Workers’ compensation benefits can be a financial lifeline to injured employees as they recover from their injury and pursue further treatment. However, these benefits don’t last forever. The duration of workers’ compensation benefits depends on various factors, and each state has different regulations and requirements. In California, most workers’ compensation benefits last anywhere from two years to 240 weeks. Knowing where your case lands in this timeline is essential if you’re planning your recovery, returning to work, and seeking alternative employment options. Given its importance, we’ve collected all the information you need to know when utilizing workers’ compensation in California.
Types of Workers’ Compensation Benefits in California
To understand why the timing of workers’ compensation varies, you must first understand the different types. After all, if you receive total disability benefits, you’ll receive financial compensation far longer than partial disability benefits. Let’s look at some of the variations.
Temporary Disability Benefits
Temporary disability benefits financially support anyone who has been diagnosed with a disability due to an accident at work. There are two main types of temporary disability benefits:
- Temporary total disability (TTD): If you receive a total disability diagnosis, you cannot perform your traditional work duties. These benefits compensate you for any medical care and lost wages you usually receive while working.
- Temporary partial disability (TPD): With a partial disability diagnosis, you can perform some tasks, but you may not be able to perform them as well or as often before a workplace accident. These benefits help you seek medical care and compensate for any reduction in your income due to lower productivity standards.
You are eligible to receive either type of temporary disability benefit for up to 104 weeks in a five-year period in California. However, this time does not have to be consecutive.
For more severe conditions that aren’t permanently disabling, such as severe burns or chronic lung disease that may take longer to recover from, you may be eligible for 240 weeks. Ultimately, the deciding factor between 104 and 240 weeks depends on your employer, your workers’ compensation benefits provider, and the medical provider who makes the diagnosis and prognosis.
Permanent Disability Benefits
For disabilities that permanently disqualify you from completing your work, you may be eligible for permanent disability benefits or Social Security Disability Insurance. This benefit is often much more challenging to acquire than temporary disability benefits, as it takes longer for the Social Security Administration (SSA) to review and approve it. Unlike temporary benefits, though, permanent benefits compensate workers who have an injury with lifelong impacts, either preventing them from working entirely or requiring medical treatment for their lifetime.
The duration and amount of permanent disability benefits in California depend on several factors, primarily the percentage of disability assigned by a qualified medical evaluator or treating physician. This disability rating, which ranges from 0% to 100%, indicates the severity of the impairment and its effect on the worker’s ability to perform future work. Generally, the higher the percentage, the greater the benefits.
Lower ratings result in fewer weeks of payments, while higher ratings allow for more extended coverage. For example, a worker with a 10% disability rating might receive benefits for around 30 weeks, whereas someone with a 70% rating could qualify for benefits lasting several years. In cases where the disability rating is 100%, the worker is considered totally and permanently disabled and may receive benefits for life.
Factors That Affect the Duration of Workers’ Compensation Benefits
In addition to the type of benefits you apply for, additional factors can also affect how long you receive these workers’ compensation benefits, such as the severity of the injury, which we’ve already discussed, and the type of work you do.
Certain occupations, especially those involving physically demanding tasks, such as construction workers who lift heavy objects often or healthcare workers who stand on their feet most of the day, may require longer recovery than those who work less strenuous roles. Injuries like back strains, broken bones, or joint damage can be more challenging to manage for those who must engage in strenuous physical activity, potentially prolonging the duration of temporary disability benefits.
As a result, those with more physically intensive jobs may be qualified to obtain TTD and prolong their disability benefits. In contrast, someone who works a desk job may be able to complete their daily responsibilities under TPD with the same injury.
Key Milestones in the Workers’ Compensation Process
To receive the maximum time for your workers’ compensation benefits, you must start the filing process as soon as possible, as your coverage time starts the day your injury occurs. For example, if you file your claim three months after the incident, you may only receive up to 92 weeks of benefits. Here’s a guide on how to go about the process:
Filing a Claim and Initial Medical Treatment
Filing a claim may seem daunting, but it’s a relatively simple process. The faster you go through the process, the faster you can take advantage of the workers’ compensation benefits. It’s essential to be mindful during each step to receive a fair amount of benefits.
- Seek medical attention: As soon as you know of the injury, seek medical attention. Let your provider know that the injury occurred at work, and they’ll provide the proper documentation and evidence needed when making a claim later. During this visit, avoid lying about previous injuries or exaggerating your symptoms. Instead, be detailed as much as possible.
- Report the injury to your employer and insurance provider: Next, let your employer know about the injury and let them know whether it interferes with your workplace responsibilities. They’ll start the paperwork and recommend how much time you need to recover.
- Complete and file the claim: In the claim, you’ll need to fill out the information, such as the incident, the injuries you obtained, your medical history, and the medical provider who diagnosed you. Afterward, you’ll turn the form in to your provider, who will fill out their portion of the claim and turn it in to the insurance provider.
- Submit information to the California Division of Workers’ Compensation: You or your employer must submit paperwork to the California Division of Workers’ Compensation to ensure you receive benefits.
- Wait for approval or denial: It typically takes insurance providers a couple of weeks to approve or deny your claim. Not only can you negotiate for lump-sum payments if approved, but you can also appeal their decision if they deny your claim.
Although you can take your time when filing, it’s best to do it as soon as possible if you want as much time to utilize workers’ compensation benefits. In California, you must at least report the incident and subsequent injury within 30 days.
Reaching Maximum Medical Improvement (MMI)
Maximum Medical Improvement (MMI) is a crucial milestone in the workers’ compensation process. Essentially, it is the point at which an injured worker’s condition has stabilized, and medical professionals do not expect it to improve further with continued medical treatment. If you’ve reached this point and your injury hasn’t improved, you may be eligible for permanent disability benefits.
Like your initial workers’ compensation claim, you will need to go through a similar filing process that includes the following steps:
- Medical evaluation: A medical professional will evaluate the disability and rate the level of permanent impairment from 0% to 100%. You will then file this paperwork with the SSA and your workers’ compensation insurance provider.
- A benefit adjustment: After the SSA and your workers’ compensation insurance provider review your case, they will approve you for permanent disability benefits to replace temporary disability benefits.
- Vocational rehabilitation: If you cannot return to your previous job, the SSA will often provide vocational rehabilitation services, which include helping injured workers develop new skills to re-enter the workforce.
- Settlement: Workers will have to work with an attorney to negotiate a payment settlement plan, such as a lump-sum payment or a structured settlement, to cover ongoing medical treatment.
With these settlement payments, you can cover any lost funds you usually receive from your wages or any follow-up medical treatments.
Statute of Limitations for Claiming Workers’ Comp Benefits
If you file your workers’ compensation claim too late, not only will you have less time to reap the benefits, but you may also reach the statute of limitations, therefore disqualifying you from filing a claim. In California, the statute of limitations for workers’ compensation benefits is one year — meaning you have one year to file a claim to avoid getting rejected.
There are some key exceptions, though. If your injury worsens due to repetitive strain from your work, you have one year from when you first notice the injury rather than the incident that caused it. In addition, if you are a minor or you have a mental health condition that could delay you from filing a claim, you can request an extension.
What Happens When Your Workers’ Compensation Benefits End?
In California, if you pass 104 weeks of workers’ compensation benefits, you can always receive an additional medical examination if you reach MMI with minimal improvement. You can apply for permanent disability benefits or vocational rehabilitation with the SSA.
If your benefits end before this period, you can always contact your insurance provider to see if they have a legal reason to end them or if there was a simple clerical error.
Either way, approaching the end of your workers’ compensation benefits can be nerve-wracking, but you’re not alone. At Request Legal Help, we specialize in helping California workers reach a compensation agreement that gives them plenty of time to recover and get back on their feet. We can also help you navigate any additional steps, ensuring you have all the resources you need to stay above water. Contact us today for more information!
FAQs About Worker’s Compensation in California
Can I Receive Workers’ Compensation for More Than 104 Weeks?
Yes, in California, workers’ compensation benefits for temporary disability are typically limited to 104 weeks within five years from the date of injury. However, certain exceptions apply for severe injuries such as lung disease, amputations, or extensive burns, which may allow for extended benefits up to 240 weeks.
What Happens If My Injury Prevents Me From Ever Returning to Work?
If your injury prevents you from returning to work permanently, you may be eligible for permanent disability benefits. The amount and duration of these benefits depend on your disability rating, which is determined based on medical evaluations. In some cases, you may also qualify for vocational rehabilitation or job retraining services.
Can I Extend My Temporary Disability Benefits If My Condition Doesn’t Improve?
While California capps temporary disability benefits at 104 weeks, certain severe conditions may qualify for an extension up to 240 weeks. If your injury does not fall under the categories that allow for an extension, transitioning to permanent disability benefits may be necessary if you reach Maximum Medical Improvement (MMI) without fully recovering.
How Does Reaching Maximum Medical Improvement Affect My Benefits?
Reaching Maximum Medical Improvement (MMI) means your condition will unlikely improve significantly with further medical treatment. Once you reach MMI, temporary disability benefits typically end, and your case may transition to permanent disability if there are lasting impairments. A doctor will provide a disability rating that affects the amount of permanent disability benefits.
What Is the Statute of Limitations for Filing a Workers’ Comp Claim in California?
The general statute of limitations for filing a workers’ compensation claim in California is one year from the date of injury. However, some exceptions, such as delayed discovery of the injury, could extend the filing deadline. You must report your injury to your employer immediately to avoid complications.
Can I Receive Workers’ Comp Benefits If I Have a Pre-Existing Condition?
Workers’ compensation benefits may be available if a work-related injury aggravates or accelerates a pre-existing condition. The key factor is whether the work incident significantly worsened the condition. Medical evaluations are typically required to determine eligibility for benefits in these cases.
What Should I Do If My Workers’ Compensation Insurance Provider Denies My Claim?
You can appeal the decision if your workers’ compensation insurance provider denies or rejects your claim. The first step is to request a hearing before a workers’ compensation judge. It may be beneficial to consult with a workers’ compensation attorney to help navigate the appeal process and gather supporting evidence for your case.
Can I Choose My Doctor for Workers’ Compensation Treatment?
In California, the choice of medical provider for workers’ compensation treatment depends on whether your employer has a medical provider network (MPN). If your employer has an MPN, you must choose a doctor from their list. If not, you may select your doctor after the first 30 days of treatment.
Do Workers’ Compensation Benefits Cover Medical Expenses?
Yes, workers’ compensation benefits cover medical expenses related to the work injury, including doctor visits, hospital stays, medications, physical therapy, and necessary medical equipment. These benefits aim to ensure that injured workers receive the appropriate care needed for recovery.
What Happens If I Can Work With Restrictions?
If you can return to work but have medical restrictions due to your injury, your employer must try to accommodate your limitations by offering modified or alternative duties. If your employer cannot accommodate these restrictions, you may be eligible for temporary partial disability benefits.
About the Author
Aaron is a professional legal writer with a B.S. in English Education from Southern Illinois University – Carbondale. He has written, published, and edited thousands of legal articles for RequestLegalHelp, which has connected over 5 million people to legal help in the United States.
With over five years of experience writing thousands of legal articles for law firms across the U.S. and Canada, Aaron specializes in covering federal, state, and city-level legal issues ranging from auto accidents to wrongful terminations.
