1. A claimant found to have a compensable injury in conformance with this chapter and entitled to benefits hereunder shall be entitled to all medical, surgical, hospital, or dental treatment and any therapy, durable medical equipment, medications, diagnostic testing, radiology, and any other medical service related thereto, as requested or prescribed by a provider selected by claimant after thirty (30) days from the date the injury was reported, or, if a medical provider network is established by the casino, then by a provider within the medical provider network.

2. Where deemed appropriate by an employee’s assigned medical provider, when a condition reaches MMI and/or P&S, and future and/or supportive medical benefits are necessary, such benefits shall be provided for the duration established in the medical service provider’s report, subject to the requirements set forth in Sections 12-108 and 12-112.

3. The algorithms and treatment recommendations prescribed by the American College of Occupational and Environmental Medicine (ACOEM) guidelines may be used to determine the appropriateness of a recommended treatment, but shall have no binding effect upon the Administrator or casino.

4. Neither the casino nor the Administrator shall be responsible for, nor shall any claimant be entitled to compensation for, any bill or amount in excess of what is allowable under the California fee schedule for similar bills in the California statutory system.

1. The casino has established a return-to-work program, such that best efforts will be made to accommodate recommendations for light duty, modified work duty, or alternate duty as prescribed by an approved physician.

2. In instances where light duty, modified duty, or alternate duty results in diminished wages as compared to the preinjury average weekly wage of the claimant, the claimant will be entitled to temporary partial disability payments at a rate of sixty-six and two-thirds percent (66⅔%) of the difference between actual weekly earnings during the period of modified and/or light duty and the preinjury average weekly wage, at levels generally comparable to the California statutory system.

3. In instances where light duty or modified duty cannot be accommodated by the casino, or where a claimant is deemed temporarily totally disabled by an approved physician, the claimant will be entitled to temporary total disability benefits at a rate of sixty-six and two-thirds percent (66⅔%) of the preinjury average weekly wage, subject to the maximum rates generally recognized by the state of California at the time such temporary total disability is applicable. Temporary total disability benefits shall not be paid during the first three (3) days of lost earnings unless a claimant is hospitalized or is eligible for temporary total disability benefits for fourteen (14) days or more. The maximum duration that temporary total disability benefits will be paid by the casino or its Administrator to a claimant is one hundred and four (104) weeks.

4. No temporary disability benefits, whether temporary partial disability or temporary total disability, shall be paid where:

5. For purposes of this section, a claimant’s preinjury average weekly wage shall be calculated by adding all reported earnings for one (1) year preceding the date of injury and dividing the resulting amount by fifty-two (52). In the event the claimant has been employed for less than a year, the preinjury average weekly wage shall be calculated by adding all reported earnings for the actual period worked prior to the date of injury and dividing the resulting amount by the number of applicable weeks worked. In the event the claimant has worked for less than a week, the preinjury average weekly wage will be calculated by multiplying the claimant’s hourly rate by the number of hours he or she was expected to or was hired to work.

1. Permanent partial impairment benefits will be paid for a compensable injury pursuant to the schedule of benefits recognized for similar injuries under comparable California workers’ compensation law.

2. Permanent total impairment benefits will be paid for a compensable injury to a claimant for life or until a settlement is reached but said benefits shall not inure to any dependent upon death of the injured claimant.

3. The casino shall not be responsible for any portion of permanent partial impairment or permanent total impairment that is attributable to a condition, disease, illness, or injury that is deemed preexisting or nonindustrial in nature.

4. In no event shall permanent partial impairment for any and all compensable injuries combined exceed an aggregate total of one hundred percent (100%).

5. No permanent impairment benefits, whether permanent partial impairment or permanent total impairment, shall be paid under circumstances where the claimant is incarcerated; provided, that such payments will only be withheld during the period of said incarceration.

1. Vocational rehabilitation benefits shall be included as an extra percentage of permanent partial impairment and shall be consistent with, and paid in an amount comparable to, similar benefits as established in the California workers’ compensation law in effect at the time the benefit is awarded. This benefit is awarded where the casino is either unable to accommodate the permanent modified duties prescribed by the physician approved by the Administrator at the time MMI is opined or would not have been able to accommodate had the employee still been employed at the time MMI was reached.

2. Where the Administrator permits, in lieu of subsection (D)(1) of this section, vocational rehabilitation benefits may be paid in the form of a voucher paid directly to the claimant.

3. However, if a claimant’s permanent impairment rating equals one hundred percent (100%), the claimant will be considered permanently and totally disabled, and therefore ineligible for vocational rehabilitation.

1. Death benefits are only payable to dependents as determined by the Administrator.

2. Death benefits will be paid at levels generally comparable to those provided to similar dependents under California law.

3. Death benefits can either be issued on a biweekly basis, at a rate commensurate to what would have been paid under temporary total disability benefits but for the death or can be paid in a lump sum at a reasonable present-day value calculation as determined by the Administrator and subject to the acquiescence of the dependents.

4. Death benefits will cease upon remarriage or death of the spouse or upon the child or children reaching the age of eighteen (18). (Res. 2022-44 (Exh. A))