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Ali MendiolaCA Insurance License # 0G02006

[email protected]: 714.496.5920

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Mark MoralesCA Insurance License # 0J21271 [email protected]: 562.237.3235Office: 800.734.3910Fax: 949.833.3687

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GuidePermanent Disability Tables

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Links & Resources

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16 - 17

18

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123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647484950

3.006.009.00

12.0015.0018.0021.0024.0027.0030.2534.2538.2542.2546.2550.5055.5060.5065.5070.5075.5080.5085.5090.5095.50

100.75106.75112.75118.75124.75131.00138.00145.00152.00159.00166.00173.00180.00187.00194.00201.00208.00215.00222.00229.00236.00243.00250.00257.00264.00271.25

690.001380.002070.002760.003450.004140.004830.005520.006210.006957.507877.508797.509717.50

10637.5011615.0012765.0013915.0015065.0016215.0017365.0018515.0019665.0020815.0021965.0023172.5024552.5025932.5027312.5028692.5030130.0031740.0033350.0034960.0036570.0038180.0039790.0041400.0043010.0044620.0046230.0047840.0049450.0051060.0052670.0054280.0055890.0057500.0059110.0060720.0062387.50

870.00 1,740.00 2,610.00 3,480.00 4,350.00 5,220.00 6,090.00 6,960.00 7,830.00 8,772.50 9,932.50

11,092.50 12,252.50 13,412.50 14,645.00 16,095.00 17,545.00 18,995.00 20,445.00 21,895.00 23,345.00 24,795.00 26,245.00 27,695.00 29,217.50 30,957.50 32,697.50 34,437.50 36,177.50 37,990.00 40,020.00 42,050.00 44,080.00 46,110.00 48,140.00 50,170.00 52,200.00 54,230.00 56,260.00 58,290.00 60,320.00 62,350.00 64,380.00 66,410.00 68,440.00 70,470.00 72,500.00 74,530.00 76,560.00 78,662.50

Permanent DisabilityIndemnity Table 2013 - 2016

Toll Free: 800.734.3910

% Weeks of Payment 2013 PD 2014 - 2016 PD

51525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899

279.25287.25295.25303.25311.25319.25327.25335.25343.25351.25359.25367.25375.25383.25391.25399.25407.25415.25423.25433.25449.25465.25481.25497.25513.25529.25545.25561.25577.25593.25609.25625.25641.25657.25673.25689.25705.25721.25737.25753.25769.25785.25801.25817.25833.25849.25865.25881.25897.25

64227.5066067.5067907.5069747.5084037.5086197.5088357.5090517.5092677.5094837.5096997.5099157.50

101317.50103477.50105637.50107797.50109957.50112117.50114277.50125642.50130282.50134922.50139562.50144202.50148842.50153482.50158122.50162762.50167402.50172042.50176682.50181322.50185962.50190602.50195242.50199882.50204522.50209162.50213802.50218442.50223082.50227722.50232362.50237002.50241642.50246282.50250922.50255562.50260202.50

80982.5083302.5085622.5087942.5090262.5092582.5094902.5097222.5099542.50

101862.50104182.50106502.50108822.50111142.50113462.50115782.50118102.50120422.50122742.50125642.50130282.50134922.50139562.50144202.50148842.50153482.50158122.50162762.50167402.50172042.50176682.50181322.50185962.50190602.50195242.50199882.50204522.50209162.50213802.50218442.50223082.50227722.50232362.50237002.50241642.50246282.50250922.50255562.50260202.50

5

Atlas | Quick Reference Guide

% Weeks of Payment 2013 PD 2014 - 2016 PD

6

123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647484950

3.006.009.00

12.0015.0018.0021.0024.0027.0030.2534.2538.2542.2546.2550.5055.5060.5065.5070.5075.5080.5085.5090.5095.50

100.75106.75112.75118.75124.75131.00138.00145.00152.00159.00166.00173.00180.00187.00194.00201.00208.00215.00222.00229.00236.00243.00250.00257.00264.00271.25

690.001,380.002,070.002,760.003,450.004,140.004,830.005,520.006,210.006,957.507,877.508,797.509,717.50

10,637.5011,615.0012,765.0013,915.0015,065.0016,215.0017,365.0018,515.0019,665.0020,815.0021,965.0023,172.5024,552.5025,932.5027,312.5028,692.5030,130.0031,740.0033,350.0034,960.0036,570.0038,180.0039,790.0041,400.0043,010.0044,620.0046,230.0047,840.0049,450.0051,060.0052,670.0054,280.0055,890.0057,500.0059,110.0060,720.0062,387.50

690.001,380.002,084.792,878.293,671.794,465.295,258.796,052.296,845.797,705.418,763.419,821.41

10,879.4111,937.4113,061.5414,384.0415,706.5417,029.0418,351.5419,674.0420,996.5422,319.0423,641.5424,964.0426,352.6627,939.6629,526.6631,113.6632,700.6634,353.7936,205.2938,056.7939,908.2941,759.7943,611.2945,462.7947,314.2949,165.7951,017.2952,868.7954,720.2956,571.7958,423.2960,274.7962,126.2963,977.7965,829.2967,680.7969,532.2971,449.91

586.501,173.001,759.502,346.002,932.503,519.004,105.504,692.005,278.505,913.886,695.887,477.888,259.889,041.889,872.75

10,850.2511,827.7512,805.2513,782.7514,760.2515,737.7516,715.2517,692.7518,670.2519,696.6320,869.6322,042.6323,215.6324,388.6325,610.5026,979.0028,347.5029,716.0031,084.5032,453.0033,821.5035,190.0036,558.5037,927.0039,295.5040,664.0042,032.5043,401.0044,769.5046,138.0047,506.5048,875.0050,243.5051,612.0053,029.38


Toll Free: 800.734.3910

% Weeks of Payment PD +15% PD -15%PD


51525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899

279.25287.25295.25303.25311.25319.25327.25335.25343.25351.25359.25367.25375.25383.25391.25399.25407.25415.25423.25 433.25449.25465.25481.25497.25513.25529.25545.25561.25577.25593.25609.25625.25641.25657.25673.25689.25705.25721.25737.25753.25769.25785.25801.25817.25833.25849.25865.25881.25897.25

64,227.5066,067.5067,907.5069,747.5071,587.5073,427.5075,267.5077,107.5078,947.5080,787.5082,627.5084,467.5086,307.5088,147.5089,987.5091,827.5093,667.5095,507.5097,347.50

116,977.50121,297.50125,617.50129,937.50134,257.50138,577.50142,897.50147,217.50151,537.50155,857.50160,177.50164,497.50168,817.50173,137.50177,457.50181,777.50186,097.50190,417.50194,737.50199,057.50203,377.50207,697.50212,017.50216,337.50220,657.50224,977.50229,297.50233,617.50237,937.50242,257.50

73,565.9175,681.9177,797.9179,913.9182,029.9184,145.9186,261.9188,377.9190,493.9192,609.9194,725.9196,841.9198,957.91

101,073.91103,189.91105,305.91107,421.91109,537.91111,653.91134,176.98139,144.98144,112.98149,080.98154,048.98159,016.98163,984.98168,952.98173,920.98178,888.98183,856.98188,824.98193,792.98198,760.98203,728.98208,696.98213,664.98218,632.98223,600.98228,568.98233,536.98238,504.98243,472.98248,440.98253,408.98258,376.98263,344.98268,312.98273,280.98278,248.98

54,593.3856,157.3857,721.3859,285.3860,849.3862,413.3863,977.3865,541.3867,105.3868,669.3870,233.3871,797.3873,361.3874,925.3876,489.3878,053.3879,617.3881,181.3882,745.3899,430.88

103,102.88106,774.88110,446.88114,118.88117,790.88121,462.88125,134.88128,806.88132,478.88136,150.88139,822.88143,494.88147,166.88150,838.88154,510.88158,182.88161,854.88165,526.88169,198.88172,870.88176,542.88180,214.88183,886.88187,558.88191,230.88194,902.88198,574.88202,246.88205,918.88

7



8

123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647484950

3.006.009.00

12.0015.0018.0021.0024.0027.0030.2534.2538.2542.2546.2550.5055.5060.5065.5070.5075.5080.5085.5090.5095.50

100.75106.75112.75118.75124.75131.00138.00145.00152.00159.00166.00173.00180.00187.00194.00201.00208.00215.00222.00229.00236.00243.00250.00257.00264.00271.25

660.001,320.001,980.002,640.003,300.003,960.004,620.005,280.005,940.006,655.007,535.008,415.009,295.00

10,175.0011,110.0012,210.0013,310.0014,410.0015,510.0016,610.0017,710.0018,810.0019,910.0021,010.0022,165.0023,485.0024,805.0026,125.0027,445.0028,820.0030,360.0031,900.0033,440.0034,980.0036,520.0038,060.0039,600.0041,140.0042,680.0044,220.0045,760.0047,300.0048,840.0050,380.0051,920.0053,460.0055,000.0056,540.0058,080.0059,675.00

660.001,320.001,994.142,753.143,512.144,271.145,030.145,789.146,548.147,370.398,382.399,394.39

10,406.3911,418.3912,493.6413,758.6415,023.6416,288.6417,553.6418,818.6420,083.6421,348.6422,613.6423,878.6425,206.8926,724.8928,242.8929,760.8931,278.8932,860.1434,631.1436,402.1438,173.1439,944.1441,715.1443,486.1445,257.1447,028.1448,799.1450,570.1452,341.1454,112.1455,883.1457,654.1459,425.1461,196.1462,967.1464,738.1466,509.1468,343.39

561.001,122.001,683.002,244.002,805.003,366.003,927.004,488.005,049.005,656.756,404.757,152.757,900.758,648.759,443.50

10,378.5011,313.5012,248.5013,183.5014,118.5015,053.5015,988.5016,923.5017,858.5018,840.2519,962.2521,084.2522,206.2523,328.2524,497.0025,806.0027,115.0028,424.0029,733.0031,042.0032,351.0033,660.0034,969.0036,278.0037,587.0038,896.0040,205.0041,514.0042,823.0044,132.0045,441.0046,750.0048,059.0049,368.0050,723.75

Permanent DisabilityIndemnity Table 2005

Toll Free: 800.734.3910


Permanent DisabilityIndemnity Table 2005

51525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899

279.25287.25295.25303.25311.25319.25327.25335.25343.25351.25359.25367.25375.25383.25391.25399.25407.25415.25423.25 433.25449.25465.25481.25497.25513.25529.25545.25561.25577.25593.25609.25625.25641.25657.25673.25689.25705.25721.25737.25753.25769.25785.25801.25817.25833.25849.25865.25881.25897.25

61,435.0063,195.0064,955.0066,715.0068,475.0070,235.0071,995.0073,755.0075,515.0077,275.0079,035.0080,795.0082,555.0084,315.0086,075.0087,835.0089,595.0091,355.0093,115.00

116,977.50121,297.50125,617.50129,937.50134,257.50138,577.50142,897.50147,217.50151,537.50155,857.50160,177.50164,497.50168,817.50173,137.50177,457.50181,777.50186,097.50190,417.50194,737.50199,057.50203,377.50207,697.50212,017.50216,337.50220,657.50224,977.50229,297.50233,617.50237,937.50242,257.50

70,367.3972,391.3974,415.3976,439.3978,463.3980,487.3982,511.3984,535.3986,559.3988,583.3990,607.3992,631.3994,655.3996,679.3998,703.39

100,727.39102,751.39104,775.39106,799.39134,176.98139,144.98144,112.98149,080.98154,048.98159,016.98163,984.98168,952.98173,920.98178,888.98183,856.98188,824.98193,792.98198,760.98203,728.98208,696.98213,664.98218,632.98223,600.98228,568.98233,536.98238,504.98243,472.98248,440.98253,408.98258,376.98263,344.98268,312.98273,280.98278,248.98

52,219.7553,715.7555,211.7556,707.7558,203.7559,699.7561,195.7562,691.7564,187.7565,683.7567,179.7568,675.7570,171.7571,667.7573,163.7574,659.7576,155.7577,651.7579,147.7599,430.88

103,102.88106,774.88110,446.88114,118.88117,790.88121,462.88125,134.88128,806.88132,478.88136,150.88139,822.88143,494.88147,166.88150,838.88154,510.88158,182.88161,854.88165,526.88169,198.88172,870.88176,542.88180,214.88183,886.88187,558.88191,230.88194,902.88198,574.88202,246.88205,918.88

9



123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647484950

3.006.009.00

12.0015.0018.0021.0024.0027.0030.2534.2538.2542.2546.2550.2554.2558.2562.2566.2570.5075.5080.5085.5090.5095.75

101.75107.75113.75119.75126.00133.00140.00147.00154.00161.00168.00175.00182.00189.00196.00203.00210.00217.00224.00231.00238.00245.00252.00259.00266.25

555.001,110.001,665.002,220.002,775.003,330.003,885.004,440.004,995.005,596.256,336.257,076.257,816.258,556.259,296.25

10,036.2510,776.2511,516.2512,256.2513,042.5013,967.5014,892.5015,817.5016,742.5017,713.7518,823.7519,933.7521,043.7522,153.7523,310.0024,605.0025,900.0027,195.0028,490.0029,785.0031,080.0032,375.0033,670.0034,965.0036,260.0037,555.0038,850.0040,145.0041,440.0042,735.0044,030.0045,325.0046,620.0047,915.0049,256.25

4.008.00

12.0016.0020.0024.0028.0032.0036.0040.2545.2550.2555.2560.2565.2570.2575.2580.2585.2590.2595.25

100.25105.25110.25115.50121.50127.50133.50139.50145.75152.75159.75166.75173.75180.75187.75194.75201.75208.75215.75222.75229.75236.75243.75250.75257.75264.75271.75278.75286.00

800.001,600.002,400.003,200.004,000.004,800.005,600.006,400.007,200.008,050.009,050.00

10,050.0011,050.0012,050.0013,050.0014,050.0015,050.0016,050.0017,050.0018,050.0019,050.0020,050.0021,050.0022,050.0023,100.0024,300.0025,500.0026,700.0027,900.0029,150.0030,550.0031,950.0033,350.0034,750.0036,150.0037,550.0038,950.0040,350.0041,750.0043,150.0044,550.0045,950.0047,350.0048,750.0050,150.0051,550.0052,950.0054,350.0055,750.0057,200.00

10


Toll Free: 800.734.3910

% Weeks of Payment 2003 PD Weeks of

Payment 2004 PD

420.00840.00

1260.001680.002100.002520.002940.003360.003780.004235.004795.005355.005915.006475.008040.008680.009320.009960.00

10600.0011280.0012080.0012880.0013680.0014480.0016277.5017297.5018317.5019337.5020357.5021420.0022610.0023800.0024990.0026180.0027370.0028560.0029750.0030940.0032130.0033320.0034510.0035700.0036890.0038080.0039270.0040460.0041650.0042840.0044030.0045,262.50

07.01.1996 - 12.31.2002 PD


51525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899

274.25282.25290.25298.25306.25314.25322.25330.25338.25346.25354.25362.25370.25378.25386.25394.25402.25410.25418.25426.50435.50444.50453.50462.50471.50480.50489.50498.50507.50516.50525.50534.50543.50552.50561.50570.50579.50588.50597.50606.50615.50624.50633.50642.50651.50660.50669.50678.50687.50

50,736.2552,216.2553,696.2555,176.2556,656.2558,136.2559,616.2561,096.2562,576.2564,056.2565,536.2567,016.2568,496.2569,976.2571,456.2572,936.2574,416.2575,896.2577,376.2598,095.00

100,165.00102,235.00104,305.00106,375.00108,445.00110,515.00112,585.00114,655.00116,725.00118,795.00120,865.00122,935.00125,005.00127,075.00129,145.00131,215.00133,285.00135,355.00137,425.00139,495.00141,565.00143,635.00145,705.00147,775.00149,845.00151,915.00153,985.00156,055.00158,125.00

294.00302.00310.00318.00326.00334.00342.00350.00358.00366.00374.00382.00390.00398.00406.00414.00422.00430.00438.00446.25455.25464.25473.25482.25491.25500.25509.25518.25527.25536.25545.25554.25563.25572.25581.25590.25599.25608.25617.25626.25635.25644.25653.25662.25671.25680.25689.25698.25707.25

58,800.0060,400.0062,000.0063,600.0065,200.0066,800.0068,400.0070,000.0071,600.0073,200.0074,800.0076,400.0078,000.0079,600.0081,200.0082,800.0084,400.0086,000.0087,600.00

111,562.50113,812.50116,062.50118,312.50120,562.50122,812.50125,062.50127,312.50129,562.50131,812.50134,062.50136,312.50138,562.50140,812.50143,062.50145,312.50147,562.50149,812.50152,062.50154,312.50156,562.50158,812.50161,062.50163,312.50165,562.50167,812.50170,062.50172,312.50174,562.50176,812.50

11


46,622.5047,982.5049,342.5050,702.5052,062.5053,422.5054,782.5056,142.5057,502.5058,862.5060,222.5061,582.5062,942.5064,302.5065,662.5067,022.5068,382.5069,742.5071,102.5098,095.00

100,165.00102,235.00104,305.00106,375.00108,445.00110,515.00112,585.00114,655.00116,725.00118,795.00120,865.00122,935.00125,005.00127,075.00129,145.00131,215.00133,285.00135,355.00137,425.00139,495.00141,565.00143,635.00145,705.00147,775.00149,845.00151,915.00153,985.00156,055.00158,125.00

% Weeks of Payment 2003 PD Weeks of

Payment 2004 PD07.01.1996 - 12.31.2002 PD

12

1 - 99.75 105 70 210.50 140


Toll Free: 800.734.3910

PD % Rate Earnings RateEarnings

01.01.84

Minimum MaximumDate of Injury

(On or After)

1 - 24.7525 - 99.75

105105

7070

210222

140180

01.01.91

1 - 14.7515 - 24.7525 - 69.7570 - 99.75

105105105105

70707070

210222237252

140148158168

07.01.94

1 - 14.7515 - 24.7525 - 69.7570 - 99.75

105105105105

70707070

210231246297

140154164198

07.01.95

1 - 14.7515 - 24.7525 - 69.7570 - 99.75

105105105105

70707070

210240255345

140160170230

07.01.96

1 - 69.7570 - 99.75

150150

100100

277.50345

185230

01.01.03

1 - 69.7570 - 99.75

157.50157.50

105105

300375

200250

01.01.04

1 - 6970 - 99

157.50157.50

105105

330405

220270

01.01.05

1 - 6970 - 99

195195

130130

345405

230270

01.01.06

1. PD is not increased by SAWW LC 4453(b)2. Permanent disability weekly payments are paid at 2/3 of weekly earnings -- not to

exceed the above maximum rate and must be at least the minimum rate.3. Permanent disability weekly payments are paid for the number of weeks specified in

the first table based upon the percentage rating.

1 - 54 55 - 6970 - 99

240240240

160160160

345405435

230270290

01.01.13

1 - 99 240 160 435 29001.01.14


13


Temporary Total Disability (TTD) and Permanent Total Disability

806.11

Year

2005

SAWW

838.422006

880.002007

914.602008

956.202009

984.832010

979.902011

1003.552012

1059.382013

1067.252014

1. Aggregate disability payments for a single injury occurring on or after 4/19/04 shall not extend for more than 104 compensable weeks within a period of two years from the date of commencement of TTD. Aggregate disability payments for a single injury occurring on or after 1/1/2008 shall not extend for more than 104 compensable weeks within a period of five years from the date of commencement of TTD.

2. Certain acute or severe disabilities* extend for 240 weeks. LC 46563. TTD payments made two or more years from the date of injury are made at the rate

in effect on the date each payment is made. LC 4661.54. For injuries occurring on or after 1/1/05 commencing 1/1/07 the limits are increased

annually by percentage increase of State Average Weekly Wage (SAWW). LC §4453(a)(10)

5. Temporary disability payments are paid at 2/3 of the weekly earnings within the limits specified in the above table. LC §4653

* Acute and Chronic hepatitis B and C; amputations, severe burns, HIV, high-velocity eye injuries; chemical burns to eyes; pulmonary fibrosis; chronic lung disease

126.00840.00

Min 189.00Max 1260.00

126.00840.00

Min 189.00Max 1260.00

132.25881.66

Min 198.37Max 1322.49

137.45916.33

Min 206.17Max 1374.49

143.70958.01

Min 215.55Max 1437.01

148.00986.69

Min 222.00Max 1480.04

148.00986.69

Min 222.00Max 1480.04

151.571010.50

Min 227.36Max 1515.75

160.001066.72

Min 240.00Max 1600.08

161.191074.64

Min 241.78Max 1611.96

Earnings TTD Payment

14

Life Pension

Toll Free: 800.734.3910

23.6526.0228.3830.7533.1135.4837.8540.2142.5844.9447.3149.6752.0454.4056.7759.1361.5063.8666.2368.6070.9673.3375.6978.0680.4282.7985.1587.5289.8892.25

31.1534.2737.3840.5043.6146.7349.8552.9656.0859.1962.3165.4268.5471.6574.7777.8881.0084.1187.2390.3593.4696.5899.69

102.81105.92109.04112.15115.27118.38121.50

38.6542.5246.3850.2554.1157.9861.8565.7169.5873.4477.3181.1785.0488.9092.7796.63

100.50104.36108.23112.10115.96119.83123.69127.56131.42135.29139.15143.02146.88150.75

38.6542.5246.3850.2554.1157.9861.8565.7169.5873.4477.3181.1785.0488.9092.7796.63

100.50104.36108.23112.10115.96119.83123.69127.56131.42135.29139.15143.02146.88150.75

77.3185.0492.77

100.50108.23115.96123.69131.42139.15146.88154.61162.34170.08177.81185.54193.27201.00208.73216.46224.19231.92239.65247.38255.11262.84270.57278.31289.04293.77301.50

PD % 07.01.96 01.01.03 01.01.0607.01.95

707172737475767778798081828384858687888990919293949596979899

Date of Injury (On or After)

1. When the permanent disability is 70% or greater, life pension weekly payments are made at the above rate, depending the percentage of disability. Formula: Life pension = ( % - 60 ) x .015 x (Weekly Earnings within maximum, table immediately above) LC 4659

2. There have been no increases in maximum weekly earnings since 1/1/2006.3. Start date of life pension payments is not reflected in the above tables because

life pension payments do not commence until permanent partial payments end. For a date of injury in 2003 with a permanent partial disability of 70% life pension payments would not start until 426.5 weeks after the permanent and stationary date. Payments would not begin until 8.17 years after the P&S date.

4. For DOI on or after 1/1/2003 the rate of payment is not known until the start of payments due to COLA increases. COLA increases commence on Jan 1 after the start of the life pension.

5. “For injuries occurring on or after January 1, 2003, an employee who becomes enti-tled to receive a life pension or total permanent disability indemnity … shall have that payment increased annually commencing on January 1, 2004, and each January 1 thereafter, by an amount …” LC 4659(c)

07.01.94

107.69

Injury Date (On or After)

01.01.84

Weekly Earnings Maximum

157.6907.01.94207.6907.01.95257.6907.01.96257.6901.01.03515.3801.01.06

15


Statewide Average Weekly Wage(SAWW)

$1,095.70

Year

2015

SAWW

$1,067.25 2014$1,059.38 2013$1,003.552012$979.902011$984.832010

Supplemental Job DisplacementBenefit Voucher

Up to $4,000

PPD Award

Less than 15%

Voucher Amount

Up to $6,000Between 15% and 25%Up to $8,000Between 26% and 49%

Up to $10,000Between 50% and 99%

For injuries before 1/1/13 the amount of the voucher for the supplemental job displace-ment benefit will be as follows:

• Voucher expires in 2 years or 5 years from date of injury.• On or after 1/1/13 voucher is $6,000. LC 4658.7

Mileage Reimbursement Ratesfor Medical and Med-Legal

44.5

Incurred in Year

2006 - July 1

Cents Per Mile

48.5200750.52008 - Jan 1502010512011

55.52011 - July 155.5201256.52013562014

57.52015

2.66%0.74%5.56%2.41%0.00%2.99%

SAWW Increase

$956.202009$914.602008$880.002007$838.422006

4.55%3.93%4.96%4.01%

10 Year Average 3.01%

542016

$1,120.67 2016 2.28%

16

Toll Free: 800.734.3910

Life Expectancy Tables | SSA.gov, 2011

0123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859

78.56578.0477.0776.09

75.10574.1273.13

72.13571.14570.15569.16568.16567.17566.1865.19

64.20563.2362.2561.28

60.31559.35

58.39557.4456.49

55.54554.5953.6452.6951.74

50.78549.8448.89

47.94546.99

46.04545.1

44.1643.21542.27

41.33540.39539.46538.53537.6136.6935.7834.8733.97

33.07532.1931.31

30.43529.57

28.71527.86527.02526.18525.35524.53

23.715

76.1875.6974.7273.7472.7671.7770.7869.7968.8

67.8166.8265.8264.8363.8462.8561.8760.9

59.9358.9758.0257.0756.1355.2

54.2753.3552.4251.4950.5649.6348.6947.7646.8345.9

44.9644.0343.1

42.1741.2440.3139.3938.4637.5436.6235.7134.8133.9133.0232.1331.2630.3929.5328.6827.8427.0126.1925.3824.5723.7822.9922.21

80.9580.3979.4278.4477.4576.4775.4874.4873.4972.5

71.5170.5169.5268.5267.5366.5465.5664.5763.5962.6161.6360.6659.6858.7157.7456.7655.7954.8253.8552.8851.9250.9549.9949.0248.0647.1

46.1545.1944.2343.2842.3341.3940.4539.5138.5737.6536.7235.8134.8933.9933.0932.1931.3

30.4229.5428.6727.8

26.9326.0725.22

All-AVG Male FemaleAge

17


60616263646566676869707172737475767778798081828384858687888990919293949596979899

100101102103104105106107108109110111112113114115116117118119

22.90522.09521.2920.5

19.71518.94

18.17517.4216.6815.9515.2314.53

13.83513.16

12.49511.85

11.21510.610

9.428.8558.31

7.7857.285

6.86.345.9

5.485.0854.7154.3754.053.763.493.25

3.0352.8452.6752.5252.3852.25

2.1252.0051.8851.7751.6651.5651.4651.3751.2851.1951.1151.04

0.9650.8950.8250.760.710.650.6

21.4420.6719.9

19.1518.4

17.6616.9316.2115.5114.8114.1313.4712.8112.1811.5510.9410.349.769.2

8.668.137.627.146.686.235.815.4

5.024.654.31

43.7

3.443.192.972.782.612.462.332.212.091.981.881.771.681.581.491.4

1.321.241.161.091.020.950.890.820.760.710.650.6

24.3723.5222.6821.8521.0320.2219.4218.6317.8517.0916.3315.5914.8614.1413.4412.7612.0911.4410.8

10.189.58

98.437.897.376.876.4

5.945.525.124.754.4

4.083.793.533.293.082.892.722.562.412.272.13

21.871.751.641.531.431.331.231.141.060.980.9

0.830.760.710.650.6

All-AVG Male FemaleAge

Life Expectancy Tables Cont. | SSA.gov, 2011

18

Toll Free: 800.734.3910

01.01.84

12 or more

10

0NA

1 or more1 or more

70,00095,000

70K + 4x annual support but not more than 95K4x annual support but no more than 70K

Total Partial Benefit MaximumDate of Injury

Death Benefits

1. Death benefits are determined at the date of injury not date of death. LC 4702(a)2. Death benefits are paid in payments at the same rate as temporary total disability unless

otherwise ordered by WCAB except the minimum payment is $224.00 per week. LC 4702(b)

3. Rate of payment is the rate in effect at the date of injury and remains that rate for the first two years following the date of injury. After two years from the date of injury any payments are increased to the temporary total disability rate currently in effect at the date of payment. LC 4661.5

4. Temporary total disability maximum and minimum are increased yearly by SAWW. If the date of injury is in 2007 the payment rate is 2/3 AWW up to maximum of $881.66. If the date of injury is in 2008 the maximum rate is $916.33. LC 4453(a)(10) Payments below maximum and above $224.00 are not increased yearly by a COLA.

5. Payments will be the same for the first two years after date of injury, then if 2/3 of weekly wage is above maximum, the payment will increase to the maximum. Payment rate will continue to increase each year until 2/3 of weekly wage is below the maximum, and then the payment rate will be constant at 2/3 of weekly wage.

6. Where there is one or more totally dependent minor children, payments shall continue after the benefit is paid until the youngest child attains the age of 18, until the death of a child or the child is physically or mentally incapacitated from earnings. LC 4703.5

7. Maximum burial expense 1/1/91 – 12/31/12: $5,000; on or after 1/1/13: $10,000.00 LC 4701

8. Dependents conclusively presumed wholly dependent when: (1) Minor child or a child of any age is found to be physically or mentally incapacitated from earning who was either living with deceased parent or the deceased parent is legally liable at the time of injury; (2) Spouse earning less than $30,000 in the preceding 12 months at time of death. (3) Where there are two or more total dependents there is no increase for partial dependents. (4) If there are no total dependents and one or more partial dependents, the partial dependents share in accordance with their relative extent of dependency.

9. Temporary or permanent disability payments, if any, stop at death. Accrued and unpaid compensation is paid to the dependents. Accrued disability compensation is in addition to death benefits if the employment injury contributed to or caused the death. LC 4700

10. The period within which to commence proceedings for the collection of death benefits is one year from death where death occurs within one year of DOI; or one year from date of last furnishing of any benefits or one year from death where death occurs more than one year from DOI. No such proceedings may be commenced more than 240 weeks from the date of injury. LC 5406

Dependents

01.01.91

12 or more

10

0NA

1 or more1 or more

70,00095,000

70K + 4x annual support but not more than 95K4x annual support but no more than 70K

07.01.94

12

3 or more10

0NANA

1 or more1 or more

115,000135,000150,000

115K + 4 x annual support but not more than 125K4 x annual support but not more than 115K

07.01.96

12

3 or more10

0NANA

1 or more1 or more

125,000145,000160,000


01.01.06

12

3 or more10

0NANA

1 or more1 or more

250,000290,000320,000


19


Medicare Coverage Restrictions

What Medicare Part A and Part B Do Not Cover

Original Medicare (Part A and Part B) does not generally cover the following services and supplies. This may not be a complete list and there may be exceptions.

• Alternative medicine• Cosmetic surgery• Dental care • Foot care• Hearing care• Health care outside of the United States and Territories • Homemaker services• Long-term care• Medical equipment & supplies (covered if used primarily

for medical purposes and is necessary for the patient)• Personal care• Personal comfort items• Prescription drugs• Vision care

What Medicare Part D Does Not Cover

Generally, Medicare Part D will only cover drugs that meet all of the following conditions:

• Only available by prescription• Approved by the Food and Drug Administration (FDA)• Sold and used in the United States• Used for a medically accepted purpose• Not already covered under Medicare Part A or Part B

Based on these criteria, there are certain drugs that Medi-care Part D does not generally cover:

• Weight loss or weight gain drugs• Erectile or sexual dysfunction drugs • Over-the-counter, non-prescription drugs• Hair growth drugs, or drugs used for cosmetic reasons• Fertility drugs• Drugs used for symptomatic relief of coughs or colds• Prescription vitamins and minerals

20


Toll Free: 800.734.3910

Medicare Eligible/Recipient:

Age 65 or older; oron SSDI for 24 months ormore; or End Stage Renal Failure.

“Total”Settlement

$25,000or

Less

Work–loadthreshold MSA

allocation shouldbe contained in

settlement documents, but CMS submissionfor WCMSA approval

not necessary.

Settlement Amount

Allocation/SubmissionStatus

MedicareEligible/Recipient:

Age 65 or older; or SSDI for 24 months; ormore; or End Stage Renal Failure.


$25,000or

More

WCMSAallocationmust be

submitted andapproved by

CMS.

Not Medicare eligible, but has a reasonableexpectation of eligibilityin (30) months:

Age 62.5 or older; or has applied or plans to apply for SSDI; orhas applied for SSDI but was denied and is appealing denial.

Morethan

$250,000

WCMSAallocationmust be

submitted andapproved by

CMS.

Not Medicare eligible,but has a reasonable expectation of eligibilityin (30) months:

Age 62.5 or older; orhas applied for SSDI; orhas applied for SSDI but wasdenied and is appealing denial;or plans on applying for SSDI.

Less than

$250,000,but

more than

$25,000




not necessary.

Not Medicare eligible, and has no reasonableexpectation of eligibilityin (30) months:

Lessthan

$250,000

NoWCMSA

necessary.

Yes

Yes

Yes

Yes

Structure Indemnity

and/orPension

PotentialStructure?

“Total” settlement includes combined indemnity and medical paid out for settlement, regardless of timing.

Not Medicare eligible, but has a reasonableexpectation of eligibilityin (30) months:

Age 65 or older; or on SSDI for 24 months; ormore; or End Stage Renal Failure.


$25,000or

Less




not necessary.

Yes

Not Medicare eligible, and has no reasonableexpectation of eligibilityin (30) months:

Morethan

$250,000

NoWCMSA

necessary.

Structure Indemnity

and/orPension


21


Helpful Links & Resources

Judicial opinionshttp://www.courts.ca.gov/opinions.htm

WCAB decisions & Case Lookuphttp://www.dir.ca.gov/wcab/wcab_dars.htmhttps://eams.dwc.ca.gov/WebEnhancement

Forms WCAB / EAMS UANshttp://www.dir.ca.gov/dwc/forms.html

http://www.dir.ca.gov/DWC/EAMS/EAMS-LC/EAMSClaimsAdmins.asp

Carve-outhttp://www.dir.ca.gov/dwc/carveout.html

Labor codehttp://www.leginfo.ca.gov/.html/lab_table_of_contents.html

QME Regshttp://www.dir.ca.gov/samples/search/querydwc.htm

WCAB Rules of Practice & Procedurehttp://www.dir.ca.gov/t8/ch4_5sb2.html

Medical Treatment Utilization Schedulehttp://www.dir.ca.gov/t8/ch4_5sb1a5_5_2.html

Schedule for Rating Perm Disability 2005http://www.dir.ca.gov/dwc/PDR.pdf

SB863http://goo.gl/3ATHul

TPA listhttp://www.dir.ca.gov/sip/tpa-roster.pdf

CIGAhttp://www.caiga.org

Self-insured Listhttp://www.dir.ca.gov/sip/PrivateRoster.pdf

WCIRBhttps://wcirbonline.org/wcirb/

EDDhttp://www.edd.ca.gov/

EEOChttp://www.eeoc.gov/

CAAAhttp://caaa.org/

Records Order Formhttp://www.getrecords.com/Order/Main.aspx

State Barhttp://www.calbar.ca.gov/

Rating & Present Valuehttp://www.getmedlegal.com/

Notes:

Notes:

Experts in Complex Workers’ Comp Cases

Tailors Settlements to Client’s Individual Needs

Protects SSI & Medi-Cal Benefits

Prepares Life Pensions and COLA Projections

Represents All Insurance Companies Offering Annuities

Medicare Set-AsidePresent value calculations

Future medical value calculations

Death Benefit Projections

StructuredSettlements for clientsinjured on the job whomust maketheir fundslast a lifetime.

www.atlassettlements.com

No Cost To You Or Your Clients

Documents

Quick Reference Guide - Patrick Farber Structured ......Quick Reference Guide Permanent Disability Tables Life Expectancy Table Medicare Coverage Restrictions MSA Submission Chart