The People's Guide

35th Edition 2013-2014

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The People's Guide 2013-2014 18 Long-term or Permanent Disability: If you expect your disability to be long- term or permanent, apply for SSDI from Social Security well before your year of SDI is over. (see page 23 Social Security). 2. Workers' Compensation If you are disabled because of a work injury or as a result of unhealthy, unsafe, or stressful conditions at work, you should apply for workers' com- pensation. Workers 'compensation is a no-fault system, meaning that injured employees need not prove the injury was someone else's fault. There are six basic types of workers' compensation benefits: A. Medical Benefits: The employer pays for the medical care resulting from the work-related injury. This can include physician services, hospitalization, prescriptions, and other necessary and reasonable care. You may be treated by the employer's physician of choice, or by your own doctor if you have previously notified your employer in writing, or by your own doctor after 30 days of receiv- ing treatment by the employer's physi- cian of choice. B. Temporary Disability Benefits: These are paid every two weeks if you are unable to return to work within three days, or are hospitalized overnight. The benefits are intended to partially replace two-thirds of the wages lost as a result of the injury, up to a maximum of $840 per week. They are paid until you are able to return to work or until the dis- ability becomes permanent and station- ary. For most injuries, payment will not last more than 104 weeks. C. Permanent Total Disability: If you have a permanent total disability you receive up to $840 per week for life. your base period you were in the military service, received workers' compensation benefits, or did not work because of a labor dispute. You have the right to appeal, and should, any disqualification, overpay- ment, or penalty that you do not agree with. Specific instructions on how to ap- peal will be provided on the state forms you receive. If you file an appeal and you remain disabled, you must continue to complete and return continued claim certifications. For residents in a state-approved alco- holic recovery home or drug-free resi- dential facility, the maximum payable period is 90 days. (However, disabilities related to or caused by acute or chronic alcoholism or drug abuse which are being medically treated do not have this limitation). When your claim is received, the SDI office will notify you of your weekly ben- efit amount and request any additional information needed to determine your eligibility. If you meet all requirements, a check will be mailed to you from a central payment center. The first seven days of your claim is a waiting period for which no benefits are paid. If you are eligible for further benefits, either additional payments will be sent automatically or a continued claim certification form for the next two weeks will be sent with the check. You must report income you receive, even though sometimes it does not reduce your SDI check. Coordination with Worker's Comp If you also have a worker comp. claim and the insurance carrier delays or refuses payments, SDI may pay you benefits while your case is pending. However, SDI will pay benefits only for the period you are disabled and will file a lien to recover benefits paid. SDI and Workers' Compensation are two separate programs. You cannot legally be paid full benefits from both programs for the same period. However, if your workers' comp benefit rate is less than your SDI rate, SDI may pay you the difference between the two rates. D. Permanent Partial Disability: The percentage of disability is based on a medical evaluation of your limitations, and takes your age, occupation, and lost earning capacity into account. You receive weekly benefits for a period that increases with the percentage of dis- ability, from 4 weeks for a 1% perma- nent disability up to 694 weeks for a 99% disability. Those with a permanent partial disability of 70% or more also re- ceive a small life pension - a maximum of $250 per week - following the final payment of permanent partial disability benefits. E. Vocational rehabilitation services: These services are for when you are unable to return to your former type of work after the job injury. You are entitled to these services if they can reasonably be expected to return you to suitable gainful employment. This includes the development of a plan, the cost of any training, and a maintenance allowance while participating in rehabilitation. You can receive up to $246 per week---less than Temporary Disability Benefits. F. Death benefits: If a worker is fatally in- jured, the employer pays burial expenses up to $5,000 and support payments for dependents. Filing a workers' comp claim: for help filing a claim or if your employer does not have Workers Comp contact: Industrial Accidents Division 107 S. Broadway, LA, CA 90012 (213) 897-1446, 1-800-736-7401. For problems with worker comp claims The Division Office in Los Angeles 320 W. 4th St., 9th floor, 90013 (213) 576-7335. County offices: You may also want to hire a private attorney to help you with your claim. Many lawyers will handle this type of case even if you cannot afford to pay in advance because their fees for workers' compensation cases are set by law and are paid by the insurance company. If you are permanently disabled and do not expect to return to work, you may also qualify for Social Security or SSI. Worker's Rights

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