6.10.710 Benefits.
Workers’ compensation benefits payable to employees pursuant to this article shall be comparable to benefits mandated for comparable employees under the California Labor Code, and this section shall be interpreted to provide such comparable benefits, which include:
(A) Medical Treatment. Gaming Enterprise shall provide quality and timely medical treatment comparable to the California Medical Treatment Utilization Schedule. An independent medical examination by an independent medical reviewer on the state’s approved list, a qualified medical evaluator on the state’s approved list, or an agreed medical examiner upon mutual agreement of the Administrator and employee shall be available to resolve a disagreement on appropriate treatment.
(B) Usual and Customary Medical Costs.
(1) Medical benefits will be provided under the Medical Providers Network and will be comparable to those established by the California Department of Industrial Relations, Division of Workers’ Compensation and the California Medical Treatment Utilization Schedule.
(2) An injured employee’s medical treatment, up to a maximum of ten thousand dollars ($10,000), will be provided for an alleged injury until the date that liability for a claim is accepted or rejected.
(C) Temporary Disability.
(1) Comparability of Benefits. The benefits payable, and the timing those benefits are paid, to an injured employee from a compensable work injury resulting in temporary disability of the employee shall be comparable to those temporary disability benefits recognized as recoverable by the California Department of Industrial Relations, Division of Workers’ Compensation.
(2) Rate of Compensation. If the compensable work injury causes temporary partial or temporary total disability, the disability payment shall be two-thirds (2/3) of the average weekly earnings. No payment is due during the first three (3) days after the employee leaves work as a result of the compensable work injury. If temporary disability continues for more than fourteen (14) days, or the employee is hospitalized as an inpatient for treatment as a result of the compensable work injury, temporary disability shall be payable as of the date of the disability. If the temporary disability compensation rates established by the state change after the enactment of the ordinance codified in this article, such new rates established by the state shall apply.
(3) Modified Duty Position. The Gaming Enterprise may offer an injured employee a temporary modified duty position on a case-by-case basis. If the employee refuses the modified duty position despite having been cleared by the assigned physician to return to the modified position, then the temporary disability benefits shall cease.
(4) Reduction of Benefit Payments. Temporary disability payments shall be reduced by the sum of unemployment compensation benefits, automobile insurance payments and recoveries, health insurance benefits, other payments from third parties related to the compensable work injury, and extended duration benefits received by the employee for a compensable work injury during the period of such disability. The injured employee shall report any pensions, disability payments or earnings to the Administrator within ten (10) days of receipt of such funds. Failure to do so shall constitute fraud and action may be taken against employee to recoup any benefits paid.
(5) Cessation of Benefit Payments. Temporary disability payments shall cease where the employee:
(a) Has reached maximum medical improvement; or
(b) Becomes incarcerated; or
(c) Is terminated for misconduct, quits work, or declines a bona fide offer by the Gaming Enterprise of light or modified duties and the employee is cleared by the assigned treating physician to engage in such modified position; or
(d) The employee is not authorized by the assigned treating physician to miss work.
(6) Supplemental Payments. An employee who sustains a compensable work injury may choose to supplement temporary disability payments with available leave credits to receive a benefit that is comparable to their full net pay. Leave credits include any accumulated sick leave, vacation, annual leave, compensated overtime, or any other form of paid leave offered by the Gaming Enterprise that is available to the injured employee.
(D) Permanent Partial Disability.
(1) Permanent partial disability benefits will be paid at a level comparable to that paid to comparable employees under state law.
(2) In determining the percentages of permanent disability, account shall be taken of the nature of the physical injury or disfigurement, the occupation of the injured worker, and the employee’s age at the time of the compensable work injury, with consideration given to the diminished ability of the employee to compete in an open labor market.
(3) The schedule of the California Department of Industrial Relations, Division of Workers’ Compensation shall be used as a comparable guideline in determining the percentage of permanent disability but is not prima facie evidence of a percentage of disability.
(E) Permanent Total Disability.
(1) Permanent total disability benefits will be paid at a level comparable to that paid to comparable employees under state law.
(F) Vocational Rehabilitation Services. If an employee who has suffered a compensable work injury is unable to return to his or her usual and customary work due to a permanent disability, or in the alternative, a permanent modified or an alternate position, the Gaming Enterprise will work with the injured employee to provide the means necessary to return the employee to suitable gainful employment. This may include either:
(1) Vocational rehabilitation maintenance allowance (VRMA) to be paid at the rate comparable to that provided to an injured worker under the California Department of Industrial Relations, Division of Workers’ Compensation, at the time of the injury; or
(2) A provision as a part of any permanent disability compromise and release settlement to cover for supplemental job displacement benefits.
When an injured employee agrees to accept, or is ordered to receive, vocational rehabilitation services, the employee thereby admits that he or she is incapable of performing the job duties of his or her former position. Upon written agreement accepting vocational rehabilitation services or upon the filing of an order to enter vocational rehabilitation services, whichever comes first, the employee shall be deemed to have voluntarily resigned his or her job position.
(G) Death Benefits.
(1) When a compensable work injury causes death within five (5) years from the date of the injury, the Gaming Enterprise shall be liable for compensation to the dependent of the injured employee as provided for in this section. The dependent must be a spouse or a minor child totally or partially dependent upon the injured worker at the time of the injury and at the time of death to qualify for benefits.
(2) The death benefit payable to an employee whose death is proximately caused by a compensable work injury shall be comparable to those benefits recoverable under the California Department of Industrial Relations, Division of Workers’ Compensation at the time the compensable work injury was sustained.
(3) The weekly compensation will be divided between the qualifying dependents in proportion to the percentage of support each received from the deceased employee. It will be presumed that each qualifying dependent received equal support from the deceased employee. [Res. 19-R-083 § 9, 7/18/2019.]