either your PTP or QME, will determine you have reached Maximum Medical Improvement (MMI). Another term used to describe this is permanent and stationary. After reaching this status a determination will be made on your permanent disability. Should you have a permanent disability (PD) you will begin receiving payments of up to $270 (date of injury 2014) per week until you reach the cap for your permanent impairment level.

If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work. PD benefits are limited. If you lose income, PD benefits may not cover all the income lost. If you experience losses unrelated to your ability to work, PD benefits may not cover those losses. 

The SJDV was designed to help an injured worker for retraining or skill enhancement if there is not a full recovery and the injured worker is unable to return to work. For the date of injuries on or after Jan. 1, 2004 and prior to Jan. 1, 2013, employees who are unable to return to work for their employer within 60 days of the end of TD payments will receive a voucher. The amount of the voucher is based on the percentage of disability.

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An employer will not be liable for providing the SJDB to an employee if, within 30 days of the end of TD payments, an offer of modified or alternative work is made, and the employee rejects or fails to accept the offer in the form and manner prescribed by the DWC administrative director.

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For injuries occurring on or after Jan. 1, 2013, the voucher amount is $6,000.00 regardless of the PD rating. The voucher will be due 60 days after a treating doctor, QME, or AME declares the employee permanent and stationary and issues a report outlining the employee's work capacities, and the employer is unable to offer alternative or modified work.

Death benefits are paid out at your temporary disability rate to your spouse, children or other dependents should you or a loved one die from a job injury or illness. Death benefits can be consolidated into a lump sum payout. Often these benefits are disputed based on who is and is not a dependant.