a) Medical Treatment: You are entitled to all “Reasonable and necessary treatment to cure or relieve you of the effects of your work injury”.
In addition, if other symptoms arise after your initial injury, they are covered also so long as the new symptoms are connected to the original injury. For Example, Joe feels a pop in his back while lifting a heavy box. Initially the injury is only to his back. Two months later he begins having upset stomach and heart burn due to the medications he is taking. This stomach problem is covered. He is also having difficulty sleeping due to pain and wakes often during the night or doesn’t sleep much at all. During the day he is more irritable, depressed, sad and angry because he is not able to work and is in pain all the time. The sleep disturbance and depression are also covered by Workers Compensation Insurance because they arise from the original injury. For this reason it is very important to always let your treating doctors know of all symptoms, aches, pains and discomfort you are experiencing as well as how your doing emotionally each time you see him or her. You and your doctors are creating a record of your injuries and disabilities and it needs to be as accurate as possible so you get all the treatment and monetary compensation which you are entitled to receive. An attorneys job is to make sure that you are aware of what is included in your claim and how to obtain the best evidence documenting all your injuries.
“We understand that you are not just a knee, an elbow or a spine but a whole person who deserves to be treated with respect and dignity, by the insurance company, their attorneys and the doctors who have pledged to provide medical care.”
b) Temporary Total Disability: This is your lost wages which are payable to you when a doctor declares you to be completely unable to work for a period of time. It is generally paid at a rate of 2/3rd of your average weekly wages, averaged over the 52 weeks prior to your injury. Wages from other employment can be combined to determine your average weekly wage if you have more than one job.There are minimum payments and maximum payments which change every year. Also your payment may be entitled to an increase every January first. Call us and we can let you know how much you would be entitled to on a weekly basis.
c) Temporary Partial Disability: This is the same wage loss payment as Temporary Total Disability but is paid when your doctor indicates you can work limited duty and you are earning less than your regular full pay. For example, your doctor allows you to continue working after your injury but light duty only. If 2/3rds of your average weekly wage is $400 per week and now you are making $200 per week on light duty, the insurance company would pay you Temporary Partial Disability payments of $200 per week. So you can see that your income while working on limited duty is the same as if you were not working at all. If your employer paid you at least 2/3rds of your average weekly wage while on light duty then the insurance company would not be obligated to make any payments to you.
d) Permanent Disability: This is money to compensate you due to the effects of the injury. How this is determined has undergone a major change since April 19, 2004 when the Governor signed SB 899 into law. For injuries occurring before January 1, 2005 in which there is a medical report which addresses permanent disability, you may be entitled to a permanent disability rating under the old law. The State of California reports that the governor’s reform laws have cut benefits to injured workers by approximately 60%. Therefore it is very important that those older injury claims that are still open be looked at closely to determine if there is any way to keep them under the old law.
For injuries on or after January 1, 2005 you are subject to the governors axing of your benefits. The determination of the percentage of your Permanent Disability under the reform law is very complex and there are many factors that your doctor needs to consider including how your injury is effecting your ability to engage in Activities of Daily Living, known as ADL’s. At Jackson & Jackson we educate our clients how Permanent Disability is determined so they know what the doctor needs to know and why it is important. This results in a more comprehensive and persuasive medical report on your behalf and helps to reduce delays in getting your case settled.
“One of the things that makes Jackson & Jackson unique is how we work together as a team with our clients and their doctors to be sure the doctor has all the medical records and a complete history of the client’s injury and how it is affecting them as a whole person.”
e) Medical Mileage Payments: The insurance company is required to pay you on a per mile basis for driving to your doctors visits and to pharmacies and other places to pick up medical equipment. They must also pay any associated parking expenses. Currently the rate of reimbursement is determined based on the rate in effect when the expense was incurred and tends to change each year.
f) Self-Procured Medical Treatment: The insurance company is required to reimburse you for any expenses actually and reasonably incurred to obtain medical treatment. This often occurs when an injured worker reports an injury and the employer simply tells the injured person to go to a doctor and use their own health insurance, rather than the workers compensation insurance. There is often a co-pay that the injured person must pay up front to receive the medical care they need. This expense is reimbursable and should be submitted to the insurance company with a proper demand for payment within thirty days.