Workers’ Compensation Injuries

With the high number of hours spent at work, the risk of sustaining injuries while on the job is high. When a worker misses work as a result of a work-related injury or sickness or incurs medical expenses, the workers’ compensation insurance covers the cash benefits and medical expenses. Employers must purchase this insurance policy for their workers as required by Section 3351, et seq; Section 3700 of the California Labor Code. According to Section 5402 of the California Labor Code, once the employer receives a notice for injury, they should provide a claim form to the employee within a day and allow medical treatment of up to ten thousand ($10,000) dollars before the claim is heard. In case you are a freelancer, the workers’ compensation insurance policy is not compulsory but can prove to be beneficial when you are out of work due to injuries. You will receive partial payments or wages during the period you are not working.

The purpose of a workers’ compensation insurance in California is to provide wages and medical indemnity when employees suffer injuries or fatalities in the course of performing their work duties. Every business is required to carry the insurance policy. Below are some of the things that are covered in this policy.

1. Medical expenses to handle immediate injuries and sicknesses or medical care.

   Although most businesses and employers put measures in place to reduce or prevent accidents and create a pleasant working environment, you cannot completely prevent accidents. If you fall and injure your back or break a limb, your employer is required to cover your medical expenses including paying for the ambulance and any other costs that are incurred due to the accident. This is according to Section 4600 of the California Labor Code. Your employer might not be responsible for all injuries and illnesses sustained in the workplace. It is thus advisable that you find out in advance what they are responsible for, and what you are entitled to as an employee.

2. Lost wages or temporary disability payments

   When an injury causes you a temporary disability, it means that you are not able to work for a given period. You thus are entitled to temporary disability indemnity. After the knowledge of the injury, the first payment should be made not later than fourteen (14) days. However, if the claim is denied, the payment will not be made. Following the California Labor Code Section 4650, et seq, the benefits paid are two-thirds of your pre-tax wage and for a period not exceeding one hundred and four (104) weeks. The cash benefits are essential at this point since a lot of injured employees have no other source of income in the duration of their temporary disability. The partial wages received are used for personal expenses.

3. Funeral costs or death benefits

   Some injuries or sicknesses can result in death. Funerals come with many expenses, and this can be overwhelming for the grieving family and coworkers. The employer should cater for the funeral costs. In some instances, there are funeral benefits where the workers’ compensation insurance policy makes payments to the family or dependents of the worker as death benefits. This happens rarely and is only for employees who perform high-risk tasks and those that succumb to work-related injuries. This is according to Section 4700.

4. Permanent disability payments

   For permanent disability, Section 4658 states that an injured employee should receive payment for injuries that cause permanent impairment. The period and amount of payments made will depend on the extent of the permanent physical or mental disability.

5. Retraining

   Before getting back on the job, your treating physician will provide your employer or company with a report detailing what type of work you can and cannot do when recovering or after recovering. In the event you are unable to go back to your original work, your employer is supposed to pay for your training for a different position, according to Section 4658.7.

Work-related injuries refer to injuries that occur when you are doing something for the interest or benefit of your employer. Injuries that occur due to reasons that can be associated with your line of work are compensable. In other words, if you are injured at work, the injury is compensable. This means that even if an accident occurs when you are at a social event that will benefit your employer, it will be compensable even if it occurred outside your work premises.

Any injury acquired during free time is, however, not compensable. If an accident occurs during coffee or lunch breaks and the place of occurrence is your work premises, you are entitled to workers’ compensation. Outside work premises, it will not be compensable. Compensable injuries can also include conditions or illnesses that develop due to repetitive motion over years of working. If you develop lung cancer due to the work environment or asbestos toxicity and emotional trauma, you qualify for compensation.

Mental illnesses or psychological problems are also compensable if the condition developed or occurred at work or was aggravated by stressful work conditions. When you begin to experience health conditions or suffer an injury at work, it is advisable that you report the incident to your employer to ensure the appropriate steps are taken.

An injury is compensable if it is covered under the California Workers’ Compensation system. You will be eligible for compensation if your injury stems from work-related activities. Some injuries are rare in the workplace while others are widespread. Some of the common compensable work-related injuries include:

1. Physical trauma

   This is a common injury in California. It is defined as a pure injury that has occurred due to an event that can be easily connected, or that is easily identifiable with the work environment. Falling from a ladder or slipping and falling are some of the examples of physical trauma. If an injury occurs due to employee negligence, it might still qualify as compensable. Some of the injuries that can be directly connected to work events include workplace violence, machine entanglement, reaction injuries and walking into an accident.

2. Physical-mental injuries

   These types of injuries are also prevalent. Physical work can sometimes cause psychiatric injuries. However, for these injuries to be compensable, you need to prove or show evidence from a medical practitioner that the mental injuries are side effects of the job. Some of the major causes include; stress, anxiety, and depression. If you are overworked, discriminated or harassed at work, you are likely to develop stress or depression. If there is proof of your condition stemming from work, then it is compensable. In the event of permanent disability due to the psychiatric injury, there is, however, no additional compensation.

3. Mental-physical injuries

   If an employee suffers a heart attack due to work stress and they can prove that the job is the cause of the injury, they qualify for Workers’ Compensation benefits. The challenge with mental-physical injuries is that it is difficult to blame your work for the injuries. Your medical records and reports can best prove this.

4. Mental injuries

   For a psychological injury to be compensable, you are required by law to have been with your current employer for more than six (6) months. You are also required to show proof that your work environment is 51% and above to blame for your mental injuries. If you have worked for your employer for less than six (6) months, it is impossible to file a psychiatric claim for psychological injury compensation. The reason being the current workplace might not be the leading cause of your injury. Victims or witnesses of work violence who have suffered trauma or stress qualify for mental injury compensation.

5. Prior-work injuries

   Sometimes employees develop injuries and might not know about it. Others might realize and seek treatment. When such employees move to new jobs and suffer a new injury that is intensified by the pre-existing one, the new injury becomes compensable. However, one must provide evidence that the new work condition aggravated the pre-existing injury.

6. Repetitive stress injuries

   These are injuries that occur slowly and over an extended period, such that the employee does not notice until the issue becomes serious. Employees with repetitive stress are likely to suffer orthopedic conditions. In the beginning, they might experience minor symptoms like headaches which they assume are as a result of fatigue. They use painkillers to relieve the pain, but if this goes on for long, it can cause tendinitis. These types of injuries are prevalent in workplaces and are compensable.

California lawmakers understood that specific work injuries might have long term effects on employees and as a result, came up with a compensable consequence. A compensable consequence is a physical injury or complication that stems from an original work condition injury. If you suffered back pain or leg injury at an original workplace and received medical or disability benefits, you qualify for the same benefits if a new complication occurs that is connected to the original one.

These compensable consequences include clinical depression caused by an injury that never heals, pain medication addiction resulting from work-related injuries and tendinitis or orthopedic conditions that cause an additional overuse condition or syndrome. Insurance companies will try hard to deny compensable consequence claims. You, therefore, will need a team of experienced lawyers to prove that the secondary injury is linked to the original work condition. If you get injured hiking and then get involved in a work mishap, the insurance company will be willing to pay a portion of the amount of injury caused by the job-induced injury.

In the state of California, the law requires every employer to have a workers’ compensation insurance policy, provided by insurance companies. These policies are meant to protect employees and prevent lawsuits against the business in case of work-related injuries. If you are injured or get ill because of a work-induced condition, you have thirty (30) days to submit a written notice to the employer according to section 5400 of the California Labor Code.

Section 5401 further states that once the employer receives the notice, they must present a claim form to the employee after twenty-four (24) hours or one (1) day of receiving the injury notice. After receiving the form, you have a year to file for a workers’ compensation claim.

If the injury is severe, get first aid and seek immediate medical attention. In case the injury is not too severe, go to a licensed medical practitioner or a physician who has been approved by the California state law and inform them that the injury is work-induced. To ensure your benefits remain valid, present your employer with a notice of injury before the end of thirty (30) days.

Your employer on the other hand, after receiving the notice should send you a claim form within one (1) day. The claim form can also be found online.

You must be very keen when completing the DWC-1 form. You need to include your name, address, date and time of injury, description, and address of the place where you were injured in the form. You are also required to describe how the accident occurred, the type of injury sustained and the part of your body that was injured. Your signature is also necessary if your claim is to be considered. You will have one (1) year to submit the claim form back to your employer.

Your employer will fill out the employer’s part and then sign it. The form will then be submitted to the claims administrator or the person who takes care of issues regarding workers’ compensation for your employer. The claims administrator often is the insurance company. They will go through the information in your DWC-1 claim and send a response within ninety (90) days stating whether they have accepted or denied your claim.

Only when the claims administrator agrees that your injury is compensable, will your claim be accepted. If the injury is not compensable, the insurance company will deny the claim. If your claim is rejected, you are allowed to appeal or challenge the decision. If you do not hear from the claims administrator within ninety (90) days after reporting the injury, it is assumed the claim is accepted.

For federal employees, you can pick any qualified doctor. The said doctor must be competent enough and fill medical reports based on the specifications of the workers’ compensation officer. To see your doctor, you must inform your employer first before suffering any injuries. This is called predesignating and should be done in writing.

Not everyone qualifies to predesignate. If you are eligible, you should write a statement to the employer by filing DWC form 9783 or use the one given by your employer. The form should contain the name of the employer, a statement showing that if you suffer a job-induced injury, you can receive medical attention from your predesignated doctor, your name, signature, and date.

Note that you should state the name, address, and contacts of the doctor you predesignate. Any qualified doctor who is your primary medical practitioner can be used. For a chiropractor or personal acupuncturist, the law, however, provides certain restrictions. One of the restrictions is that you must inform your employer in writing before the injury. The other one is that you must request to see the acupuncturist after you first see the doctor chosen by the expert handling your employer's workers’ compensation claim.

For employees under the Federal Employees' Compensation Act (FECA), you can see a personal physician, but there must be a second opinion from the doctor chosen by your employer. If your employer’s doctor agrees with the treating doctor’s report, the compensation payment will go on smoothly. If your employer pays the doctor treating you, you should not open up about your pre-existing injuries because these might reduce your benefits.

After your physician prepares medical reports and you have filed a claim, your hope will be having the claim accepted. However, this is not always the case since your claim might be disputed. When this happens, your employer will notify you within ninety (90) days. Take your time and review the notification. At this point, it is good to hire the best attorneys.

The first step is visiting an approved medical evaluator. These are the medical practitioners who are trained to review workers’ compensation claims. These doctors conduct an independent evaluation different from that of your doctor or the employer's doctor. If after the review you believe you should not be denied the claim, get an application for adjudication form and complete it. The form is similar to the DWC-1, but most of its focus is on the description of the event that caused the injuries and the type of injuries.

After filing the form, please submit it to the DWC office in Long Beach County or in the County where the work-induced injury occurred. You should also submit another copy of the application for adjudication form to your employer. Once you have applied, you will receive a mail with your case number and other instructions. This means you will have a case and hiring an attorney at this point will be a wise thing to do.

Some people might decide to proceed with the trial without legal representation. If you decide to do it on your own, visit the DWC site and file a declaration of readiness to proceed to get a hearing form. You will then attend the hearing where you will meet the claims administrator and the judge. The hearing is for helping the involved parties to try and reach an agreement without proceeding to trial.

If an agreement is not reached, the case will proceed to trial. During case preparations, you are required to share documents that are touching on the issues you are disputing with the employer and witnesses. They should also share documents regarding the reasons they are denying the workers’ compensation claim.

On the trial date, you and your employer will be allowed to air your issues or side of the story before the court. You or your lawyer will also get to question the witnesses before the court. After the trail, the ruling will be made, and it will be sent to either you or your lawyer.

The California division of workers’ compensation in the effort to try and help employees, has published a guidebook for injured workers which will help you with the workers’ compensation injuries.

Our team of attorneys will discuss your case without charging you for consultation. We will help you make preparations for trial and provide emotional and legal support until the end of the trial. If you live in Long Beach, CA and have questions or need clarification on California’s workers’ compensation, call our Long Beach workers compensation attorney today at 714-716-5933. We will provide the best representation to enable you to receive your due benefits or get indemnified for work-induced injuries.