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The California Workers’ Compensation Program is an excellent resource for injured employees throughout the state. It provides an outlet for financial recovery to any employee injured during job-related activities – without requiring the employee to prove anyone else’s negligence or go to court. To file a claim under the workers’ comp system for a recent workplace injury, you should learn the common acronyms used in the system. Understanding the language can make the claims process simpler for injured employees.
If a workplace accident results in temporary partial disability (TPD) to the worker, such as a broken limb, he or she can apply for TPD payments. These benefits will cover lost wages while the employee can only perform reduced duty or part-time work. TPD payments can bridge the gap between what the worker used to make and what he/she is now making because of reduced duty work. The insurance company must pay two-thirds of the gross wages the employee loses while in recovery from an injury.
TTD payments come into play when the workplace injury results in total temporary disability, such as bed rest. In these situations, the employee cannot return to work at all during recovery, even to perform light work. The insurance company will issue TTD payments to cover two-thirds of the amount of total lost wages from missed time at work. The employee does not have to pay any income taxes on workers’ comp disability benefits. Determining TPD and TTD amounts can be difficult if the worker had more than one job, a seasonal job, or earned other income such as tips.
Workers who suffer permanent, but not complete, disabilities are those who may be able to return to work performing light duty or in a different position than he/she previously held. Permanent partial disability (PPD) benefits use a ranking system to determine the severity of the partial disability. Those with more severe injuries generally receive higher benefit amounts.
If an employee suffers an injury that leaves him or her permanently and totally disabled, he or she can receive permanent total disability (PTD) benefits. The worker will fill out a permanent and stationary (P&S) report that describes the medical problems, extent of disability, and future medical costs. The workers’ comp system will give you a rating depending on your P&S report, which will then determine the amount of compensation benefits.
An agreed medical evaluation (AME) is one that takes place under a provider that the injured workers’ attorney and claims administrator agrees upon. The purpose of an AME is to obtain a medical examination and report from an unbiased, agreed-upon party to help settle a claims dispute. The AME can determine how the work injury led to disability and potential causes of the injury. California law does not allow healthcare providers to advertise as AME centers.
The workers’ comp program will calculate an injured worker’s average earnings to determine the individual’s wage loss benefits. Most cases abide by the average weekly wage (AWW) method, which looks at a worker’s average earnings by week for a certain period of time. However, in some cases, an AWW is not an accurate representation of the employee’s earnings. In these situations, the program will calculate benefits based on average daily wage (ADW), or the average daily earnings. The professional overseeing the case will then use either the AWW or ADW amount to compute wage loss benefits.