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California Workers’ Compensation FAQs
Plain-English California workers’ compensation FAQs on TD, PD, QME and AME exams, SDI, unemployment, medical care, claim denials, and return to work.
These answers are for injured workers researching California benefits. They are not a substitute for advice on your claim. Related reading includes what MMI means and why temporary disability stops.
Workers’ compensation questions
- What is workers’ compensation?
- Workers’ compensation provides benefits to employees who suffer a work-related injury or illness. Benefits can include medical treatment, temporary disability, permanent disability, a retraining voucher, and death benefits. Read the full answer
- What is Temporary Disability (TD)?
- Temporary Disability, or TD, is wage-replacement money paid when a work injury temporarily prevents you from doing your regular job while you recover. There are two types: Temporary Total Disability (TTD), when you cannot work at all, and Temporary Partial Disability (TPD), when you can work but lose wages because of restrictions or reduced hours. Read the full answer
- How much do I receive in TD benefits?
- Generally, TD is about two-thirds of the gross wages you lose, subject to minimum and maximum weekly benefit limits. Other earnings, including overtime, bonuses, commissions, tips, and sometimes earnings from a second job, may affect the calculation. Read the full answer
- What is Permanent Disability (PD)?
- Permanent Disability, or PD, is compensation for lasting impairment caused by your work injury after your condition has stabilized. You may receive PD even if you return to work. Read the full answer
- How is my PD percentage determined?
- A doctor determines your level of impairment after you reach Permanent and Stationary status or Maximum Medical Improvement. That impairment is then used in a rating formula that considers factors such as the injury, occupation, and age to calculate a permanent disability percentage. Read the full answer
- What does Permanent and Stationary or MMI mean?
- Permanent and Stationary (P&S) and Maximum Medical Improvement (MMI) generally mean your medical condition has stabilized and is not expected to substantially improve with additional treatment. This is usually when permanent disability is evaluated. Read the full answer
- What is a QME?
- A Qualified Medical Evaluator (QME) is a physician certified by the California Division of Workers’ Compensation to evaluate medical disputes in workers’ compensation cases. QMEs may address whether an injury is work-related, permanent disability, work restrictions, future medical care, and other disputed medical issues. Read the full answer
- What is an AME?
- An Agreed Medical Evaluator (AME) is a physician that the injured worker’s attorney and the insurance company or defense attorney mutually agree to use to resolve medical disputes. AMEs are used when the worker is represented by an attorney. Read the full answer
- What is the difference between a QME and an AME?
- A QME is ordinarily selected through California’s QME panel process. An AME is a doctor selected by agreement between the attorneys. Once an AME is used for the dispute, the parties generally do not separately proceed to a QME for that dispute. Read the full answer
- Can I collect unemployment and workers’ compensation at the same time?
- It depends on the type of workers’ compensation benefits and whether you are able and available to work. Someone who is completely unable to work and receiving TTD will generally have difficulty qualifying for unemployment because unemployment ordinarily requires the person to be able and available for work. A worker with restrictions who is capable of performing suitable work may present a different situation. Benefits and earnings must be accurately reported to EDD. Read the full answer
- Can I apply for California State Disability (SDI) while receiving workers’ compensation?
- Yes. You can file a claim for SDI even if the condition may be work-related. Normally you do not receive full workers’ compensation wage-loss benefits and full SDI for the same period, but there are important exceptions. Read the full answer
- When can I receive SDI and workers’ compensation at the same time?
- EDD identifies situations including when workers’ compensation is delayed or denied, when the workers’ compensation weekly benefit is less than the available SDI benefit, or when workers’ compensation is paying only medical benefits. EDD may pay the difference in some circumstances. Read the full answer
- What happens if SDI pays me while my workers’ compensation case is pending?
- EDD may assert a lien in the workers’ compensation case to recover benefits it paid for periods that ultimately should have been covered by workers’ compensation. Read the full answer
- Who pays for my medical treatment?
- If the treatment is reasonably required because of the industrial injury, workers’ compensation generally pays the medical expenses. The injured worker normally should not be personally paying deductibles or copays for authorized workers’ compensation treatment. Read the full answer
- Can I choose my own doctor?
- Sometimes. The answer depends on issues such as whether the employer has a Medical Provider Network, whether the employee properly predesignated a physician before the injury, and where the claim is procedurally. An injured worker should check before changing doctors because unauthorized treatment can create disputes. Read the full answer
- What happens if the insurance company denies my claim?
- A denial does not necessarily end the case. An injured worker can challenge the denial before the Workers’ Compensation Appeals Board, and medical disputes may require evaluation by a QME or AME. California also generally requires the claims administrator to accept or deny the claim within 90 days after receiving the completed claim form; particular rules and exceptions can affect that analysis. Read the full answer
- Can I be fired while I have a workers’ compensation case?
- Workers’ compensation itself does not guarantee that an employee can never be terminated. However, California law prohibits certain retaliation or discrimination because an employee suffered an industrial injury or pursued workers’ compensation rights. Whether a particular termination is lawful depends heavily on the facts. Read the full answer
- Do I have to return to work if my doctor gives me restrictions?
- You generally should not be required to work outside the medical restrictions established by your physician. If the employer offers modified or alternative work within those restrictions, however, declining suitable work can affect entitlement to temporary disability benefits. Read the full answer
- What is a Supplemental Job Displacement Benefit voucher?
- The SJDB voucher is a benefit available to some injured workers with permanent disability whose employer does not provide qualifying regular, modified, or alternative work. It can be used toward retraining, education, and certain related expenses. Read the full answer
- Do I need a workers’ compensation attorney?
- Not every workers’ compensation claim requires an attorney, but representation may be particularly useful when a claim is denied, benefits are stopped, surgery or substantial treatment is disputed, a QME/AME evaluation is involved, permanent disability is disputed, the worker cannot return to the former job, or settlement is being discussed. Read the full answer
Disclaimer
This page is general education about California workers’ compensation—not legal advice. Your facts, dates, and medical reports control. Workplace Rights Advocacy focuses on civil employment claims. Benefit and medical disputes inside the workers’ compensation system are often best handled by a workers’ compensation attorney. If an employer is forcing you out, denying accommodations, or retaliating around a work injury, that may be an employment case we can evaluate.