Worker's Compensation Benefits Mandated by State Law
Pursuant to Labor Code 4600 the injured Employee is entitled to receive any and all immediate and adequate medical treatment necessary to cure or relieve the effects of the injury BUT only from an authorized medical treatment provider. The Labor Code provides that the Employer has medical control during the first 30 days after the injury unless the Employee has predesignated their personal physician. The County has a Medical Panel consisting of qualified physicians and facilities whose operations are geared toward the needs of the injured worker as well as having competent knowledge of current Workers’ Compensation reporting and billing requirements. A copy of the County’s Medical Panel can be found in the Worker's Compensation Packet.
In addition to the Medical Panel, an Employee may predesignate a personal physician by submitting a Predesignation Request Form to Risk Management PRIOR to the injury in question. A personal physician is one who before the injury in question directed the medical treatment of the Employee and maintains the Employee’s medical records and medical history.
In either event, pursuant to Labor Code 4601, if the Employee so requests, the employer shall tender the Employee one change of physician. The Employee may, after notification of the County’s Workers’ Compensation Administrator, continue treatment for the injury with a physician of the Employee’s own choosing. At the time of notification the Employee must provide the name and address of the new physician in writing.
Medical treatment includes but is not limited to:
- physician services
- laboratory testing
- physical therapy
- physical rehabilitation
- dental care
- any other necessary and reasonable care ordered by the attending or consulting physician.
When the County policy is followed, payment for medical treatment is absorbed 100% by the County with no liability at all to be incurred by the Employee. There are no deductibles or co-payments and all billings for medical treatment should be sent directly to the County’s Workers’ Compensation Administrator.
. . .also known as TD payments are regulated by the State and made at a rate of sixty-six and two-thirds of the Employee’s weekly wage at the time of the injury in question up to the following specific maximums:
- for a date of injury on or after 07/01/96, but on or before 12/31/02: $490 per week
- for a date of injury on or after 01/01/03, but on or before 12/31/03: $602 per week
- for a date of injury on or after 01/01/04, but on or before 12/31/04: $728 per week
Personnel qualified for benefits under Labor Code Section 4850 may be eligible for salary replacement benefits that may be paid up to one year. To qualify, an Employee must be totally unable to perform his/her usual and customary duties as a result of the injury and must have a written statement from an authorized medical provider which confirms the disability period.
TD benefits are not paid for the first 3 days the Employee is disabled unless disability extends for more than 14 days or when the Employee is hospitalized. There is a statutory limit as to the length of time TD is paid; TD benefits terminate when the Employee 1) returns to work, or 2) is determined to be at maximum recovery, or 3) five years from the date of injury. At this point, the Employee may qualify for other types of Workers’ Compensation benefits.
The Employee who is unable to return to his/her usual and customary duties may be entitled to Vocational Rehabilitation benefits. These benefits are designed to provide a permanent change of occupation for the disabled Employee, either within the County or with another employer. When it appears that rehabilitation will be required, Risk Management, the County’s Workers’ Compensation Administrator, a qualified Vocational Rehabilitation Counselor and the Employee work together to assess the potential of rehabilitation. The Employee may also qualify for rehabilitation maintenance payments while preparing for, or undergoing a Rehabilitation Plan with another employer. As with all Workers’ Compensation benefits the cost of rehabilitation services is paid by the Employer. Maximum vocational maintenance allowance is as follows:
- any injuries prior to 1/1/90 maximum of $224 per week
- any injuries after 1/1/90 maximum of $246 per week
Enacted into law and operative January 1, 1994 the maximum amount allowed to be spent by the employer for vocational rehabilitation is $16,000.
When the injured Employee is not expected to recover to 100% of the Employee’s pre-injury physical state, Permanent Disability benefits may be awarded, also known as PD. This benefit is regulated by law and is not reduced by income from any other source. The degree of Permanent Disability is established by the Office of Benefit Determination on the basis of medical reports.
The Permanent Disability is rated on a scale from 1% to 100% which is then translated as to the length of time weekly PD payments are to be made.
Should a work related injury result in the death of the Employee, the State mandates benefits be paid to any qualified surviving dependents.
NOTE: The following notes apply to injuries sustained on or after 1/1/90 resulting in death:
- If working spouse, who is married to the dependent on the date of death, earned $30,000 or less in the 12 months preceding the death, he/she is conclusively presumed to be totally dependent on the decedent.
- Additionally, minors, or others who are physically or mentally incapacitated from earnings, shall be conclusively presumed to be totally dependent on the decedent with whom the child was living at the time of injury.
- Notwithstanding the maximum set forth above, for injuries on or after 1/1/90, death benefits shall continue until the youngest child reaches the age of 18, at the temporary disability rate, but in no event less than $224 per week.
For specific information regarding death benefits, please contact the Workers’ Compensation Coordinator located in the office of Risk Management, 650/363-4612.
IT IS THE RESPONSIBILITY OF THE INJURED EMPLOYEE TO SUBMIT THE DLWP REQUEST IN A TIMELY MANNER WITH THE PROPER ATTACHMENTS TO HIS/HER SUPERVISOR FOR SIGNATURE.