Frequently Asked Questions


Workers Compensation FAQ

Q1. What Is Workers' Compensation And How Much Do I Receive If Injured?

Workers' compensation is a very limited compensation system intended to provide protection to employees injured in the course and scope of their employment. Workers' compensation in California is a "No Fault" system in which neither the fault of the employee or employer is considered before benefits are paid. Thus, negligence or intentional wrong doing are generally irrelevant as to whether you receive workers' compensation. However, because it is "No Fault," there are no jury trials and damages or recovery is limited. You do not receive "Pain and Suffering" damages in the workers' compensation system.

There are four primary benefits you may receive when injured on the job:

  1. Temporary Disability Compensation
  2. Medical Treatment for the Industrial Injury
  3. Permanent Disability Compensation
  4. Job Displacement Allowance

Q2. Will I Be Paid If I Miss Time From Work Due to a Work-related Injury?

Yes!

You are entitled to receive disability compensation when you are temporarily disabled from your job. As a result of the legislative changes in 2004, there is now a two year limit on temporary disability and such payments arenot payable more than two years from the date of first payment.

The amount of compensation you receive while temporarily disabled depends on whom you work for and your actual average weekly earnings. In general, the following guidelines apply:

Private Sector Employees: 

Employees working in the private sector receive two thirds of their average weekly earnings up to a maximum of $986.69 per week for injuries occurring on or after January 1, 2010. This compensation is normally paid by the employer's workers' compensation insurance carrier, and is commonly referred to as the "State Rate" of compensation. An employer may supplement this amount with additional compensation such as partial salary, but is not required to do so.

Los Angeles County Employees:

Safety Members (Sheriffs, Firefighters, etc.) -- Members of the Sheriff\'92s Department whose principal duties involve law enforcement activities and firefighters receive full salary, tax free, up to one full year while so disabled from an injury. This benefit is paid pursuant to Labor Code Section 4850, and is often referred to as "4850 Benefits,' "4850 Time," or "I Time."

Civilian employees -- Pursuant to a County ordinance, civilian employees receive 70% of their salary tax free for up to one calendar year from the date of their injury. If they are still temporarily disabled beyond one calendar year, they receive the maximum allowable under the state rate of temporary disability.

Los Angeles City Employees:

Safety Members (Police and Firefighters) -- LA City firefighters receive 100% of their salary tax free, for up to one full year for each injury. This is commonly referred to as "Injured on Duty Pay" or "IOD Pay." LA City police officers also receive "IOD Pay," but only receive salary tax free if the injury is due to a "Sudden and severe traumatic event" as determined by the medical liaison unit of the Personnel Division.

Civilians -- Pursuant to the City Charter and Los Angeles Administrative Code, all civilians receive "Injured on Duty" (IOD) for up to one full year for each injury. Each City department has negotiated different contracts governing IOD pay. Some employees receive 90% of their salary tax-free, while others receive their normal salary with all taxes, etc., deducted. In either event, a City civilian will not receive less than what he/she would receive if working.

Public Sector Employees (Non-State, LA County or LA City):

Safety Members (Police and Fire) -- Safety employees who are members of the Public Employees Retirement System (PERS), are entitled to receive 100% of their salary for up to one year for each industrial injury. This payment is made pursuant to Labor Code Section 4850, and is commonly referred to as "4850 time," "4850 benefits," etc.

Civilians -- Civilians working for non-State governmental agencies are normally paid pursuant to each City's charter or regulatory code provisions. Each city differs in how they pay employees, but in no event can the employee be paid less than the maximum allowable under the State Rate of temporary disability. Civilians working for all governmental agencies should check with their respective personnel department to determine the rate of pay for an industrial injury.

Q3. If I Do Not Fully Recover From an Injury, Do I Receive Any Additional Compensation?

Yes!

You may be entitled to receive "Permanent Disability" compensation if you suffer any permanent residual effects from the injury. A determination of the extent of permanent disability is based upon a review of the medical evidence, which can include your treating physician, or other physicians reporting for your employer and/or your attorney. The percentage of disability you receive is based on "impairment" as defined by the American Medical Association guides for impairment and may be payable even if you return to your usual and customary occupation. The actual monetary value of any settlement is computed from a disability schedule adopted by the State of California.

Q4. What Type of Treatment Do I Receive For an Industrial Injury, And For How Long Is Treatment Rendered?

When you are injured on the job, you are entitled to have the employer and/or its' workers' compensation insurance carrier pay for all medical treatment that is reasonable and necessary to cure and relieve you from the effects of the injury. The employer must pay for all costs without liability to you, the injured employee. Medical care can include doctor's consultations/visits, hospitalization, surgery, physical therapy, medications, laboratory and diagnostic testing, nursing care, psychiatric treatment, and mileage costs for travel to and from doctors, therapists, etc.

As a result of the so called reform legislation of 2003 and 2004, medical treatment, particularly for orthopedic injuries, is severely limited. All medical treatment is now subject to "utilization review" which allows the employer insurance carrier, to submit the treatment requests to a doctor for review to determine if the treatment is appropriate. To be approved, the medical treatment must be recognized by nationally accepted guidelines approved by the Administrative Director of the Division of Workers7 Compensation. These guidelines are "presumed correct" and if the recommendations of your treating physician do not fall within the guidelines, they may not be approved.

Further, for all orthopedic injuries occurring after January 1,2004, there is a lifetime limit of 24 physical therapy and chiropractic sessions. While a claims examiner may approve more therapy, there is no appeal process if they deny medical treatment beyond the limit stated above.

Q5. Who Selects The Treating Doctor?

Effective January 1,2005, all employers may create a medical network provider (MNP) to control medical treatment for your work related injury. If your employer creates a MNP, you must treat within the network for a work related injury. While you have the right to choose a doctor within the network, you do not have the right to treat outside the network unless you successfully appeal to the Administrative Director.

You may be able to avoid treating within the MNP if you pre-designate a doctor to treat you for a work related injury. This doctor must be one who has been your primary treating doctor or surgeon and who consents to the pre-designation. Pre-designation may be done at any time so long as it is prior to an injury.

Q6. Are There Time Limits in Filing Workers' Compensation Cases?  

Yes. There are various statutes of limitations that apply to filing a workers' compensation case, and they can be extremely complex. Any injury that requires treatment should be reported immediately to your employer, who in turn should provide to you, within 24 hours, an "Employee Claim for Workers' Compensation." This form is then completed by you and returned to your employer.

If an employer denies responsibility for a work-related injury, you should consult with an attorney. An attorney may file an "Application for Adjudication of Claim" with the Workers' Compensation Appeals Board in order to invoke the jurisdiction of the Appeals Board to rule on your claim. The time limits to file an "Application" may be one year from the date of the injury, or possibly five years from the injury date, depending on whether liability has been accepted and if any workers' compensation benefits have been provided. Again, time limitation questions are complex, and if you have any question that a claim needs to be filed within a certain date, consultation with an attorney is recommended.

Q7. Can I Be Terminated For Filing a Workers' Compensation Claim?

Legally, an employer may not discriminate in any way against an employee who files or threatens to file a workers' compensation claim. Labor Code Section 132(a) prohibits such action by an employer and allows for increased compensation and possible reinstatement with back benefits if the employer is found to have violated this policy. Often, the acts of discrimination may not be actual termination, but rather a demotion or denial of a promotion. Further, refusal to provide normal work benefits that other non-injured employees may receive could constitute a violation of this section. A petition for violation of this section must be filed with the Workers' Compensation Appeals Board within one year from the act of discrimination.

Discrimination by your employer resulting from an injury may also give rise to civil actions such as claims with the California Department of Fair Housing; EEOC, Americans With Disability Act. You may wish to consult with your attorney to see if you have a viable claim under any such statute.

Q8. Is Workers' Compensation My Only Legal Remedy?

Normally, if injured on the job, you are limited to recovering from your employer in workers' compensation only. You may not sue your employer for "damages" in a separate civil action, and thus workers' compensation is referred to as the employee's "exclusive remedy." However, there are various exceptions to this rule which do allow you to sue the employer in a court of general jurisdiction, and recover general and special damages. These exceptions generally cover situations where the employer may have intentionally caused the injury or violated some public policy when the injury occurred (i.e., sexual or racial harassment).

You may also have legal rights against a third person or party as a result of a work-related injury. A common example is an on-duty traffic accident where the accident was caused by the negligence of the other driver. In such a case, you could pursue a separate civil action against the other driver and/or the driver's automobile insurance carrier.

As with all legal actions, time limitations apply in filing separate civil actions against an employer and/or a third party, and an attorney should be consulted if any questions exist.

Q9. What If I Am Unable to Return to My Job as a Result of The Injury?

If you were injured prior to January 1,2004 and you find that as a result of your injury, you are unable to return to your usual and customary occupation, your employer is obligated to provide vocational rehabilitation services up to a maximum of $16,000.00 in costs and payments.

For those injured after January 1,2004, vocational rehabilitation does not exist. If you are unable to return to work, you may be entitled to a "job displacement allowance" ranging from $4,000 to $10,000 which is payable in a voucher form to a school or training facility.

Q10.  Is an Attorney Required When I Am Injured on The Job.

Not all injured employees need the services of an attorney to pursue their rights to workers' compensation. Many claims adjusters provide prompt and thorough service and if you make a complete recovery from an injury without any residual problems, then an attorney may not be necessary. However, if you are not receiving benefits in a timely manner, have difficulty obtaining appropriate medical care, have residual permanent disability justifying final permanent disability compensation, or a need for "future medical care" benefits, you should consult with an attorney to insure that all appropriate benefits are and will be provided to you.

Q11. If I Die as a Result of a Work Related Injury, Are My Dependents Entitled to Compensation?

YES. Surviving dependents (total or partial) may be entitled to any benefits that accrued while the injured employee was alive. Surviving dependents may also be entitled to workers' compensation death benefits, including burial expenses if the death was job related. Questions as to causation and the amount of such benefits vary with each case and should be discussed with an attorney. Similarly, there are specific time limitations to file a death claim with the workers' compensation appeals board and each case should be discussed with an attorney to insure a statute does not expire.


Personal Injury FAQ

Q1. If I am injured on the job and I have filed a workers' compensation claim, do I have other legal rights independent of workers' compensation?

If your on-the-job injuries were as the result of the negligence of a "third-party," you have the right to proceed with a civil action independent of the workers' compensation claim. For example: If you are driving a vehicle in the course and scope of your employment and you are rear-ended and suffer injuries, you have the right to file a workers' compensation claim as well as file a civil action against the person who rear-ended you. 

Q2. Is there an advantage to filing a third-party action in addition to a workers' compensation claim?

Workers' compensation benefits are limited to payments for disability, such as temporary disability and permanent disability, including providing for medical care. However, in a personal injury action, additional benefits are available such as obtaining reimbursement for loss of overtime, loss of future earning capacity some out-of-pocket expenses (such as for a replacement rental vehicle), and the most recognized benefit, compensation for pain and suffering.

Q3. Can I receive both workers' compensation benefits and a personal injury recovery for the same incident?

You cannot receive a double recovery for one accident. Normally, the workers' compensation carrier is reimbursed for any expenditures made.

If you file a personal injury action and the employer paying the workers' compensation benefits files a lien, intervenes in the suit, or has filed a separate suit, the employer will be entitled to reimbursement for benefits paid.

To maximize a net recovery, the workers' compensation case and personal injury case should be coordinated, as each case can have an impact on the other.

Q4. Do I have to pay an attorney to represent me in a personal injury action?

Most attorneys handling personal injury cases are paid on a contingency basis. This means that if the injured party receives a recovery, the attorney is paid a percentage of the recovery. If the injured party receives no recovery, the attorney is paid nothing.

If the injuries are as the result of a work-related injury, again, the coordination of the two related cases is important to maximize the recovery.


City of Los Angeles Fire & Police Pension System FAQ

Q1. Who administers the Fire & Police Pension System of the City of Los Angeles?

The Department of Pensions of the City of Los Angeles administers all applications for disability retirement of any kind, including death benefits. The Board of Pension Commissioners of the City of Los Angeles meet on a regular basis and either approve or deny applications for the aforesaid disability pension benefits.

Q2. How do I qualify for a disability pension?

To qualify for a service-connected disability pension, it must be found that you are permanently incapacitated from the performance of your duties and additionally to duties to which you may be assigned, including light or restricted duties. In order to receive a service-connected disability pension, you must show that your disability is as a result of service-connected causes.

Q3. What does "Service-Connected" mean?


Generally speaking, "Service-Connected" means work-related; however, there are legal distinctions between benefits that may be received through workers' compensation and benefits to which you may be entitled under the Charter of the City of Los Angeles.

Q4. If I am granted a disability retirement, do I get a refund of my contributions which I have made to the pension fund?

No. All individual contributions will be commingled with the contributions made on your behalf by the City of Los Angeles. These contributions and the investments made with the pool funds are the funds from which you receive a monthly pension allowance for the remainder of your life.

Q5. How do I know if I qualify or should apply for a disability pension?

You must have a medical condition of such seriousness that it substantially precludes you from undertaking your assigned duties. You will be evaluated by three doctors on behalf of the Department of Pensions. Accordingly, it is best to consult with your treating doctors prior to filing your Application for Disability Retirement.

Q6. If a doctor does support my claim indicating that I cannot perform my job duties, when should I apply?

The timing of the filing of an application is complicated; however, you generally have a right to apply at any time that you are a member of the Pension Department, or within one year from the separation of service (such as due to resignation, termination or the taking of a service retirement). If you have filed a workers' compensation claim within this one year separation of service, you may be allowed to file later. However, it is recommended that you file your disability retirement application before you conclude service with your Department wherever possible. If you file after separation of service, you must show that you were disabled at the time of separation and continuously thereafter.

Q7. After I have applied for disability pension, how long does it take to complete the process?

This is a difficult question to answer, but presently most applications seem to take at least 9-12 months. Sometimes, depending on several factors, the process can take less or more time.

Q8. Do I need an attorney to apply for disability retirement?

While an attorney is not necessary, nevertheless an attorney can improve the chances of success by presenting the case in an accurate and complete manner. All applications which are brought before the Board are prepared by city employees of the Department of Pensions. These employees are allowed to write a written and detailed recommendation as to how the Board of Pension Commissioners should rule on your application. The Police and Fire Department will also be allowed to have a representative at your hearing, who will make a statement as to whether a job should be made available consistent with your work restrictions.

Q9. If I hire an attorney, how much does it cost?

Attorneys fees vary depending on the case. Generally the largest portion of the fee is on a contingent basis. This means that you do not pay a fee unless you are successful in obtaining a disability retirement.


Los Angeles County Employees' Retirement Association FAQ

Q1. What is LACERA?

LACERA is an acronym for Los Angeles County Employees' Retirement Association. It is a separate legal entity from the County of Los Angeles. The governing authority of LACERA is a nine member board which is composed of four elected positions, the treasurer/tax collector, and members appointed by the Los Angeles County Board of Supervisors.

Q2. Do I qualify for a disability pension with LACERA?

To qualify for a service-connected disability retirement from LACERA, you must be found to be permanently incapacitated from the performance of your job duties, and that the injury is service-connected. In addition to service-connected injuries, as a member of LACERA, you can be granted a non service-connected disability retirement, which is granted when you are incapacitated from the performance of your job duties, but for non-service related causes.

Q3. What does "Service-Connected" mean?

The words "Service-Connected" are found in the Government Code of the State of California which regulate the rights of LACERA members. Generally speaking, "Service-Connected" means work-related. However, there are legal distinctions between benefits that may be received through workers' compensation under the Labor Code and benefits to which you may be entitled under the Government Code for disability retirement purposes.

Q4. If I am granted a disability retirement, do I get a refund of the contributions which I have made to the LACERA pension fund?

No. All individual contributions have been commingled with the contributions made on the member's behalf by the County of Los Angeles. These contributions and the investments made with the pooled funds are the funds from which members, including yourself, receive a monthly pension allowance.

Q5. How do I know if I qualify or should apply for a disability pension?

In order to apply for a disability pension from LACERA, it must be the opinion of a doctor that you are no longer able to perform your job duties on a permanent basis. That doctor must complete the LACERA Physician Statement indicating that you are "Substantially and Permanently" incapacitated from the performance of your duties. Without a doctor to support the claim, an application cannot be filed with LACERA.

Q6. If a doctor does support my claim indicating that I cannot perform my job duties, when should I apply?

The timing of the filing of an application is quite complex; however, you have the right to apply at any time you are a member of LACERA, or within four months from a separation from service, such as due to resignation, termination or the taking of a service retirement. Additionally, an application can be filed at any time after separation from service if you have been continuously disabled.

Q7. After I have applied for a disability pension with LACERA, how long does it take to complete the process?

Normally, it takes nine months to process the application. However, depending on several factors, it may take more or less time.

If the initial application is denied, the appeal process will also take approximately nine additional months, depending upon a variety of factors.

Q8. Do I need an attorney to apply for a disability retirement?

While an attorney is not necessary, an attorney can improve the chances of success by presenting the case in an accurate and complete manner. If the disability pension is initially denied, you have the right to appeal and request an administrative hearing. At that point, an attorney specializing in the area of disability retirement law is highly recommended as the process is complex and LACERA will be represented by an attorney at that level of the proceedings.

Q9. If I hire an attorney, how much does it cost?

Attorney's fees vary depending upon the case; however, generally, at the application level, the fees are on a contingent basis. This means that the client will not pay a fee unless he or she is successful in obtaining a disability retirement.