Workers Comp & Disability In California: Faqs
What is workers compensation?
Workers comp provides you with benefits if you become ill or injured because of your workplace. It may also pay medical bills or benefits for temporary or permanent disabilities.
You can also file a Disability Insurance claim if you get hurt at work, develop a medical condition because of your occupation, or an existing work-related condition becomes worse. You typically cannot receive DI benefits and workers comp at the same time. You may receive DI benefits if:
- Your employer or their insurance carrier denies your workers comp benefits
- Your workers comp benefits are less than your DI benefit amount
What is disability insurance?Disability Insurance is part of Californias State Disability Insurance program. DI provides partial wage replacement to California workers who cannot work due to non-work-related injuries or illnesses. These benefits are only paid for a short amount of time.
You can apply for DI if you get sick or injured at work, but you usually cannot receive DI benefits and workers comp payments at the same time. Even if youre not sure if youre eligible, you can still file a DI claim.
Is my injury work-related?If you think an injury, sickness, or disability is work-related, report it to your employer. A physician can help determine whether or not your condition is work-related. They must submit a medical report about your condition to your employers workers comp insurance carrier.
What Is Workers Compensation
Workers compensation provides benefits for workers when their injury or illness arises out of or is caused by their work. Workers compensation may also pay medical bills and benefits for temporary or permanent disabilities.
If you are hurt at work, have a medical condition due to your occupation, or an existing work-related medical condition that has become worse, you can file a Disability Insurance claim.
Some examples of when you may receive DI benefits are:
- Your employer or employers workers compensation insurance carrier denies or delays workers compensation benefits.
- Your workers compensation weekly benefit amount is less than your DI weekly benefit amount, you may be eligible to receive the difference.
However, you usually cannot receive both workers compensation and DI benefits at the same time.
If SDI issues benefits while a workers compensation case is pending, a lien will be filed to recover those benefits when the workers compensation case is settled.
If Your Disability Started Within Four Weeks Of The Last Day You Worked
Who pays benefits: Your employer’s disability benefits insurance carrier.
How to Apply
- File the claim with your employer or insurance carrier, using Notice and Proof of Claim for Disability Benefits .
- Form DB-450 may be obtained using the link above, from your employer, your employers insurance carrier, your health care provider or any Board office.
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Can I Get Short Term Disability Benefits If Workers Compensation Denies My Case
Probably, but you need to be careful. Workers compensation insurance companies often deny injuries that they should accept. Because of that, you often need to request a hearing to fight the workers compensation denial.
Most short term disability insurance companies will pay you benefits while your workers compensation case is being denied. But, you and your doctor have to fill out forms to qualify for short term disability.
These forms often ask questions about whether your injury is work-related. You need to make sure that the forms are completed properly. If you or your doctor indicate on these forms that the injury is not work-related, those same forms probably will be used as evidence against you in your workers compensation case.
What Our Lawyers Can Do For You
We highly recommend contacting a lawyer who has experience with both workers compensation and SSD claims. Depending on your situation, there are sometimes advantages to filing for one before the other. Our lawyers can advise you on the best course of action for your situation and your needs.
For workers compensation and SSD cases, our lawyers can:
- Help you file all your legal applications, documents, and paperwork accurately so that there are no issues.
- Prove your workers compensation or SSD case by gathering evidence that supports your injury or condition.
- Talk to experts in various fields to obtain their supporting testimony on your behalf.
- Represent you and your best interests at all times against the insurance company or the SSA.
Talking to one of our lawyers comes with zero risk or obligation. Remember, our main goal is to see you succeed and win your benefits. You pay us nothing upfront, and if we cant win your case or get you approved for SSD benefits, you dont have to pay us for our services.
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Does My Doctor Have To Fill Out Forms For Short Term Disability
Yes. Your doctor will probably have to fill out paperwork for you to receive short term disability. The short term disability insurance company may have specific paperwork they require your doctor to complete.
This paperwork usually addresses what medical condition you have and how that condition affects your ability to work. Doctors often charge you to complete this paperwork. But, the insurance company will want to know whether you can work or not with your injury to decide if they are going to pay you disability benefits.
What Happens If The Dac Gets Married
If the child receives benefits as a DAC, the benefits generally end if they get married. However, some marriages are considered protected.
The rules vary depending on the situation. Contact a Social Security representative at 1-800-772-1213 to find out if the benefits can continue.
To speed up the application process, complete an Adult Disability Report and have it available at the time of your appointment.
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Will You Continue To Receive Disability Benefits After A Workers Comp Settlement
Its possible. You may be eligible for SSDI after a workers compensation settlement. This can happen before or after you get approved for workers compensation. But the SSA may reduce your benefits, depending on your earnings.
However, you probably will not qualify for SSI. The amount you receive from the settlement will likely mean you do not meet the limited-resources requirement.
Why Does A Structured Settlement Make Sense If I Am Receiving Both Workers’ Comp And Ssdi
Remember, if you are receiving both workers’ compensation and SSDI for an on-the-job injury that has left you seriously disabled, the SSA may offset the amount of money you are receiving from workers’ compensation. The current total amount is 80 percent of what the SSA estimates as your average current earnings.
While accepting a lump-sum agreement may provide you with a sizable amount of cash, it could also prevent you from receiving any SSDI benefits for several years if the total sum is more than the 80 percent figure. However, a structured settlement that spreads out the payout of any agreement you reach with your employer reduces the offset from the SSA. In some cases, it can eliminate it entirely.
It works this way: A 50-year-old man accepts a $20,000 lump-sum payout from workers compensation. Actuarial tables estimate he may live another 30 years. The SSA divides that $20,000 by 360, or the number of months in 30 years. This figure is then used to estimate the monthly offset, which in this case is $550 a month.
Again, before you talk with your employer or his or her insurance company about any lump-sum agreement, or sign any agreement, make sure you first consult a workers’ comp lawyer. They have a lot of experience in negotiating structured settlements and will work with you to make sure you remain within the 80 percent figure if you are also receiving SSDI benefits.
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What If I Decide To Accept A Settlement
Another good reason to apply for workers comp benefits is that you can negotiate a settlement if you wish.
Sometimes your employer will offer you a lump-sum settlement, in which you agree to give up certain rights in exchange for a one-time payment. You may also negotiate a structured settlement with your employer that guarantees you smaller payments over a period of agreed-upon time five years, ten years, etc.
There is nothing wrong with accepting a settlement if you believe it works to your benefit. It is important to know, however, that many lump-sum or secured-settlement agreements require you to relinquish all further claims for medical payments or lost wages. If you have an injury that doesnt appear in its complete form until after you have signed a settlement agreement, you cannot expect your employers insurance company to pay those medical costs.
If you think you will need medical treatment over a period of several years after your injury, it is probably not in your best interest to accept a settlement.
A further concern is that some states will not allow settlements until your workers’ comp claim has reached a certain stage, which may be one reason your employer does not offer you a potential settlement in the early stages of a workers compensation claim. In other states, settlements that concern medical benefits are not allowed. Employers must continue to pay medical benefits in these states, even if there is a lump-sum agreement on other matters.
Health Conditions That May Qualify For Ssd
The following mental health conditions, some of which can result from a workplace accident or assault, are compensable through SSD:
- Manic depression and bipolar disorder
- Post-traumatic stress disorder
- Autism and other pervasive developmental disorders
- Congenital disorders like Down Syndrome
- Intellectual disability i.e., low IQ
- Sociopathic tendencies
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Consult An Experienced Workers Compensation Attorney
While you can collect SSDI and workers compensation concurrently, you may have some advantages to applying to one prior to the other. If you are planning to apply for both SSDI and workers compensation, its best that you consult with an attorney who is experienced with both programs.
In addition to protecting your rights, an attorney can advise you on how to apply for each benefit as well as how to structure your claim. He or she can also help with an appeal if necessary. You have a greater chance of acceptance with professional help throughout the process.
Contact Gerber Holder Law Firm today for your free consultation.
Can I Get Social Security Disability And Workers Compensation
The short answer is yes, you can receive both Social Security Disability Insurance and workers compensation benefits when you qualify for both.
Theyre not the same program. SSDI is a federal government program run by the Social Security Administration . Workers compensation programs are administered by the state of Georgia.
Currently, Georgia workers compensation benefits will provide you with rehabilitation support, medical benefits and supplemental income. You may be eligible for 2/3 of your weekly income up to $575 per week.
Lets compare the programs together.
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Fees How Often How Much
It is extremely important to Silverman, Silverman & Seligman, P.C., that you discuss with us any questions you may have regarding legal fees arising out of your claim.
In prior years, claimants attended numerous hearings and the administrative law judge would authorize a fee for the attorney at each of those hearings. Under the new administrative scheme, there are far fewer hearings and the majority of the work is now done prior to the appearance in court.
Any fees paid to our law firm must come out of the money that is moving as a result of the hearing. In most instances, this money is being paid to you, the claimant, and hence our fee is deducted from the benefits you receive. The fee must be awarded by the administrative law judge prior to any payment to our office. If there is no money moving on your claim, no matter how long we represent you, there will be no fee to our office.
Should I Hire A Lawyer To Help Me With Workers’ Compensation Claims
Yes. Filing a workers compensation claim involves many different factors. A workers comp lawyer can help you navigate your way through the many different benefits available to you and advise you on how to apply for the right benefits at the right time.
If you decide to take a lump-sum agreement from your employer, a workers comp lawyer will make sure the agreement does not just benefit your employer but ensures you receive the benefits to which you are entitled because of your injury.
A workers’ compensation lawyer also makes sense because if you’ve just been hurt, you may not be in the best place to negotiate an agreement or to remember to file your workers compensation claim forms before the three-year statute of limitations expires. A lawyer will be your best ally in ensuring you get all the benefits to which you are entitled.
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Understanding Social Security Offsets
When receiving both workers comp and SSDI payments, the total amount you receive in benefits cannot exceed 80 percent of what you made while fully employed. If the SSA determines that collecting full benefits from both programs goes over the maximum allowance, they may reduce your SSDI payments accordingly.
Can I Apply For Ssd & Workers Compensation
Yesyou can apply for SSD and workers comp benefits. However, you should understand that workers comp benefits typically come immediately after your injury, while SSD benefits can take months to get approved. So if you plan to apply for SSD benefits, you can receive workers comp while your application gets processed and reviewed.
Once you start receiving SSD benefits, things can get complicated when it comes to receiving both simultaneously. Before moving forward with your applications, you should talk with an experienced workers comp attorney about your situation.
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Dependency And Indemnity Compensation
DIC is a tax-free monetary benefit generally payable to a surviving spouse, child, or parent of Servicemembers who died while on active duty, active duty for training, or inactive duty training, or to survivors of Veterans who died from their service-connected disabilities. Parents DIC is an income-based benefit for parents who were financially dependent on of a Servicemember or Veteran who died from a service-related cause.
Can I Get Disability After I Get A Workers Comp Settlement
Yes, and you can collect workers comp and SSD at the same time, but keep in mind that the amount of SSD you are entitled to depends upon the amount of workers comp you received.
SSD can only be collected up to 80% of your former income as an employee. Workers comp benefits figure into that calculation and will reduce the amount of SSD you receive. Contrast workers comp benefits with other income you might have in this situation. If you are collecting private disability insurance benefits or your pension, neither of these will affect the amount of SSD you are entitled to.
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Getting Approved For Workers Compensation And Disability Benefits
After a work injury that leaves you disabled, you should get started with your claim as soon as possible. You will need to:
- Report your work injury to your employer
- Complete and file a Form WC-14 with the SBWC
- Send a copy of the form to your employer and their insurance company
- Get all the necessary medical treatment for your injuries
- Contact a Georgia workers compensation lawyer who can help you with your claim and protect your rights
If you win your workers comp claim, it doesnt affect your ability to seek SSD benefits or whether or not youll get accepted for benefits. That being said, you should also get started on your SSD application, as it can take many months to get approved for benefits.
For a free legal consultation, call
Your Permanent Disability Rating Is Disputed
The bulk of most workers’ comp settlements and awards are for permanent disability benefits. These benefits are calculated based on your permanent disability rating. If the insurance company doesn’t agree with the rating assigned by your treating doctor, it can require you to attend an independent medical examination with a doctor of its choosing. The IME doctor will likely assign a much lower disability rating, which the insurance company will use to justify paying you less in benefits. A lawyer can be essential to getting you a fair settlement or convincing a judge that you are entitled to the higher rating.
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Is Your Condition Severe
Your condition must significantly limit your ability to do basic work-related activities, such as lifting, standing, walking, sitting, or remembering for at least 12 months. If it does not, we will find that you do not have a qualifying disability.
If your condition does interfere with basic work-related activities, we go to Step 3.
Payment & Timing Of Benefits
These benefits are not usually paid in the employees regular paycheck. Instead, they are most often paid in a separate check by the employers insurance company.
No benefits are due for those first seven calendar days of the disability period unless the disability period lasts at least 14 calendar days. Employees may want to use other paid leave options for those first seven unpaid calendar days if their period of disability doesnt last 14 calendar days.
Temporary disability payments for work missed due to a compensable work-related injury or illness must be received by the injured employee no later than 15 calendar days after the notice of injury. Unpaid or untimely paid benefits may be subject to a penalty.
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