Difference Between CA Workers Comp Benefits and State Disability Insurance Benefits

From filing and eligibility to amount of benefits and appeal, there are a variety of differences in California workers’ compensation benefits and state disability insurance (SDI) benefits. The state’s disability insurance benefits are designed to pay monies for illnesses or injuries unrelated to work, while the state’s workers’ compensation benefits are designed to pay monies for wages and medical expenses due to an injury or illness caused in the scope of employment.

Eligibility for State Disability Insurance and Workers’ Comp Benefits

The list for eligibility for California state disability insurance benefits includes:

  • Being unable to perform regular work for a minimum of eight consecutive days
  • Submission of claim within 49 days of disability
  • Employment or active engagement in seeking work
  • Earnings of at least $300 from which disability deductions have been withheld
  • Under the treatment of a licensed doctor during the first eight days of disability
  • Medical certification of your disability by a licensed physician
  • Agreement to an independent medical exam to determine disability

The eligibility requirements for workers’ compensation benefits are different than for state disability insurance. The following is a list of requirements for eligibility:

  • Filing an application for adjudication of claim within one year of injury
  • Medical treatment from an authorized doctor, unless an emergency
  • Documentation of medical treatment
  • Direct cause of the injury or illness connected to scope of employment

Amount of Benefits

For state disability insurance benefits, weekly benefits range from $50 to a maximum of $1,129 as of January 2016. To qualify for the highest weekly benefit amount, a worker must have earned at least $26,070.91 in a calendar quarter during the initial period. Workers can receive up to a year’s worth of benefits.

California state workers’ compensation pays temporary disability benefits. It’s two-thirds of your average weekly wage. In 2014, the maximum weekly wage was $1,074.64. If you’ve been permanently injured, partially injured or totally injured, you are eligible for permanent disability benefits. The amount is calculated on the percentage of the impairment incurred.

Claim Denial and Appeal

It’s possible that your claim for state disability insurance benefits may be denied. If you’re disqualified for benefits, you’ll receive an appeal form with your disqualification letter. You have the right to appeal, as long as you do it within 20 days of the mailing date of the notice. Complete the appeal form with a detailed explanation of why you believe the denial is wrong. You’ll have to also include your claim identification number, name, phone number, address and signature. The EDD then reviews the facts and notifies you of the findings. The EDD may also forward your claim to the California Unemployment Insurance Appeals Board local Office of Appeals. A notification is then sent out about the hearing date and location. At the hearing, an administrative law judge listens to both the claimant and the state disability insurance rep and makes a determination.

Your employer’s workers’ comp insurance company may also deny your claim for benefits. They may allege there’s insufficient evidence of injury, the injury isn’t job-related or that you can return to work. To appeal a denial of benefits, you must file a Declaration of Readiness to Proceed with the Workers’ Compensation Appeals Board (WCAB). This form must also be provided to the employer’s insurance company. The WCAB will schedule a hearing to determine whether or not the appeal should be approved or denied.

Using an Attorney for Approval of Benefits

If you’ve been denied benefits for state disability, it may be wise to consult a California employment attorney. An attorney can review your denial letter and help guide you through the appeal process. It just may be that you didn’t properly state your condition or you need more medical documentation. It’s also smart to consult with a workers’ compensation attorney if your claim has been denied. This legal professional has in-depth knowledge of the required documentation and required criteria. It’s also wise to consult with an attorney if your injury requires surgery, you have pre-existing conditions or have been permanently disabled.

For those injured, receiving benefits is a critical component of being able to pay for living expenses. An attorney knows that your livelihood is at stake and will act as your advocate.

 

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