Injured workers are entitled to receive all medical care reasonably required to cure or relieve the effects of the injury/illness, with no deductible or co-payments by the injured worker. Reasonable medical treatment required to cure or relieve the effects of an industrial injury/illness means treatment that is based upon the guidelines adopted by the administrative director or, prior to the adoption of those guidelines, the updated American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines.
Generally, the employer controls the medical treatment for the first 30 days after the injury is reported, and the employee is then free to select any treating physician or facility. However, if the employee has notified the employer in writing prior to the injury that he or she has a “personal physician” — a physician or surgeon who has previously treated the employee — the employee may be treated by that physician from the date of injury. Choice of treating physician differs; however, if the employer has developed a state certified Medical Provider Network.
Workers Compensation Medical Provider Network Information
salary continuation and temporary disability benefits
Many City employees are entitled to salary continuation benefits that are paid in lieu of state rate temporary disability benefits as designated in each Memorandum of Understanding (MOUs). Certain classes of City employees are entitled to statutorily derived benefits that exceed the state temporary disability rate.
Those workers unable to return to work after exhausting salary continuation are entitled to temporary disability benefits to partially replace wages lost as a result of the injury. The benefits are generally designed to replace two-thirds of the lost wages, up to a maximum of $840 per week. Temporary disability benefits are payable every two weeks, on a day designated with the first payment, until the employee is able to return to work or until the employee’s condition becomes permanent and stationary.
permanent disability benefits
Injured workers who are permanently disabled – those who have a permanent labor market handicap — are entitled to receive permanent disability benefits. A worker who is determined to have a permanent total disability receives the temporary disability benefit – up to $840 per week – for life. A worker determined to have a permanent partial disability receives weekly benefits for a period which increases with the percentage of disability, from four weeks for a one percent permanent disability up to 694.25 weeks for a 99.75 percent disability. Permanent partial disability benefits are also payable at two-thirds of the injured worker’s average weekly wages, but are subject to a much lower maximum. As of Jan. 1, 2004, the rates are $220 per week for disabilities less than 69.75 percent and $270 per week for disabilities rated at 70 to 99.75 percent. Those with a permanent partial disability of 70 percent or more also receive a small life pension – a maximum of $257.69 per week – following the final payment of permanent partial disability benefits.
The percentage of permanent disability is determined by using the Permanent Disability Rating Schedule and an assessment of the injured worker’s permanent impairment and limitations. The Permanent Disability Rating Schedule specifies standard percentage ratings for permanent impairments and limitations, and provides for the modification of these standard ratings based on the injured worker’s age, occupation, and considers the employee’s diminished future earning capacity. The standard rating is adjusted for age by lowering the rating for younger workers and increasing it for older workers on the theory that it is easier for younger people to adjust to a permanent handicap. The standard rating is adjusted for occupation by increasing the rating if the permanent impairment or limitation will be more of an impediment in performing the worker’s occupation, and lowering the rating if it will have a lesser impact.
VOCATIONAL REHABILITATION SERVICES (FOR INJURIES BEFORE JAN. 1, 2004)
Injured workers who are unable to return to their former type of work are entitled to vocational rehabilitation services if these services can reasonably be expected to return the worker to suitable gainful employment. This includes the development of a suitable plan, the cost of any training, and a maintenance allowance while participating in rehabilitation.
Once an injured worker is determined unable to return to his or her previous type of work, the employer and worker jointly select a rehabilitation counselor who will determine whether vocational rehabilitation is feasible, and if appropriate, develop a suitable rehabilitation plan. The goal of a rehabilitation plan is to return the injured worker to “suitable gainful employment” – employment or self-employment that is reasonably attainable and which offers an opportunity to restore the injured worker as soon as practicable and as near as possible to maximum self-support. The maintenance allowance payable to an injured worker while in rehabilitation is, like temporary disability benefits, designed to replace two-thirds of lost earnings, but the maximum weekly amount is lower – $246 per week. The worker may, however, supplement the maintenance allowance with advances of permanent disability benefits up to the point where the worker is receiving the same weekly amount as he or she received in temporary disability benefits. Total costs for rehabilitation are now limited to $16,000 for workers injured on or after Jan. 1, 1994. For dates of injury on or after Jan. 1, 2003, injured workers who have legal representation may settle vocational rehabilitation for a lump sum. Vocational rehabilitation does not apply for dates of injury after Jan. 1, 2004.
SUPPLEMENTAL JOB DISPLACEMENT BENEFIT (FOR INJURIES ON OR AFTER JAN. 1, 2004)
This is a nontransferable voucher for education-related retraining or skill enhancement, or both, payable to a state approved or accredited school if the worker is injured on or after Jan. 1, 2004. To qualify for this benefit, the injury must result in a permanent disability, the injured employee does not return to work within 60 days after temporary disability ends, and the employer does not offer modified or alternative work. The maximum voucher amount is $10,000.