Facts for Injured Workers
Workers’ Compensation Benefits & Alternative Dispute Resolution
Southern California Pipe Trades District Council 16 has entered into a Workers’ Compensation Agreement for the benefit of its members. The Workers’ Compensation Agreement is described below.
Workers’ Compensation insurance is required by law and the UNION is working to insure that you obtain ALL the benefits to which you are entitled.
By working together, controlling Workers’ Compensation costs and overhead costs, Union Contractors are able to remain competitive. The contractor can continue to provide jobs and benefits in order to pursue our common goal.
An employee working under the District Council 16 Workers’ Compensation Program can be covered by workers’ compensation provided under Labor Code §3201.5. This law replaces much of the cumbersome administration of the traditional workers’ compensation system with an ALTERNATIVE DISPUTE RESOLUTION system. This website provides you with basic information about the program and system so that you may gain an understanding and make an informed decision should you have a work-related injury. All benefits for workers’ compensation under the District Council 16 P.I.P.E. ADR Workers’ Compensation Agreement are equal to, or are an improvement to, the traditional system.
What is Workers’ Compensation?
Workers’ Compensation is an insurance required by law, which provides benefits to workers who are injured or become ill due to employment. It also provides death benefits to dependents in the event of the worker’s death.
Questions & Answers
Am I covered under the Benefit, and how does it apply to me?
Yes, whenever your job causes you to have an injury or illness, you will be covered. This includes everything from first aid, to serious injuries, to work-related illnesses.
When does this coverage begin for me?
Employees are covered from their first day of work.
What benefits are available in the workers’ compensation policy?
Workers’ Compensation policy includes five basic benefits:
- Medical Care necessary to cure or relieve the effects of your injury is provided at no cost to you. You may pre-designate a treating provider or treat with the provider offered by the employer or insurance carrier. If you are not satisfied with your treating provider, you may select a medical provider who is a participant of the Southern California Pipe Trades Health and Welfare Trust Fund’s plan.
- Temporary Disability Benefits are provided if you are unable to work for more than three days because of your on-the-job injury or illness.
- Permanent Disability – additional benefits are available.
- Death Benefits
- When worker is fatally injured on the job.
- Reasonable burial expenses – maximum set by law.
- Qualified surviving dependents may receive benefit payments.
- Supplemental Job Displacement Voucher – if you are unable to return to your regular work and your employer cannot offer permanently modified or alternative work, you may qualify for a non-transferable job displacement voucher.
- Voucher ranges from $4,000 to $10,000 – allowance depends on your level of permanent disability.
- Voucher may be used for re-training or enhancing your skills.
- Voucher can also be used towards tuition, books and fees associated to your educational costs.
- If you prefer, a counselor may assist with selecting an appropriate training facility – counseling fees may not exceed 10% of the voucher allowance.
What can I do if my employer discriminates against me for filing a worker’s compensation claim?
- The law forbids an employer to discriminate against an employee for filing a workers’ compensation claim because of a work-related injury or illness.
- Contact the Ombudsman if discriminated against.
- Employers are subject to the Americans with Disabilities Act (ADA) or Fair Employment Housing Act.
- You may also call the Equal Employment Opportunity Commission at 1-800-669-4000.
How much will I receive and when does temporary disability begin?
- Temporary disability benefits are based on two-thirds of your average weekly wage.
- Maximums are set by law.
- For injuries after January 1, 2008, the maximum TTD rate is $916.33 per week.
- For injuries after January 1, 2009, the maximum TTD rate is $958.01.
- A letter of explanation will be mailed to you outlining which day of the week your check will be mailed.
- During the qualification period, insurance companies mail checks automatically every two weeks.
- Expect a check within 14 days if your claim is filed right away.
- You are not paid for the first three days, unless you are in the hospital or unable to work for more than 14 days.
What is the first step in reporting a work-related injury or illness?
- First, contact your foreman or supervisor.
- Contact person will send you to the approved industrial clinic.
- Then, a Claim Form will be given to you that should be returned as soon as possible.
If I have any questions or need assistance, who may I go to?
Richard A. Robyn, Sr. has been appointed as the Trust Official or Ombudsman for the PIPE Contractors Safety Association, Inc. program.
The Ombudsman’s job is to help the injured employee receive workers’ compensation benefits without delay. The Ombudsman will work with the insurance company, doctor, employer and union representative to make sure you get all the workers’ compensation benefits you are entitled to receive. This service is free to workers who become injured or ill because of work.
How does the Alternative Dispute Resolution (ADR) Program work?
If you experience any problems with your workers’ compensation claim or benefits, there are three steps available –
Ombudsman / Mediation / Arbitration to replace the traditional judicial system.
- Alternative Dispute Resolution (ADR) Program with the assistance of the Ombudsman reviews your claim, or…
- If unable to resolve your matter, Ombudsman will assist you with proceeding with a Mediator, or…
- Ombudsman will assist you with going through Arbitration if Mediation is unsuccessful.
What is Arbitration?
Arbitration is like a court hearing. If mediation is not successful, you may request arbitration. An Arbitrator will be assigned to hear your case. A hearing will be scheduled; evidence will be presented and the Arbitrator will render a decision. The decision of an Arbitrator has the same authority as a workers’ compensation judge.
What will going to Arbitration accomplish?
Because the Arbitrator has the same powers and authority as a workers’ compensation judge, disputes are normally resolved faster and with reduced cost. Although the employee has the right to be represented by an attorney, the need for an attorney on either side is also reduced.
Call Richard A. Robyn, Sr. (866) 254-7473 if you have any questions or need assistance with your –
- Claim Form
- Temporary or permanent disability benefit
- Benefits or coverage
- Communicating with your employer, doctor, insurance company claims representative or union representative
- Medical care and disability payments
- Returning to work
- Vocational rehabilitation program
- Supplemental job displacement benefit
CA License #OK 21323
Chris R. Reinhardt, CIC
P.O. Box U
Moreno Valley, CA 92556
Outside CA Call: (909) 234-7290
Fax: (909) 494-4164
Richard A. Robyn, Sr.
American Ombudsman Enterprises
P.O. Box 127
Imperial Beach, CA 91933
Tel./Fax: (866) 254-7473 | Email