WHAT IF I GET INJURED AND CAN’T GET WORK?
1. State Disability Insurance
If you cannot work for a temporary period because of an illness or injury that is not work related, or pregnancy, you may be able to get state disability insurance benefits (SDI). These benefits can last up to one year (39 weeks for employers and self-employed people who elected SDI coverage).
You must be unable to do your regular or customary normal work for at least eight consecutive days. You must have lost wages because of your disability or, if unemployed, have been actively looking for work. You must be under the care and treatment of a doctor during the first eight days of your disability, and to continue receiving benefits.
You must complete and mail a “Claim Statement of Employee” within 49 days of the date you became disabled. If your disability prevents you from completing the claim form, or you are filing for benefits on behalf of a disabled or dead claimant, call (800) 480-3287 for required forms and help.
Your must also ask if your doctor needs to complete and sign the “Doctor’s Certificate”. If your doctor will mail your completed claim to SDI, provide give him/her with an envelope addressed to the SDI office listed below. Mail your claim no earlier than 9 days,but no later than 49 days after the first day you became disabled. Mail the completed, signed “Claim Statement of Employee” together with the completed, signed “Doctor’s Certificate” to:
You can file a claim online at https://edd.ca.gov/claims.htm
or call (800) 480-3287.
You may not be eligible for SDI benefits if you:
• Are claiming or receiving asking for or getting Unemployment Insurance.
• Are receiving workers’ compensation benefits at a weekly rate equal to or greater than the amount of SDI you would get.
• Are in jail, prison, or recovery home because you were convicted of a crime.
• Don’t have an independent medical examination when asked to do so.
You have the right to appeal any denial, disqualification, overpayment, or penalty. Specific instructions Information on how to appeal will be provided on the state forms you receive. If you file an appeal and you remain disabled, you must continue to complete and return continued claim certifications.
For residents in a state-approved alcoholic recovery home or drug-free residential facility, the maximum payable period is 90 days. However, you can get SDI if your disability is related to or caused by acute or chronic alcoholism or drug abuse which you are being medically treated for.
When your claim is received, the SDI office will notify you of your weekly benefit amount and ask for any additional information needed to determine your eligibility. If you meet all requirements, a check will be mailed to you from a central payment center. If you are eligible for further benefits, either additional payments will be sent automatically or a continued claim certification form for the next two weeks will be sent with the check. You must report income you receive, even though sometimes it does not reduce your SDI check.
Coordination with Workers’ Compensation
If you also have a Workers’ Compensation claim and the insurance carrier delays or refuses payments, SDI may pay you benefits while your case is pending. However, SDI will pay benefits only for the period you are disabled and will file a lien to recover benefits paid.
SDI and Workers’ Compensation are two separate programs. You cannot legally be paid full benefits from both programs for the same period.
However, if your Workers’ Compensation benefit rate is less than your SDI rate, SDI may pay you the difference between the two rates.
Long-term or Permanent Disability: If you expect your disability to be long-term or permanent, lasting for more than one year, apply for SSDI and/or SSI from Social Security well before your year of SDI is over (see Social Security Programs).
2. Workers’ Compensation
If you are disabled because of a work injury or as a result of unhealthy, unsafe, or stressful conditions at work, you should apply for Workers’ Compensation. Workers’ compensation is a no-fault system, meaning that injured employees need not prove the injury was someone else’s fault. There are five basic types of workers’ compensation benefits:
A. Medical Benefits: The employer pays for certain medical care expenses resulting from the work-related injury up to $10,000 while your claim is still being considered by the insurance company. You may be treated by the employer’s physician or company clinic, or by your own doctor if you have previously notified your employer in writing of your request to select, or “pre-designate” your own doctor.
B. Temporary Disability Benefits: These benefits are paid every two weeks if you are unable to return to work within three days, or are hospitalized overnight. The benefits are intended to partially replace two-thirds of the wages lost because of the injury. These benefits are paid until you can return to work, or until the disability becomes “permanent and stationary”, which means a doctor determines that your medical condition has stabilized and you are not expected to have a significant change in condition for a period of one year, with or without medical treatment.
C. Permanent Disability: When you reach a point where your medical condition is not improving and not getting worse, your condition is called “permanent and stationary” (P&S). When this happens, your primary treating physician writes a P&S report. This report is the first step in determining how disabled you are for purposes of deciding how much you will receive in benefits. The percentage of disability is called a “rating”. You receive benefits every two weeks for a period that increases with this rating, and will vary depending upon your average weekly wage at the time of your injury, and on the date you were injured. . If you have a permanent total disability you may receive weekly payments for life. There is helpful information at https://www.dir.ca.gov/InjuredWorkerGuidebook/Chapter7.pdf
E. Supplemental Job Displacement Vouchers: Employees who are injured and are permanently unable to do their usual job, and whose employer does not offer other work, may qualify for the supplemental job displacement benefits (SJDB). SJDB comes in the form of a non-transferable voucher that can be used to pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools.
F. Death Benefits: Death benefits are payments to a spouse, children or other dependents if an employee dies from a work-related injury or illness. This includes reasonable burial expenses.Death benefits are paid at the total temporary disability rate, but not less than $224.00 per week.
Filing a Workers’ Compensation claim: File a claim form to protect your rights and start the workers’ compensation process. Your employer must give or mail you a claim form within one working day after learning about your injury or illness. You can get a form at https://www.dir.ca.gov/dwc/FileAClaim.htm
For help you can also call (916) 928-3101 or (800) 736-7401.
For problems with worker comp claims:
Information & Assistance Unit https://www.dir.ca.gov/dwc/IandA.html or 800-736-7401
Injured worker workshop: See https://www.dir.ca.gov/dwc/Workshop/Workshop_English.htm . The workshops are currently cancelled due to COVID but may begin again soon.
You may also want to hire a private attorney to help you with your claim. Many lawyers will handle this type of case even if you cannot afford to pay in advance because their fees for Workers’ Compensation cases are set by law and are paid by the insurance company. If you are permanently disabled and do not expect to return to work, you may also qualify for Social Security or SSI