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Why California Workers’ Compensation Benefits May Stop Being Paid

desk with binder on compensationHave your temporary disability benefits stopped? Were you unable to get coverage for some of your medical bills?

Workers’ compensation benefits usually are not paid forever. There are certain limitations on your benefits, and some of them are triggered by you going back to work. Below, find out some of the main reasons why benefits may stop being paid. If you have more questions, do not hesitate to call our experienced law firm for a free consultation. 

When do Medical Benefits End?

California workers’ compensation law requires the claim administrator to pay for medical care that is “reasonably required to cure or relieve” the effects of your work injury. The care you receive must follow guidelines in the medical treatment utilization schedule published by the Division of Workers’ Compensation. The guidelines help provide physicians with information on appropriate treatment.

If your physician recommends treatment that is not in the guidelines, the claims administrator is required to pay for this treatment if it follows other scientifically-based guidelines that are generally recognized by the national medical community.

There are certain limits to medical benefits. The claims administrator is required to authorize payment for necessary non-emergency care up to $10,000. Additionally, you are limited to the following:

  • 24 chiropractor visits
  • 24 physical therapy visits
  • 24 occupational therapy visits

There are exceptions to these limits, such as if the visits are after surgery or if the claims administrator authorizes additional visits. There may be other limits based on the medical treatment guidelines.

If your case is settled with an agreement on future medical care, you should receive the benefits that you and the claims administrator agreed on, which are still subject to the guidelines.

Limits on Temporary Disability Benefits

Injured workers receive temporary total disability benefits when they are unable to work for seven consecutive days. If they are unable to work more than 14 days, the first week is compensable. These benefits provide for two-thirds of your average weekly wages.

You can still receive benefits after returning to work if you are earning less than an amount set by law. However, your benefits will be two-thirds of the difference between your compensation before the injury and what you are currently earning.

Individuals can only get temporary disability benefits for up to 104 weeks. These 104 weeks must occur during the first five years of the injury.

When your payments end, the claims administrator must send you a letter explaining the reason why your benefits are ending. The letter must also include a list of all temporary disability payments that have been sent to you. The letter must be sent within 14 days of your final temporary disability payment.

Disputing the End of Benefits

If your benefits have ended and you think this is in error, you can dispute this. If you have received 104 payments, there are certain medical conditions that may qualify for up to 240 weeks of temporary disability benefits, such as:

  • Amputations
  • Lung disease
  • Acute and chronic hepatitis B
  • Acute and chronic hepatitis C
  • HIV
  • Severe burns
  • Pulmonary fibrosis
  • Chemical burns to the eyes
  • High-velocity eye injuries

If your doctor believes that you will never recover completely from the work-related accident or illness, you may be able to receive permanent disability benefits or supplemental job displacement benefits.

However, workers rarely qualify for up to 240 weeks of disability benefits. An experienced attorney can discuss your injury and determine the benefits you may qualify for and how long they may be paid out.

Contact a Knowledgeable Lawyer for More Assistance

If you have questions about why your workers’ compensation benefits have stopped, you can talk to one of our knowledgeable Bakersfield workers’ compensation lawyers.

The skilled legal team at Berry, Smith & Bartell may be able to assist you with all aspects of your claim and the appeal process. We work on a contingency-fee basis, so we only get paid if you get paid. Contact us today to schedule a free consultation.

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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