Frequently Asked Questions about the New Workers’ Compensation Law

I’m interested in reading the new law myself, where can I find it?

SB 899 (Poochigian), Chapter 34 of 2004, and legislative staff analyses of that bill may be found on the internet at www.sen.ca.gov. 

When do the provisions of the bill become effective?

There are several provisions within the bill that have specific effective dates.  All other provisions of the bill became effective on April 19, 2004.

Does the new law limit the number of temporary disability payments I can receive?

The new bill limits temporary disability payments for most injuries to 104 weeks within a period of two years.  The following enumerated illnesses and injuries are entitled to 240 weeks within a period of 5 years:  (1)  Acute and chronic hepatitis B; (2)  Acute and chronic hepatitis C; (3) Amputations; (4) Severe burns; (5) Human immunodeficiency virus (HIV); (6) High velocity eye injuries; (7) Chemical burns to the eyes; (8) Pulmonary fibrosis; and, (9) Chronic lung disease.  The good news is that the vast majority of cases are determined to be permanent and stationary (meaning TD ends, and Permanent Disability (PD) begins), prior to two years.  Further, there is an additional requirement under the new law that injured workers receive advances on their PD benefit payments as soon as TD payments cease.

I was already injured and am currently receiving temporary disability payments.  Does this new limitation on temporary disability payments apply to me?

No.  For those injured prior to enactment of the bill, the existing cap continues to apply.  In most cases, that means that an injured worker will receive temporary disability benefits until he is determined to be permanent and stationary or until 240 weeks within a five year period has expired.

Am I still entitled to vocational rehabilitation benefits?

Workers injured prior to January 1, 2004 who would otherwise have qualified for traditional vocational rehabilitation benefits, will continue to be eligible for those benefits until 2009.  Workers injured on or after January 1, 2004 are now entitled to a “Supplemental Job Displacement Benefit” also known as an educational voucher.  These vouchers are worth between $4,000 and $10,000 depending on the injured workers’ disability rating, and may be used for tuition, educational materials and tools, and for vocational rehabilitation counseling services.

Are my PD benefits going to be lower under the new bill?

If your PD rating is under 15%, the new bill calls for a reduction in one benefit week per percentage point of disability.  If your PD rating is over 70%, the new bill calls for an increase in seven weeks per percentage point of disability.  Additionally, the PD rating schedule will be revised to provide for a greater level of certainty and consistency in ratings.  This revision is not however, anticipated to reduce PD benefits further.

Is there a change to my PD benefits dependant upon whether my employer returns me to work?

California has one of the worst return-to-work rates in the nation.  Studies show that the best thing for the injured worker is to return to work.  The new bill provides for incentives for employers to return their employees to work.  Incentive #1:  If the injured worker is not offered his regular job, or an alternative or modified version of that job, then the employee is entitled to an additional 15% of the weekly rate of payments of the PD award.  Incentive #2:  If the injured worker is offered his regular job, or an alternative or modified version of that job, then the employee’s weekly rate of payments of PD award are decreased by 15%.  Incentive #3:  If the employer fails to retain the services of the employee for the statutorily required 12 month period, then the employee is entitled to the pro-rated share of that additional 15%.  Incentive #4:  Small employers (with 50 or fewer employees) are entitled to up to $2,500 in reimbursements for workplace modifications to accommodate injured workers that they return to the workplace.

When is the employer required to provide medical treatment for my workplace injury?

The employer is now required to provide immediate medical treatment to the injured worker, not to exceed $10,000 until the claim is accepted or rejected.  Employers used to have up to 90 days to make a determination regarding whether they would accept or deny the claim, and often denied medical treatment until that determination had been made.

Can I choose my own doctor?

You can “pre-designate” your own doctor if your employer provides you with group health coverage.  The doctor must be your primary care physician who has previously directed your care, and who agrees to be pre-designated.  If you pre-designate, your doctor will be able to treat you from the time of injury.

If your employer doesn’t provide you with group health coverage, and your employer establishes a “workers’ compensation medical provider network” (network) then your employer may choose your doctor for the first visit, and you may select another doctor from within the network after that visit.

If your employer doesn’t establish a network, then the old law applies, meaning that your employer may select your doctor for the first 30 days (180 days if your employer provides an HCO), and then you may select your own doctor thereafter.

  Can I choose a chiropractor as my doctor?

You can not pre-designate a chiropractor as your doctor, however, if your doctor recommends chiropractic care you are entitled to 24 visits per injury.  This cap may be exceeded if your employer/insurer determines, in writing, that you should have more visits.

What happens if I don’t agree with the course of treatment my doctor wants to give me?

There have been several changes to the law in the medical treatment arena over the past two years.  Last year, California adopted utilization guidelines, which are the presumptively correct measure of care under the law.  What that means is that if your health care provider is recommending treatment that falls within those guidelines, and you think you are entitled to care outside of those guidelines, you would have to refute the presumption that care within those guidelines was the correct level of care for you.

This year, changes were made to how employees can get treatment determinations and treatment, outside of employer control.  Treatment determinations, and outside care issues depend on whether your employer provides you with group health, your employer has established a network, or your employer provides neither.

If your employer provides group health, then the group health rules for disputes over medical treatment apply.

If your employer establishes a network, then you are entitled to obtain 2 nd and 3 rd opinions from within the network.  If you still disagree, you are entitled to obtain a “hands-on” Independent Medical Review (IMR).  If the IMR finds in your favor, then you are entitled to seek treatment outside of the network.

If your employer neither provides group health nor has established a network, then you are entitled to seek alternate medical treatment opinions and care after the statutory 30 or 180 day medical control period has elapsed.