C-IV.B · Commercial Casualty Insurance
Medical and temporary disability benefits
Medical benefits: Labor Code §4600(a) requires the employer to provide treatment reasonably required to cure or relieve the effects of the injury. It sets no overall dollar or time limit. Treatment must still follow the medical treatment guidelines, and some visit types are limited. While a claim is being considered, the Division of Workers' Compensation says up to $10,000 of treatment is available.
Chiropractic and therapy limits: §4604.5(c)(1) allows no more than 24 chiropractic, 24 occupational therapy and 24 physical therapy visits per industrial injury, so each type has its own limit of 24. The cap does not apply when the employer authorizes more visits in writing, or to postsurgical services under the postsurgical treatment schedule.
Waiting period: under §4652, no temporary disability is paid for the first three days after the employee leaves work, unless the disability lasts more than 14 days or the employee is hospitalized as an inpatient. Either event makes it payable from the date of disability. The day of injury counts toward the wait only if the employee was not paid full wages for it. Example: a worker hurt Monday and paid full wages that day stays off from Tuesday for 10 days with no hospital stay; the first three days are unpaid and the last seven are paid.
Weekly benefit: §4653 sets temporary total disability at two-thirds of average weekly earnings, so $900 a week becomes $600. Section 4453 limits the earnings used, with minimum and maximum amounts that rise each January 1, so a high earner's payment is capped. Section 4656 sets a 104-week limit on temporary disability payments; that limit is on disability pay, not on medical care.
Remember
· Medical care: no overall dollar or time limit (Lab. Code §4600).
· 24 visits each for chiropractic, occupational therapy and physical therapy, unless authorized in writing or postsurgical.
· 3-day wait, paid back if over 14 days or hospitalized; TTD = 2/3 of weekly earnings.
CA
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