Workers’ Comp FAQ

Workers’ compensation is a form of insurance taken by the employer to insure workers from the cost of medical expenses and lost wages arising from work-related injuries. California requires all employers to have workers' compensation coverage in place. In workers’ compensation, the employer assumes responsibility for injuries or illnesses sustained as part of the costs of running the business. Workers’ compensation serves two main purposes:

• It protects employees from the financial burden of medical costs and loss of income from the injury, and

• Protects employers from lawsuits filed by employees for the negligence of the employer

To benefit from workers' compensation, you have to be an employee and must have a work-related injury.

The employer pays for workers ’ compensation as part of the costs of running their business. It is, therefore, not supposed to be deducted from your salary.

It depends. When you are working, the employer is responsible for your actions. This means that you can be compensated for injuries that occur during the course and within the scope of employment. However, you may be denied compensation in specific circumstances such as:

• Self-inflicted injuries

• Injuries sustained when you are committing a serious crime

• Injuries sustained when you are not working

• Injuries sustained when you violated the company's policies

• Injuries sustained when commuting to or from work unless your employer requires you to perform work-related tasks or pays for the time you are commuting

Your employer will need to prove that your behavior was the main cause of the injury and was outside the accepted behavior at the workplace to disqualify you from receiving workers' comp benefits.

Workers’ compensation covers all work-related injuries including those that are acquired over time and those sustained on a specific date. Injuries acquired over time occur due to exposure to toxins at the workplace or from repeated motions and can cause illness such as lung cancer.

All injuries sustained in the course or within the scope of employment are considered to be work-related. This includes any injuries sustained when running errands for your boss.

Illnesses that are covered by workers’ compensation include;

• Repetitive strain injuries such as carpal tunnel syndrome

• Occupational illnesses such as black lung diseases, loss of hearing that are developed due to exposure to conditions in the working environment.

• Injuries that aggravate an existing condition such as arthritis. When you get a new injury that intensifies your pre-existing condition, you can qualify for workers’ compensation.

• Stress-related injuries such as post-traumatic stress disorder

Workers’ compensation covers employees of any organization. An employer may classify you as an independent contractor to escape the responsibility of reimbursing you for losses in work-related injuries. Under California labor laws, you are an employee if your employer:

• Controls the manner and details of your work

• Has the right to terminate you

• Pays an hourly wage or salary

• Contributes to your social security and unemployment deductions

• Controls the hours and days you work

• Supplies you with the materials or tools for performing your tasks

Workers’ compensation does not cover independent contractors. If you are an independent contractor, you are supposed to get your personal insurance cover to cater for your medical costs in case of an injury.

Workers whose jobs involve traveling and making deliveries such as truck drivers, taxi drivers, and salespeople are covered by workers comp where they are injured in the course of their job.

Your employer is required to provide a safe working environment for their employees. This includes removing hazards in the workplace, notifying employees of the presence of possible hazards, conducting workplace inspections to correct hazardous conditions and providing the employees with the right equipment that is less likely to cause injury.

Employers also have the responsibility to provide workers' compensation insurance for employees and notify new and existing employees about the presence of the workers’ compensation. They should have a visible notice at the work site providing employees with relevant details of the workers’ compensation and information about where they should get treatment in the event of an injury.

When the employer learns of your injury, they have the duty to provide you with a claim form within one working day as well as forward it to the claims administrator.

Meanwhile, they are supposed to authorize payment of up to $10,000 towards medical costs for your injury as the claim is in processing. Your employer may provide you with alternate or modified work during or after recovery.

When you are injured on the job, and your employer does not have an insurance policy in place, your employer is responsible for paying for all your medical bills. You can also file a civil lawsuit against the employer. The civil suit will help you obtain compensation from your employer's business or their liability insurance. You will most likely need a lawyer who understands the complicated nature of suing an uninsured employer. You will need to file the lawsuit against your employer for a work-related injury within three years of your injury. Failure to sue your employer within the statute of limitations will disqualify you from receiving any benefits.

You can also file a personal injury claim against your employer. In a personal injury claim, you are likely to get damages for pain, suffering and emotional distress. You will also be required to follow all the guidelines and requirements similar to those of personal injury lawsuits, which could delay your compensation for months or even years.

Alternatively, you can recover certain compensation from the Uninsured Employers’ Funds. The fund could help you recover medical bills and a portion of your lost wages resulting from the work-related injury.

If your employer ignores the requirement to provide a safe working environment, you or your co-workers can report to the OSHA and other bodies that deal with workplace safety. These bodies will inspect your workplace to identify whether there are hazards and the measures that are taken to eliminate these hazards. When you play the role of a whistleblower, the organization will keep your details from your employer. When you are injured because of the negligence of the employee, you can cite the inspection by OSHA to prove that the employer was negligent.

Reference to OSHA inspections is especially important where you are seeking compensation for a railroad injury. Railroad injuries require you to prove fault for the accident.

When you are an employee, you have several responsibilities in relation to workers compensation. These include:

• Working in a responsible manner that conforms to the set safety protocols. For instance, it is irresponsible to operate heavy machinery when intoxicated. When an injury occurs due to irresponsible behavior, you may forfeit your right to workers’ compensation

• Reporting the injury as soon as possible so that your employer can work on obtaining compensation

• Seeking medical attention soon after your injury, which increases the possibility of recovering your losses

• Cooperating with the insurance provider in providing the required documentation and requests

• Keeping and maintaining accurate records such as doctors’ reports and reports from the insurance carrier.

• Acting responsibly after the injury by following the doctor’s instruction to prevent re-injury or aggravation of the existing injury

When you are injured on the job, you are supposed to report the injury as soon as possible. Usually, you are supposed to inform your employer within thirty days and fill in a claim form. Reporting the injury or illness earlier gives your employer time to investigate the injury and removes the possibility of the denial of your claim.

Where you need medical treatment, you need to do so promptly. Ensure you inform your doctor all the signs and symptoms you are experiencing and that the injuries are related to your employment. Getting early medical treatment will also erase the doubt that you sustained the injuries from an activity that is not related to work.

Informing your doctor that the injury is work-related will enable him/her to provide evidence-based treatment as required by California law in treating work-related injuries.

Filling the claim form is important as it notifies your employer of your injury and entitles you to a treatment fee of up to $10,000 as you await feedback on your claim.

The process of filing a workers’ compensation claim begins as soon as you notify your employer of the injury. The doctor may provide you with a workers’ compensation form to fill out if they realize you sustained your injury from work-related activities. The doctor will submit the claim form to your employer who should forward it to the insurance company.

The process for filing a workers’ compensation claim can include the following steps:

• Notifying your employer of the injury or illness

• Completing a workers’ compensation claim form

• Filing the claim form with your employer

• Participating in any settlement negotiations

• Filing the claim with the Workers’ Compensation Appeals Board

• Deciding on whether to appeal or petition the decision

The results of the feedback you receive at the settlement negotiation will determine whether there will be a need for further action.

In a workers’ compensation claim, you can receive one or more of the five basic benefits. Most of these benefits aim at reimbursing you for the medical expenses you incur and the wages you lose as you recover from a work-related injury. The common benefits include:

• Medical Care: your employer will pay for the medical expenses you incur from the time of the injury until you recover. In most cases, you will be required to get treatment from a doctor or hospital designated by your employer. You will need to confirm with your employer to determine whether you can have your doctor treat you.

• In most cases, you will be required to get treatment from a doctor designated by your employer or claims administrator for the first thirty days, after which you can use your physician. The costs for medical care can also include the travel costs you incur to get treatment for your injury. To receive compensation for travel costs, you need to fill out the medical mileage expense form.

• Temporary Disability Benefits: these benefits are paid out when the injury prevents you from performing your normal tasks during recovery. Temporary disabilities are calculated based on your pay and cannot exceed the maximum limits or fall below the minimum limits set by the law. Temporary benefits begin when your doctor restricts you from performing all or certain normal duties at work for more than three days. Temporary benefits are not taxable.

• Permanent Disability Benefits: these are paid out if you can never fully recover from your injuries and cannot perform some or all of the tasks you previously performed.

• Supplemental Job Displacement Benefits: these are paid out to employees who require rehabilitation or retraining to resume work. They can be paid out when the job you receive from your employer is below the salary you earned before the injury. Usually, the supplemental job displacement benefits cover costs for education, books, tuition and rehabilitation in state-approved or accredited schools.

• Death Benefits: these are awarded to the surviving family of employees who die as a result of work-related injuries. They can be paid out to the spouse, children and any partial or total dependents of the deceased. Where there are minor children, the benefits are paid out until the youngest child reaches 18.

Unlike personal injury cases, you cannot receive non-economic damages for pain and suffering from a workers’ compensation.

The amount you get from workers’ compensation depends on the nature and extent of your injury, your ability to return to work and the medical bills you incur. You will receive temporary disability benefits weekly until you recover from your injuries or enter a permanent and stable condition. Usually, the payments do not exceed 2/3 of your pre-tax weekly wages.

When your condition reaches a permanent and stable condition, and you can never fully recover from the injury, you will continue receiving permanent disability benefits regularly.

Normally, temporary benefits are paid for a maximum of 2 years or 104 weeks from the date of your injury. You can get temporary disability benefits for up to 240 weeks if you suffered severe injuries or illness. Permanent disability benefits are paid 14 days from your last temporary disability benefit for a lifetime.

Normally, workers’ compensation pays for the medical expenses and lost income resulting from a work-related injury for most employees. However, if you are a railroad worker, you are entitled to workers’ compensation under the FELA claims. Pain and suffering in FELA workers’ compensation claims are paid out due to the increased dangers railroad employees are exposed to.

The claim administrator may deny your claim and any benefits you are entitled to after a work-related injury or illness. You will receive a denial letter detailing the reasons your claim was denied. The reasons that could result in the denial of your claim include:

• Failure to report the injury in time

• Your employer did not learn of the injury within 90 days of the injury

• You did not file the claim in time

• You did not obtain any medical treatment

• The claim adjuster believes your injury is not work-related

• You cannot prove that the illness such as a heart attack is related to your work

When this happens, you have the right to challenge the decision. You can appeal the decision by, first, talking to your employer and the insurance claim administrator. If that avenue fails, you can request a hearing with an administrative law judge through the labor department or the state workers’ compensation board.

During the hearing, bring along all the relevant documentation and evidence that proves you were injured at work. These documents could include all your medical records from the time of injury and the letters you received from the insurance company.

The hearing for the workers’ compensation involves presenting evidence and witnesses from both sides. The judge will then send you a written decision. You can petition for reconsideration if you are not happy with the judge’s decision.

After filing a petition for a reconsideration, the Workers' Compensation Appeals Board will examine the evidence and decide whether to approve or deny your petition. If your petition is declined, you can pursue the matter with the California Court of Appeal.

You can always return to work after you recover from your injury or during the recovery period.

Your employer may offer you modified or alternative work as you are recovering or after recovery. In other cases, your employer may retrain you to acquire new skills that will enable you to work within the limits of your injury.

The law does not mandate employers to re-employ you after an injury. However, most employers are willing to take you back if you can still handle certain work.

When you return to work, you are entitled to fair treatment. Discrimination or retaliation of any kind because you applied for workers’ compensation, or because of your injury is wrong and punishable.

In the ideal situation, your employer should willingly give you the right amount of compensation in case you are injured in a work-related accident. However, workers’ compensation claims can be a little complicated than that.

The insurance provider may not want to compensate you fully and may give you an initial offering. The offering may appear big and worthy at first, but when you compute the medical expenses, the extent of the injury and the time you take to recover, the settlement will soon lead you to financial strain.

Hiring a workers’ compensation attorney will help you avoid the pitfalls associated with these claims. An attorney who has handled similar cases will help you in collecting evidence, negotiating your claim and determining whether the claim you are awarded compensated you as per the requirements of the law.

In cases where the claim has been denied, a lawyer can help you file for adjudication and a petition which will enable you to get justice.

There are many issues related to workers compensation that you may fail to understand. For this reason, an attorney will help by explaining different concepts and the laws and guidelines for workers compensation.

If you are looking to hire a workers’ compensation attorney in Long Beach, CA, consult The Workers' Compensation Attorney Group. We are a team of lawyers with accumulated years of experience in successfully handling workers' compensation claims. Contact our Long Beach Workers Compensation Attorney at 714-716-5933 to schedule a free consultation with us.