Typically, the Golden State is on the cutting edge of legal affairs. But in terms of workers’ compensation length, California is straight down the middle. Most states are between one and three years. Job injury victims in California can be on workers’ comp for up to two years. The Golden State does have an unusual wrinkle. The 104 weeks don’t have to be consecutive. This rule makes sense. As job injury victims recover, they often have good weeks and bad weeks.
During these two years, job injury victims receive important benefits, mostly lost wage replacement and medical bill payment. These benefits are no fault, which means a victim doesn’t have to prove negligence or anything else, except that the injury was work related. California has a strong exclusive remedy law, which means that most job injury victims must file for workers’ comp. A few victims can sue outside the system and obtain additional compensation.
During the 104 Weeks of Workers’ Comp in California
We mentioned lost wage replacement and medical bill payment above. Now, let’s break it down a little further.
Victims who can return to work within 104 weeks are temporary disability victims. In most cases, the workers’ compensation insurance company must pay two-thirds of the victim’s average weekly wage (AWW) for the duration of that temporary disability.
Most insurance companies only use prior cash wages to calculate the AWW. That’s a good start, but it’s not enough. The AWW also includes lost future compensation. For example, if Kim is hurt at her retail job in November, she’ll miss December overtime opportunities. Her lost wage replacement checks must reflect those losses.
Additionally, the AWW includes non-cash compensation. Housing allowances and school tuition payments are very common employee benefits.
California law requires workers’ comp insurance companies to pay reasonably necessary medical bills. To most insurance adjusters, this phrase means “lowest possible” medical bills. If Kim needs physical therapy, which she probably will, the insurance company sends her to a cut-rate provider that’s probably affiliated with the insurance company. If Kim has a lawyer, she’ll get the PT she needs, as opposed to the PT an adjuster pays for.
After the 104 Weeks of Workers’ Comp in California
If the injury recovery process lasts more than 104 weeks, victims may be entitled to permanent disability payments.
Future lost wage replacement payments depend on the nature and extent of the medical disability. These payments also depend on the victim’s future employability. If Lisa’s knee injury leads to permanent loss of motion, she probably can’t ever work retail again.
Total disability victims are also entitled to future medical bill payments. Usually, the insurance company offers a “buyout,” or an additional lump sum payment to cover these expenses. These buyouts are usually bad deals for victims. Because of inflation, today’s dollar is usually worth less than tomorrow’s dollar. Lawyers help ensure that victims get dollar-for-dollar future medical bill payment awards.