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Workers’ Compensation and Permanent Disability

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Archive: Apr 2015

Workers’ Compensation and Permanent Disability

Many people who file for workers’ compensation claims immediately or ultimately need permanent disability benefits as a result of their injury or illness. You may even be entitled to benefits for permanent disability even if your workers’ compensation claim is denied. Here is some information to clarify how permanent disability works within and outside of workers’ compensation policies.

Types of Permanent Disability

You do not have to be paralyzed or suffer from another form of catastrophic injury or illness to qualify for permanent disability. There are two types of permanent disability: partial and total. Under permanent partial disability, you may suffer from a life-altering condition that does not completely exclude you from the workforce. These injuries may include mental disorders, hearing loss, chronic pain syndromes, certain amputations, and more. Anything that will prevent you from working normally into the future can be considered grounds for permanent disability benefits.

Depending on the nature of your injury or illness, you may be compensated for part or all of your lost wages through a permanent disability policy. If you suffer from a condition that remains even after you have reached maximum medical improvement, you are eligible for some form of permanent disability compensation through workers’ compensation.

Permanent Disability Through Workers’ compensation

Any illness or injury directly or proximally work-related may be covered by permanent disability coverage through your workers’ compensation policy. The amount you receive is based on the nature of your condition, the total reduction of your earning capacity, and other factors. You may not be entitled to receive full compensation for lost income through permanent disability.

A physician will determine whether or not an injury or illness has led to permanent disability. He or she will then be able to notify your claims administrator about your disability status. Anything not caused by a work-related experience will not be eligible for coverage. You will start receiving your benefits after temporary disability benefits end and once the claims department approves your status.

Workers’ compensation permanent disability benefits are determined based on American Medical Association guidelines. If you have a dispute with the benefits you receive for permanent disability, you can ask the California Division of Workers’ Compensation to review your case. If you have an attorney working with you, you will need to present your case to a judge for reconsideration.

Permanent Disability Without Workers’ Compensation

Infirmities that are not work related may still be eligible for permanent disability through Social Security. For instance, if you are diagnosed with cancer, heart failure, or another illness, you may not be eligible for coverage through workers’ compensation. Over time, these conditions can create a permanent disability, making it impossible for an employee to continue working at the same level as before.

Social Security disability benefits are paid through a federal program. You will still need notice from a doctor to prove a claim, but these disability claims are not handled through your employer.

When to Contact an Attorney

The laws surrounding workers’ compensation and permanent disability are complex. Insurance companies may reject your claim or your employer may fail to cooperate fully to see that you receive the compensation you deserve. If you are concerned about your illness impairing your ability to work in the future, consider consulting a workers’ compensation attorney.

In addition to helping you navigate your claim, workers’ compensation attorneys at DiMarco | Araujo | Montevideo can also help keep your claim moving forward in a timely fashion and speak to insurance companies and your employer on your behalf. You don’t have to go through the difficulties of securing permanent disability alone. Contact us today for more information.

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What Is the Difference Between Temporary Disability and Workers’ Compensation?

After an on-the-job injury, you may feel overwhelmed with all of the forms and employee benefits information. Even the best human resources department may not be able to help you fully understand everything. One of the questions many employees have after an accident is about the difference between temporary disability and workers’ compensation.

Workers’ Compensation Benefits

Workers’ compensation benefits are specifically for work-related injuries and illness. For instance, if you are diagnosed with cancer or another illness not directly linked to a workplace hazard, you will not be able to claim workers’ compensation to cover your costs associated with illness. However, if you were exposed to a known carcinogen during your regular work duties, you may be able to claim workers’ compensation.

Under most workers’ compensation benefits policies, you are entitled to a number of different benefits, including up to $10,000 of treatment during the time in which your claim is being considered, disability benefits through workers’ compensation, and other medical care costs. If you file for workers’ compensation, your employer is required to provide you with the necessary paperwork within 24 hours of your injury being reported. You must file the claim within a year to receive benefits. If you do not receive the necessary paperwork, ask your employer or claims administrator to receive the necessary forms.

Temporary Disability Benefits

Temporary disability insurance provided by your employer covers any physical malady that prevents you from working. Depending on your company’s policy, these benefits may cover anything from rehabilitation programs for mental illness or drug dependency to car accident injuries and other illnesses that will prevent you from working your normal schedule. Your claim for benefits will be reviewed by your human resources department to determine whether or not your infirmity is covered under the policy.

An absence from work for a week or so may be required for you to apply for temporary disability benefits, and any absence exceeding 6 months may require an application for long-term disability. Your benefits for short-term disability may pay part of your normal wages or all, depending on your company. You are also entitled to receive up to $10,000 of medical treatment while your claim is being processed, similar to a workers’ compensation policy.

Can I File for Both Temporary Disability and Workers’ Compensation Benefits?

You can file for both if you are unsure about the nature of your infirmity. It is always better to file for multiple relief policies than to count on one to provide you with the compensation you need. File for workers’ compensation first. If you are denied, you may still be eligible for coverage under a temporary disability policy. In some cases, you may be able to receive temporary disability while your workers’ compensation case is being evaluated or disputed. If you ultimately receive workers’ compensation, you may be required to pay back the amount granted through temporary disability.

Who Should I Talk to About Specific Questions?

Your human resources department is always a good resource for company specific policies. Through the department, you should have access to any information and documentation you need to pursue a case. You can also consult your physician for more information about your injury and how it may be evaluated in a workers’ compensation case.

In the event you need to dispute a settlement or are unsure about your rights, consider talking to a local workers’ compensation attorney. The team of attorneys at DiMarco | Araujo | Montevideo can help you with every aspect of your case, from evaluating your options for compensation to negotiating with insurance companies on your behalf. Let us know how we can help you by contacting us for a free consultation today.

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Do I Pay Taxes on Workers’ Compensation?

Filing a claim for insurance often brings up questions about taxes and personal responsibility for benefits. Luckily, workers’ compensation is an employee benefit not normally considered part of your taxable income. If you received benefits under a California workers’ compensation act or a federal policy for an illness or injury incurred on the job or as a result of your work, you generally do not have to pay taxes on that amount.

The Exception to the Rule

In some cases, you may be required to pay taxes on workers’ compensation benefits if you also received benefits associated with:

  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)

If this is applicable to you, the amount you will be liable for paying is equal to the amount by which your additional benefits offset your workers’ compensation benefits. Even though there is a chance you may be liable for these taxes in these circumstances, individuals who qualify for both types of benefits often do not have a high enough taxable income to owe taxes at the state or federal level.

What if I Continue to Earn Income While Receiving Workers’ Compensation Benefits?

If you are being compensated normally for an overlapping period during which you are also receiving workers’ compensation benefits, you will only be responsible for paying taxes on the regular income paid by your employer.

How Can I Find Out if I Owe Taxes on My Benefits?

There are a couple of ways you can determine whether you owe taxes. You will owe taxes on the amount provided to you in a W-2. This amount will not reflect your workers’ compensation benefits. Any other benefits that may be considered income may be reflected in this amount. You can also consult a workers’ compensation attorney or a tax advisor if you have any questions regarding your tax liability after receiving workers’ compensation benefits.

I Owe the IRS. Can They Use My Workers’ Compensation Settlement to Cover My Liability?

The IRS has the power to use many different asset types to remedy tax debt. They cannot use any type of workers’ compensation benefits you receive, including your settlement. You will receive the amount of compensation you are due in full.

What Are My Options to Reduce Tax Liability After a Settlement Offset by Social Security?

If you are facing a situation where your Social Security benefits will offset your workers’ compensation settlement, you may want to consider consulting an attorney. An experienced workers’ compensation attorney can help you structure the settlement to reduce your tax payments over time. With a settlement structure, you may be able to completely remove your tax liability, even if your compensation is coming primarily from Social Security benefits.

What Other Tax Issues Might I Face if I Have Workers’ Compensation?

  • If you retired as a result of an illness or injury that leads to a workers’ compensation claim, your additional retirement benefits will still be taxable.
  • You may receive interest payments as well as your primary settlement. An insurance company delay or other misconduct may lead to compensation with interest. If you do receive interest, that amount is eligible for taxation.
  • When a worker dies as a result of his job, surviving members who receive benefits through workers’ compensation do not have to pay taxes on that amount.

Contacting an Attorney

Every workers’ compensation case is different. If you have any questions about your benefits and tax liability, consult an experienced workers’ compensation attorney for information about your rights and obligations. The attorneys at DiMarco | Araujo | Montevideo have a strong understanding of local and California state laws. We can help you with every aspect of your workers’ compensation case.

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Claim Denial & Filing for Adjudication of Workers’ Compensation Claims in California

Being injured on the job may leave you feeling frustrated at the mountain of paperwork needed to secure the benefits essential to recovery. When you submit a claim and it is denied, the process becomes even longer and more difficult to accept. While the process can be lengthy, there are measures you can take to make the process go more smoothly.

Why Was My Claim Denied?

Workers’ compensation claims may be denied for different reasons. Here are a few of the most commonly cited reasons:

  • The insurance company believes your injury is not covered by the policy.
  • There is insufficient evidence that your injury was caused on the job or as a result of a workplace hazard.
  • They believe you failed to take the necessary steps to secure compensation.
  • You filed a claim after you were discharged from a company.
  • You failed to provide the documentation and information necessary for the company to process the claim.

Some of these reasons may be legitimate and prevent you from receiving workers’ compensation. Other times, however, the rejection may be an error on the part of the insurance company or a misrepresentation of the facts or circumstances surrounding your claim.

When Should I Seek Legal Assistance?

If you have doubts about the compensation, benefits, or other circumstances surrounding your claim, an experienced workers’ compensation attorney in California can help you evaluate your situation and actively ensure you receive the benefits you deserve. Seek legal advice regarding a claim denial if:

  • You don’t understand the process and your rights well enough to move forward with addressing a claim denial. Many people secure legal representation for peace of mind after a workplace injury.
  • You need to dispute a decision made by your employer or the insurance company that resulted in a claim denial.

Your attorney may be instrumental in helping you understand your legal options after your claim has been denied. They can also keep the adjudication process moving forward in a timely manner and represent you in legal proceedings to ensure your case is fully addressed. In workers’ compensation cases, your attorney cannot charge you directly for legal assistance. They receive payment from your workers’ compensation benefits.

Filing for Adjudication in California

In the state of California, you must file an “Application for Adjudication of Claim” to have your situation heard by a judge for further evaluation. If you believe your claim was wrongfully denied, filing this form creates a case with the local Workers’ Compensation Appeals Board. You must file the application in your resident county or in the county where you suffered the injury.

After the application has been filed and presented to the appropriate parties, you or your attorney will need to make sure you receive a notice of filing. Keep the assigned case number on hand, as you will need it for any further documentation regarding the case.

The next step to take after receiving notice is to file a “Declaration of Readiness to Proceed.” This declaration is a request for a hearing in front of a judge. You, your attorney (optional, but recommended), and your insurance administrator will sit down with a judge during this hearing and try to reach a settlement. If no agreeable settlement can be met, the judge will schedule a time for trial with another judge.

Additional Information

The process can become complex when an insurance company refuses to settle or if a trial renders an unsatisfactory decision. There are additional steps you can take, but everything must occur within a specific time frame. Hiring our experienced workers compensation attorneys at DiMarco | Araujo | Montevideo will provide you with the expertise you need to navigate California’s workers’ compensation laws.

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