Temporary Disability: If your injury prevents you from performing your usual and customary occupation, your employer has not offered you modified work in accordance with the restrictions provided by the doctor and your condition has not stabilized, you are entitled to Temporary Disability. This benefit is 2/3 of your Average Weekly Wage. It is payable for up to 104 weeks and it is tax free.
Wage Loss: You are entitled to Wage Loss in two ways. First, if you are medically unable to perform your usual and customary occupation and your employer has provided you with modified work at a lower weekly rate than you customarily worked pre-injury, you are entitled to 2/3 of the difference between your pre-injury earnings and current earnings, tax free. Second, if your employer discriminates against you for filing a workers' compensation claim and this discrimination has the effect of lost time from work, your employer owes you lost wages.
Medical Care: You are entitled to medical treatment to cure or relieve you of the effects of your work related injury. This includes treatment, medications, diagnostic testing, consultations with specialists and surgeries. This coverage also extends to treatment for consequences of your injury which may include treatment of depression, anxiety, gastro-intestinal problems, diabetes and hypertension.
Permanent Disability: If, at the time your condition stabilizes you are left with permanent impairment, you are entitled to a Permanent Disability award. The value of this award depends on your percentage of Permanent Disability.
Retraining: If your injury results in Permanent Disability and you cannot return to work, you are generally eligible for a Supplemental Job Displacement Benefit, also referred to as a voucher. See Labor Code sections 4658.1, 4658.5 and 4658.7 for further details. If you were injured post 12/31/12, you are ADDITIONALLY entitled to $5,000 from the Return to Work Supplement Program while funds last. Use the following link to apply: https://www.dir.ca.gov/RTWSP/RTWSPApplication.html
Costs: You are entitled to mileage for visits to doctors, testing and pharmacy along with any other costs that go along with such visits.
Total Disability: Should your injury render you totally disabled, you may be entitled to Permanent Total Disability Award which is Temporary Disability for life. A COLA adjustment also applies for injuries post 12/31/2002.
Subsequent Injuries Benefits Trust Fund: According to Labor Code section 4751: If an employee who is permanently partially disabled receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree of disability caused by the combination of both disabilities is greater than that which would have resulted from the subsequent injury alone, and the combined effect of the last injury and the previous disability or impairment is a permanent disability equal to 70 percent or more of total, he shall be paid in addition to the compensation due under this code for the permanent partial disability caused by the last injury compensation for the remainder of the combined permanent disability existing after the last injury as provided in this article; provided, that either (a) the previous disability or impairment affected a hand, an arm, a foot, a leg, or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member, and such latter permanent disability, when considered alone and without regard to, or adjustment for, the occupation or age of the employee, is equal to 5 percent or more of total, or (b) the permanent disability resulting from the subsequent injury, when considered alone and without regard to or adjustment for the occupation or the age of the employee, is equal to 35 percent or more of total.
Social Security Disability Appeal: You should prevail if you can prove that you cannot perform the work you did prior to your disability, you cannot adjust to other work because of your medical conditions and your disability is expected to either last one year or result in death.
What should I do if Utilization Review (UR) TIMELY denies my treatment? You have four remedies:
1. Ask your physician to file appeal with UR. Some UR companies have an internal appeal process and may overturn an adverse determination internally.
2. File a formal appeal with Independent Medical Review (IMR).
3. Discuss with your doctor an alternative to the treatment denied by UR.
4. Work with your doctor to determine whether a new request may be made based on a documented change in the facts material to the UR decision.
IMPORTANT NOTE: An UNTIMELY UR denial is not valid.
Should I have surgery? This is a decision that should not be entered into lightly and the law allows for a second and third opinion in the event you disagree with a medical recommendation such as a recommendation to have surgery.
What is Complex Regional Pain Syndrome (formerly referred to as Reflex Sympathy Dystrophy)? www.MayoClinic.org provides an excellent description. Briefly, according to the site, CRPS, formerly known as RSD, is a form of chronic pain, generally affecting an arm or a leg that is out of proportion to the severity of the original injury. Symptoms may include continuous burning or throbbing pain, usually in your arm, leg, hand or foot; sensitivity to touch or cold; swelling of the painful area; changes in skin temperature — at times your skin may be sweaty; at other times it may be cold; changes in skin color, which can range from white and mottled to red or blue; changes in skin texture, which may become tender, thin or shiny in the affected area; changes in hair and nail growth; joint stiffness, swelling and damage, muscle spasms, weakness and loss (atrophy); decreased ability to move the affected body part; occasionally it may spread to other parts of the body. see: http://www.mayoclinic.org/diseases-conditions/complex-regional-pain-syndrome/basics/definition/con-20022844
Please feel free to either call us at 408-298-8300or email us at Consultation@MayenHerrera.com with any questions.
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