What is Workers’ Compensation?
Workers’ Compensation is an insurance required by law, which provides benefits to workers who are injured or become ill due to employment. It also provides death benefits to dependents in the event of the worker’s death.
Questions & Answers
Am I covered under the Benefit, and how does it apply to me?
Yes, Whenever your job causes you to have an injury or illness, you will be covered. This includes everything from first aid, to serious injuries, to work-related illnesses.
When does this coverage begin for me?
Employees are covered from first day of work.
What benefits are available in the workers’ compensation policy?
Workers’ Compensation policy includes five basic benefits:
- Medical Care necessary to cure or relieve the effects of your injury is provided at no cost to you. You may pre-designate a treating provider or treat with the provider provided by the employer or insurance carrier. If you are not satisfied with your treating provider, you may select a medical provider who is a participant Medical Provider Network specified by your ADR program.
- Temporary Disability Benefits are provided if you are unable to work for more than three days because of your on-the-job injury or illness.
- Permanent Disability. Additional benefits are available.
- Death Benefits.
- When worker is fatally injured on the job.
- Reasonable burial expenses – maximum set by law.
- Qualified surviving dependents may receive benefit payments.
- Supplemental Job Displacement Voucher – if you are unable to return to your regular work and your employer cannot offer permanently modified or alternative work, you may qualify for a non-transferable job displacement voucher.
- Voucher ranges from $4,000 to $10,000 – allowance depends on your level of permanent disability.
- Voucher may be used for re-training or enhancing your skills.
- Voucher may also used towards tuition, books and fees associated to your educational costs.
- If you prefer, a counselor may assist with selecting appropriate training facility – counseling fees may not exceed 10% of the voucher allowance.
What can I do if my employer discriminates against me for filing a worker’s compensation claim?
- Law forbids employer to discriminate against employee for filing a workers’ compensation claim because of a work-related injury or illness.
- Contact the Ombudsperson if discriminated against.
- Employers subject to the Americans with Disabilities Act (ADA) or Fair Employment Housing Act.
- You may also call Equal Employment Opportunity Commission at (800) 669-4000.
How much will I receive and when does temporary disability begin?
- Temporary disability benefits based on two-thirds of your average weekly wage.
- Maximums set by law.
- For injuries after January 1, 2008, the maximum TTD rate is $916.33 per week.
- For injuries after January 1, 2009, the maximum TTD rate is $958.01.
- A letter of explanation will be mailed to you explaining which day of the week your check will be mailed.
- During qualification period, insurance company mail checks automatically every two weeks.
- Expect a check within 14 days if claim filed right away.
- Not paid for the first three days, unless you are in the hospital or unable to work for more than 14 days.
What is the first step in reporting a work-related injury or illness?
- First, contact your foreman or supervisor.
- Contact person will send you to the approved industrial clinic.
- Then, a Claim Form will be given to you that should be returned as soon as possible.
If I have any questions or need assistance, who can I go to?
Call Barbara Shogren Lies: (800) 905-7595 or send an email
The Ombudsperson’s job is to help the injured employee receive workers’ compensation benefits without delay. The Ombudsperson will work with the insurance company, doctor, employer and union representative to make sure you get all the workers’ compensation benefits you are entitled to receive. This service is free to workers who become injured or ill because of work.
How does the Alternative Dispute Resolution (ADR) Program work?
If you experience any problems with your workers’ compensation claim or benefits, there are three steps available –
Ombudsperson / Mediation / Arbitration to replace the traditional judicial system.
- Alternative Dispute Resolution (ADR) Program with the assistance of the Ombudsperson reviews your claim, or
- If unable to resolve your matter, Ombudsperson will assist you with proceeding with a Mediator, or
- Ombudsperson will assist you with going through Arbitration if Mediation is unsuccessful.
What is Arbitration?
Arbitration is like a court hearing. If mediation is not successful, you may request arbitration. An Arbitrator will be assigned to hear your case. A hearing will be scheduled; evidence will be presented and the Arbitrator will render a decision. The decision of an Arbitrator has the same authority as a workers’ compensation judge.
What will going to Arbitration accomplish?
Because the Arbitrator hast the same powers and authority as a workers’ compensation judge, disputes are normally resolved faster and with reduced cost. Although the employee has the right to be represented by an attorney, the need for an attorney on either side is also reduced.
Call Barbara Shogren Lies at (800) 905-7595 if you have any questions or need assistance with your –
- Claim Form
- Temporary of permanent disability benefit
- Benefits or coverage
- Communicating with your employer, doctor, insurance company claims representative or union representative
- Medical care and disability payments
- Returning to work
- Vocational rehabilitation program
- Supplemental job displacement benefit
Shogren Ombudsperson Services
7177 Brockton Ave., Suite 101
Riverside, CA 92506
Tel. (800) 905-7595
Fax: (951) 788-0320