Understanding the benefits you can seek after sustaining an occupational injury is the first step to your recovery. You may receive workers’ compensation and FMLA (Family and Medical Leave Act) benefits at the course of your recovery. Our work at The Workers Compensation Attorney Group (Orange County), a law firm based in Orange County, LA, is to help you recover losses incurred from a work-related injury. In this guide, we discuss ways in which workers’ compensation and FMLA benefits differ from each other.

What are FMLA Benefits?

The Family and Medical Leave Act (FMLA) entitles a specific group of employees to unpaid, secure leave every year. The leave lasts up to 12 weeks allowing workers to balance their family and work responsibilities when faced with medical or family issues. FMLA aims at accommodating employers’ legitimate interests and promoting equal job opportunities for all genders. The act only applies to employees of private and public schools (elementary and secondary ones), companies with 50 workers or higher and public agencies.

Laws and Regulations on FMLA

The FMLA, which was enacted on 5th February 1993, falls under Title 29 of the federal labor laws. This regulation emphasizes the development of high performing organizations and the needs of employees in the US. FMLA was passed into law based on the fact that the American workforce has elderly individuals or children who depend on them. The law makes it easy for workers to attend to medical or family emergencies without having to worry about losing their jobs.

Both employees and their respective employers are expected to benefit from the FMLA because stability in the family correlates to workplace productivity. Workers manage to fully commit to their occupations if the conditions at their workplaces allow them to exercise their rights. Family and medical leave help guarantee the stability of workplace relationships when employees are meeting serious health obligations outside work.

What are Workers' Compensation Benefits?

The workers’ compensation system in California requires your employer to pay for benefits if you experience a work-related sickness or injury. Ways you can sustain an occupational injury include getting burns from chemical splashes or hurting your shoulder from performing the same work over and over. Once you sustain a job injury, you have to report it to your employer through your supervisor. Obtain a claim form from your employer or download one from the DWC website and fill it to begin the compensation case.

A workers’ compensation award may include temporary disability benefits and permanent disability benefits. Temporary disability benefits are paid to you if an injury temporarily stops you from performing your job duties. Permanent disability ones, on the other hand, help you recover losses from an occupational injury resulting in permanent disability or reduced earning capacity. Other benefits include supplemental job displacement benefits, death benefits, and medical care.

Laws Regarding Workers’ Compensation in California

Division 4 of the California Labor Codes highlights all the dynamics associated with workers’ compensation and insurance in California. Under these laws, employers must purchase workers’ compensation insurance to help speed the compensation process in case their employees are hurt at work. Besides issuing you a claim form, your employer must authorize a maximum of $10,000 for your medical treatment. You may also seek light work while recovering from an occupational sickness or injury.

An employer is not supposed to ask you to pay for workers’ compensation insurance. You should expect to see a poster at your workplace confirming workers’ compensation coverage for the employees. If your employer is uninsured and you were hurt at work, the UEBTF (Uninsured Employers’ Benefit Trust Fund) will require you to file a claim for an award of benefits. UEBT can use approaches such as filing liens on your employer’s property to reimburse your losses.

Eligibility Requirements for Workers’ Compensation and FMLA Benefits

Workers’ compensation and FMLA benefits have different eligibility requirements. Understanding these requirements can make it less daunting for you to navigate through the systems for recovering the benefits. Discussed below are the conditions you must meet for each award:

Eligibility Requirements for Workers’ Compensation Benefits

The first requirement is for you to be an employee (with an occupational sickness or injury) working for an employer with workers’ compensation insurance. You must also observe California’s statute of limitations for filing injury claims. If your occupation categorizes you as an independent contractor (such as a consultant or freelancer), you are ineligible for workers’ compensation. Your injury or sickness may qualify as a work-related one if it was caused by hazardous conditions or an accident at the workplace.

The time limits for pursuing an injury claim in California is two years. You will be barred from recovering any benefits once this two-year period passes. The California Division for Workers Compensation also limits the kinds of treatment you can receive. The DWC limits the treatments to 24 occupational therapy visits, 24 physical therapy visits and 24 chiropractic visits.

Eligibility Requirements for FMLA Benefits

Potential FMLA beneficiaries are supposed to meet the following conditions:

  • Work for an employer with an insurance policy on workers' compensation
  • Be part of a company with 50 or more workers within 75 miles
  • Have at least 1,250 working hours on your log 12 months before beginning the leave
  • Work for the employer for at least 12 months (not in any particular order)

Only the time spent working for the employer counts in the 1,250 hours. Taking time off for a vacation or taking sick leave will not count towards this number. If you are a service member with a severe illness or injury, the FMLA allows you to take leave (of up to 26 weeks) only in a one-year period. Your employer must grant you FMLA benefits for one or more of the reasons outlined below:

  • Adopting a child and taking time to bond with the child
  • Taking medical leave when a serious health condition deems you unable to work
  • Delivering a child or taking time to bond with your newborn child
  • Taking care of an immediate family member (parent, child or spouse) suffering from a severe health condition
  • Having your son, daughter, spouse or parent called to attend an active duty in the Regular Armed Forces, Reserves and the National Guard

Do You Have to Prove an Injury or Illness to Recover FMLA and Workers’ Compensation Benefits?

The awards for workers' compensation and FMLA benefits rely on the proof presented to support the emergency, injury or sickness you are experiencing. Systems for recovering both benefits are governed by transparency and accountability. Any false information provided may attract negative consequences to your life and career.

Proving a Severe Health Condition to Receive Family and Medical Leave

Your employer expects you to present a document issued by a licensed health care provider before seeking leave for a severe health condition. You will be allowed at least fifteen days to consult with a health care provider to acquire the medical certification. If the information provided is insufficient, the employer may make you get a second or third expert medical opinion. Your employer will cover the charges for seeking this service.

Besides asking for a second expert opinion, the employer can contact your current health care provider to inquire about your condition. Health care providers must cooperate when approached or clarification or authentication of the health status of a worker or their immediate family member. A human resource representative from your workplace can verify this information on behalf of your employer.

Demonstrating an Occupational Injury or Illness to Recover Workers’ Compensation Benefits

For injuries or illnesses to be considered as occupational ones, they must be limited to those caused by accidents or other people's negligence at workplaces. You cannot base a workers' compensation claim on an injury or sickness you got when attending a non-work-related event or entertaining friends at home. You have to precisely list the equipment, individual or work conditions that exposed you to harm.

Doctors working under the workers' compensation system in California must offer evidence-based medical treatment to injury victims. You will need their help to fight injuries or illnesses gotten from your workplace. The doctors must prepare documents showing the treatments needed for your injuries, the extent of pursuing the treatment and duration for recovery. The same transparency and accountability involved in treating injury victims should be adopted when injury victims are being diagnosed for their ailments.

Who Facilitates the Claim for Workers’ Compensation and FMLA Benefits?

An administrative law judge is usually appointed to resolve a workers’ compensation claim. Consequently, your employer is the key player in facilitating your family and medical leave. The processes for recovering these benefits begin when you submit your claim/request to the relevant facilitators as discussed below:

Who’s in Charge of Resolving Your Workers’ Compensation Claim?

Expect an award or settlement for benefits once the amount of damages has been determined. Awards for the damages usually take place in an administrative court while settlements are offered out of court. In each case, an administrative law judge will review the award or settlement agreement. If you suffered permanent disability from an occupational accident, you will receive payments for the injury before the judge decides on the amount of permanent disability benefits.

Your attending doctor, managers representing your employer and the claims administrator will determine your ability to return to the workplace. The administrator and employer need to know the kind of work you were handling before getting injured. You can also discuss the kinds of jobs you can do as you recover from the ailment.

Who Facilitates Family and Medical Leave?

Since your employer is the key facilitator of the leave, you have to offer them a 30-day notice in advance when you identify the need of taking the leave. The employer should promptly respond if they want to give you the leave in a 30-day advance period. If your need for taking the break was not foreseeable, your employer should explain why your request was denied. Your duty is to give as much information as possible to convince your employer regarding your need.

You are supposed to observe the call-in procedures governing your workplace. The employer may deny or delay your leave request if you disobey these rules. You may also have to face hefty disciplinary measures. Taking an unforeseeable leave without permission may make you get suspended from your job for not giving appropriate notice.

What are Your Rights When Requesting or Taking Family and Medical Leave?

Meeting the eligibility requirements is a gateway to accessing FMLA benefits. However, your employer may violate your rights in various ways when requesting or taking leave. One of them is the right to take time off work to take care of yourself or your immediate family members. Others are discussed below in detail:

  1. The Right to Paid Leave

Your employer should pay you during your leave if the company's policy allows for paid family and medical leave. You may even use the money accrue from a recently paid leave to find your family and medical leave. Companies have different regulations on paid leave. Try understanding those used at your workplace to determine whether they can work in your favor.

  1. The Right Not to Perform Employment Duties

Peace of mind is among the things you require during a family and medical leave. You may find it annoying if your employer expects or asks you to work at this time. The employer may even ask you to read or respond to work emails remotely. Regardless of the intensity of the job duties, you have the right not to work while on a family and medical leave.

  1. Access to Continued Health Insurance

If you are covered by a group health insurance policy paid by your employer, you have the right to continually access the coverage while taking a family and medical leave. Your employer must also pay the same amount of premiums paid while you were at work. However, you will have to reimburse the employer the premiums paid during the leave if you choose not to resume work. You may be excused from paying the premiums if your reason for not returning to work is based on a severe health condition or uncontrollable circumstances.

  1. The Right to Reinstatement

Once you complete your leave, you have the right to be reinstated in the same job position you were holding or an equivalent one. The equivalent job position should offer you the same worksite, schedule, shift, duties, benefits and pay as the previous one. Your employer must facilitate the reinstatement as soon as you report to the office unless the return date was extended. If you decide to report in a later date, your employer must have you reinstated two business days after you notify them about your return date.

What are Your Rights When Pursuing a Workers’ Compensation Claim?

One way to have your legal rights protected in a workers' compensation process is reporting the injury or illness to the employer. Your workers' compensation attorney can also advise you on your specific rights as a plaintiff. Filing the injury claim with a relevant court can also help safeguard your rights. After filing your claim, various automatic protections come to play. They are as follows:

  • Right to filing a claim for an illness or injury in a state industrial court or workers’ compensation court
  • Entitlement to seeing a doctor and pursuing medical treatment
  • Right to a suitable type of disability benefits when temporarily or permanently injured
  • Freedom to return to your workplace and resume work after a licensed physician discharges you
  • Right to legal representation throughout the process
  • Freedom to appeal any disagreements between you and your employer or you and the employer’s insurer

While your employer may try to persuade you against making a claim, it is your right to refuse the offer. You are entitled to pursuing the case without fear of harassment or reprisal from any party including the employer. You can take additional legal action against your supervisor or manager who tries to harass you for seeking compensation for your losses.

Can You Exercise Your Rights When Taking Legal Action Against Third Parties?

An occupational injury or sickness may be triggered by the negligence of a party rather than your employer. The third party may be a manufacturer or designer of a defective product (especially if your injury was caused by design or manufacturing defects in a product). You can pursue a claim against the entity or individual in a civil court to recover compensatory damages.

You also have the right to recover additional personal injury damages for a work-related sickness or injury. You may recover these damages if they are not retrievable in a workers' compensation case. They may include reimbursement for lost wages and medical expenses. You can also ask for non-economical damages to compensate your anguish, pain and suffering and emotional distress at the time you were injured.

When is Legal Help Necessary When Seeking Workers' Compensation and FMLA Benefits?

The process of recovering FMLA benefits involves agreements being made and requests being honored. The same applies to the process of making a workers' compensation claim. Legal help will be necessary for both occasions when one party (preferably the employer) fails to honor the other party's request. Here is how to differentiate the legal processes involved in these two scenarios:

When to Talk to a Lawyer for a Family and Medical Leave Matter

Your employer granting family and medical leave does not prevent various legal issues from arising during your leave. At times, you or your immediate family member may need additional time to recover from a health condition. In this case, you will have to ask the employer to give you more time on the leave. An attorney can frame the request letter and gather supportive documents on your behalf.

A lawyer can advise you on the suitable courses of action to take if your employer is pressuring you to work during your leave period. With this kind of legal help, you can engage your employer in scheduling an appropriate date for the family and medical leave. Legal help also comes handy when your employer fires you or takes illegal actions against you for taking or requesting leave. Working with an attorney can help you understand the laws against discrimination or wrongful termination in California.

When to Talk to a Lawyer for a Workers’ Compensation Matter

Since having workers’ compensation insurance is a requirement for employers, their insurers are usually involved in the compensation process. Consider hiring a reputable and skilled lawyer if you are disputing with the insurer. A workers’ compensation attorney can help you request independent medical exams and take depositions to be used as evidence. The lawyer will also oversee the hiring of expert witnesses to strengthen your injury claim.

While it is possible for an insurance company to deny your claim, your best hope is a workers' compensation lawyer. The company may challenge your claim by linking your injury or sickness to a non-work-related event. Your attorney can help you appeal the denial through California's workers' compensation system. The appeal process will require technical procedures such as filing of formal paperwork, gathering evidence and presenting your claim at a specific hearing.

You need a lawyer's help when you want to maximize the compensatory damages, or you are experiencing difficulties accessing treatment. If you are a beneficiary of Social Security Disability Insurance (SSDI), your workers' compensation benefits may be reduced. Your attorney can help you determine the amount of SSDI benefits you want to be reduced instead of the workers' compensation ones.

Have Your Injury Claim Pursued by a Workers’ Compensation Attorney Near Me

Workers may qualify for family and medical leave as well as workers' compensation benefits at various times in their careers. Our law firm, The Workers Compensation Attorney Group helps those who find the legal systems for requesting these benefits complex to navigate. We are located in Orange County, CA and our legal services are available to any persons who have experienced a workplace injury. Call our Orange County workers compensation attorney at 562-485-9694 for expert consultation on inquiries related to the workers' compensation system in California.