Workers' Compensation

Workers' compensation Laws in California aim at providing fixed monetary awards to employees injured at work, during the course of their duties. The laws also provide a safety net to those injured at work but do not wish to file for claims against their employers. Concurrently, the laws are aimed at protecting employers by limiting the amount of money reclaimable and prevent employees from filing lawsuits against their workmates.

After an injury has occurred, you should first seek medical attention if need be. In addition, you should submit a notice of your injury in writing to your employer no later than 30 days. You should retain a photocopy of your notice and the employer’s response. Immediately after you submit your report, the employer should give you a claim form which should be completed in full and handed back immediately. You should also retain a photocopy of the claim form.

The employer will then inform their workers’ compensation insurance company as soon as possible and receive medical assistance straight away. You may be asked to not file an official injury report and they commit to caring for you. Most of the time when this occurs, the company will give injured employees light duties and eventually terminate them.

Workers' compensation claims are sought through the administrative process instead of the court. To become entitled to request for your reward, you must have completely depleted the administrative procedure and after all the parties have finished all the necessary steps to reach an agreement about the petition. A special workers' compensation board or a proposed court will listen to your appeal and if you’ve met all the enacted requirements, you may find restitution in civil court.

You may follow the following steps immediately after you get injured:

1. Gather information

   After getting injured in an accident at work, if you make up your mind to legally file a petition, the court will look at the events that happened to result to the petition and the damages caused by the injury. Workers' compensation claims may drag for years. Therefore, it’s significant to write down notes from the beginning, for records that you can make reference later. Some of the important things to note down include:

   • Events that led to the injury, what happened during and soon after the injury including the place and time, anyone that was present, any discussion that took place, the real incident, your experiences, emotions, the weather condition, any recollection even though you don’t think it’s important;

   • The magnitude of the injury, both mental and physical;

   • Any treatment you have already received and any treatment you’ll need in the future;

   • The consequences of the injury on your social and personal life, your work, the visits to the doctor, the physical therapy, being away from work, canceled or postponed schedules and the aftermaths of your injury on the immediate family members and relationships.

   Occasionally, the extent of injuries from a slip, a fall or similar incidents may reveal itself later in life. It’s important to report any incident right away however insignificant it may seem. If possible, take video or photographic evidence.

   Note down any new developments throughout the claim procedure, any dialogue with witnesses, insurance company and health care providers. Note the date and location of the discussion and any important information, names, and contacts.

2. Meet a lawyer

   At your first meeting with a lawyer, you have to give all the information in regards to the accident. It’s important to respond to all questions with honesty, clarity, in detail and to your best ability, however difficult and traumatizing it may be. Some questions asked by the attorney include:

   • Questions in regards to your insurance cover

   • The condition of your injuries

   • Details of any discussions held with your insurance or employer regarding the injury or incident

   • Sign a document authorizing medical providers to submit your medical history to your attorney

   If have any chronic medical condition, the lawyer will recommend that you see a physician. It is important because the medical history is a crucial part of the evidence of the injury.

   The attorney may request to go through your case before advising you on the best legal options. You may then be requested to sign a representation agreement and the attorney will advise you on what you may do next, which includes an authentic investigation.

3. Pretrial Motions

   The attorney will petition a proposition for the courts to decide your case. Supposing you do not agree with the judge’s decision you may file for a Petition for Reconsideration.

Workers' compensation insurance covers the following;

1. Diseases contracted as a result of being exposed to toxins during working conditions, for example, lung cancer.

2. Injuries resulting from mental or physical strain as a result of increased work duties, work-related stress and conditions arising from constant harassment by a supervisor and constant job demands.

3. Pre-existing medical conditions which are stimulated at the workplace.

4. Injuries sustained off-site or at the workplace by the facilities of the company, during working hours.

The court will reduce the amounts payable or limit compensation due to the following reasons:

1. If the injured employee was partly responsible by inflicting the injury on themselves

2. If they got injured while doing personal errands during working hours outside the work premises

3. If the employee sustained the injuries while they were intoxicated

Workers' compensation benefits are categorized as follows:

1. Medical benefits - These include all the hospital and medical benefits needed to heal or soothe pain resulting from the injury. It include compensation for traveling to the doctor and back. Your employer has an obligation to direct you to physicians of their choice if they have not organized for a Medical Provider Network. However, you can change doctors under special conditions. If there’s an existing Medical Provider Network, which most of them have, it will be necessary for you to receive medical attention from the network. You’re allowed to find another doctor inside the network but you can choose doctors out of the network in case your employer doesn’t adequately inform you about the network.

   All health care should pass through a Utilization Review. This is a process where a doctor that doesn’t see you has permission to review the findings by your physician, to ascertain that your doctor has sufficiently proven their recommendation and that the recommendation falls within the guidelines.

   Whenever you are involved in an industrial injury requiring medical attention, you’ll be entitled to medical benefits which can be granted to the future according to need. Your employer will be liable for medical care of $10,000 maximum, as they still decide whether to admit that your injury took place at work. If they say that your injury was not sustained at your place of work, they aren’t liable for the medical care until the court later determines that you suffered the injury at your place of work.

2. Temporary disability - This is payment received for wages missed as you were recovering. It’s calculated at a ratio of two-thirds of your mean earnings per week before taxes. The maximum mean earnings per week vary based on your injury date. You’ll need to medically prove that you aren’t able to resume work. The benefits are normally paid bi-weekly. The benefit is restricted to 2 years or 104 weeks despite the fact that you still can’t work when the time elapses.

3. Permanent disability - This is payment received if you fail to completely recover, and the injury leads to measurable, permanent mental and physical impairment. If you become 100% disabled, you’ll be paid your rate for temporary disability for life. Supposing your permanent disability is more than 70 percent, you also may quality for a life pension, which is a dissimilar amount of money weekly as long as you’re alive. You can still have a permanent disability as well as resume your previous job. Permanent disability is also paid biweekly.

   If you get back to your job or get employed somewhere else with similar pay, you won’t get benefits for permanent disability till the disability percentage is granted by the court after a trial or an agreement.

   For injuries sustained before 1st January 2013 and on or after 1st January 2005, your permanent disability amount will differ whether you receive a job offer from your employer to either return to your old job or an alternate or modified job which pays within a range of 85 percent of your regular job. If your employer has employed 50 or more people and gives you an assignment, you receive a reduction of 15 percent on your permanent disability if you accept the job or not. If the employer doesn’t give you a job, you receive an increase of 15 percent on your permanent disability weekly rate.

4. Retraining or Vocational Rehabilitation - This is payment for retraining if you are not able to resume your previous employment. If you sustained injuries after 1st January 2004 and before 1st January 2013, you qualify for a Supplemental Job Displacement Benefit that can be used only for a training school. The sum is based on your disability level with the amount limited to $10,000. 10 percent of the voucher can be used to assist you to get appropriate training. The sum of the voucher amounts to $6,000 for injuries sustained on or after 1st January 2013. The vouchers can’t be paid in cash. You are awarded the voucher if your boss hasn’t given you an assignment in a span of 60 days after you reach the limit for medical advancement for conditions brought about by the injury.

5. Return to work fund - You qualify for a significant fund formed by California State to offer help to workers who sustain injuries and can’t resume their jobs if you are eligible for the Supplemental Job Displacement Benefit. This benefit can be applied online. Exceptional computer terminals are configured in the Workers' Compensation Appeals Board, District Offices, where you need to register for these special documents. Certain vocational rehabilitation advisers will assist you with the process. For you to register as a beneficiary, you’ll need your Supplemental Job Displacement Benefit. Currently, the benefit amount is limited to $6,000 per injury. This money is paid by California State and not your employer or the workers’ compensation insurance.

6. Death benefits - If the deceased employee had dependents who relied on them for support, they are eligible for this benefit, if the cause of death was employment related. The death must not necessarily have occurred at work provided that the condition that led to the employee’s death is work-related.

7. Compensable consequences - Supposing the first injury leads to other issues, you’re eligible to all the compensation for these ensuing compensable consequences like they took place at work. Examples include:

   • A back injury prompted by limping as a result of your industrial ankle or knee injury

   • A broken wrist that takes place in a fall as a result of your industrial knee injury letting you down

   • Injuries brought about by medical negligence of a physician treating your work-related injury

   • Injuries suffered in an accident on your way to your doctor for your industrial injury

Your lawyer can explain to you other penalties for example:

• Penalties against your employer for not having workers' compensation Insurance

• Penalties that you can recover from your boss for committing willful and serious acts that put the safety of his/her employees at risk

• Penalties for being discriminated against because you got injured and filed a claim

• The employer who is uninsured and the insurance company get penalties for irrationally delaying payments of your benefits. They are automatically penalized 10% for the delay

The basic requirements to qualify for a workers' compensation Benefit are as follows:

1. You should be an employee - Not every worker is classified as an employee when it comes to the eligibility for a workers’ compensation benefit. Particularly, independent workers like consultants or freelancers are not entitled to the benefits;

2. The injury should be work-related - If you get injured while doing something for the benefit of your employer then the injury is work related and you are entitled to benefits;

3. Your employer must be covered by workers’ compensation insurance;

4. You should meet the deadline for recording the injury and filing a workers’ compensation claim.

Categories of workers exempted from the benefits include:

• Domestic workers

• Farm and Agricultural workers

• Loaned or Leased employees

• Seasonal or casual workers

• Undocumented workers

The two distinct ways you can reach an agreement regarding your case are:

1. Stipulated Finding and Award - This is a consensus that has similar effects as the decision of the judge. It is undertaken deliberately by both parties and not imposed on them by the judge. Once the judge reviews it and signs the award, the effect is similar to if the award had been made by the judge after a trial. Main elements that make up a finding and award are whether the applicant requires additional medical care or not and the disability percentage.

2. A Compromise and Release concludes the entire case and gets rid of the need to make payments for a while. It also ends the entitlement to any medical care in the future. You should think about a Compromise and Release if you are entitled to medical care in the future but you’d prefer to pay for it on your own, or you have health insurance to pay for your medical care.

Most workers' compensation cases are resolved without going through a trial. However, if it goes through a trial, your attorney should have a meeting with you before the trial and prepare you for the process. The case is presided over by a workers’ compensation judge only. There isn’t any jury. The trial happens in a small hearing room with no gallery or audience. The trial may only happen for a few minutes or hours but if it doesn’t end on the day it starts, it has to continue in two or three months. Sometimes it may take years for the trial to end.

At the trial, you’ll be called as a witness. Your attorney will ask you direct questions which you have to answer concisely and briefly. The defense attorney will then cross-examine you. At the trial, you are not allowed to take a break unless there’s an emergency. In case you are not testifying, you shouldn’t talk in the courtroom however, you can silently pass over notes to your lawyer.

It’s very disappointing and shocking when you get a letter from your employer’s insurance that your claim is denied. Sadly, it’s very common for claim administrators and insurance companies to come up with some reason to deny that you are an employee and that the injury took place at work. Sometimes employers don’t want to acknowledge that the injury occurred at work. They will come up with many reasons for delaying or denying the determination of a workers’ compensation case. After receiving a letter of denial, you are entitled to oppose the decision of the insurance. If your claim is delayed you should check the delay letter to see the reason(s) given for the delay.

The lawful process of opposing the insurance decision to deny your claim starts with filing for an Application. After filing an Application, you become an Applicant. You can use an attorney to assist with the process. In case you don’t want a lawyer or can’t find one to represent you, the Workers' Compensation Appeals Board has employees who are not lawyers but they are more knowledgeable about the workers' compensation laws than most attorneys.

An attorney will guide you through the process of opposing the decision to deny your claim. It may need to go through a trial in order to settle the facts, although most cases that are denied are later on found to be compensable either after a trial or through an agreement. Many undisputed cases can be resolved without settling all issues.

The court will provide forms to be filled by the attorney; either a Stipulated Finding and Award agreement or a Compromise and Release. The forms will be submitted to a judge who has to review the medical reports and documents to ensure they are sufficient for the injuries. The judge then signs either the Award formed in accordance with the Stipulated Finding and Award or an Order Approving Compromise and Release. When these documents are signed by a judge, they have the effects of a court order. After receiving this order, you’ll be given your check for the settlement amount minus permanent disability paid in advance and the attorney’s fees in 30 days.

The workers' compensation claim process involves many steps. The process must follow strict procedures that can be confusing to understand and that’s why it’s important to get an attorney that is experienced in the field. The Workers Compensation Attorney Group in Long Beach, California, will help you understand every step of the process. Our attorneys will give you the best advice to help you obtain fair compensation for your injuries. Call 714-716-5933 if you need our service.