Workers' compensation is a set of laws that details the benefits you are entitled to as an employee in case of a work-related injury and the specific procedures of claiming those benefits. Workers' Compensation Attorney serves clients working in and around Orange County, CA. Our attorneys have extensive experience in workers' Compensation and can assist you in filing your claim successfully.
California’s Law on Workers' Compensation
In California, your employer is legally required by Section 3351 and following sections, and Section 3700 of the California Code to take up insurance for your work-related illness or injury, either through self-insurance or a workers' compensation insurance policy. Your compensation claims and medical bills are handled by the claims administrator. Section 3751(b) of the California Labor Code makes it illegal for a medical facility or practitioner to bill you if they know your injuries are work-related. The benefits are capped by law and decrease progressively as you heal and begin to resume your duties at work.
Your injury will be covered by workers' compensation if you are an employee and if the injury resulted from your employment. However, these two factors are not always a guarantee for you to file for workers' compensation. If you work in a category of employees that is exempted, if the injury was self-inflicted, or as a result of intoxication, you may not claim workers' compensation.
Your employer must provide you with a claim form within a day of receiving a notice of injury. Additionally, your employer must authorize medical care while the claim is under investigation. While the claim is pending, the insurer is responsible for your medical bills up to a maximum of $10,000. Under Section 5402 of the California Labor Code, your claim is presumed approved if it is not rejected within 90 days after you submit the claim form.
Under the California Labor Code Section 132a, your employer is prohibited from retaliating against you for claiming workers' compensation. It is also unlawful for your employer to fire you after sustaining an injury or fire your co-workers for testifying in your claim case. If it happens, you should report to the nearest workers' compensation office. The California Fair Employment and Housing Act and the Americans with Disabilities Act protect you from discrimination by your employer if you suffer serious disability. The two acts prohibit your employer from denying you the work you want based on your disability if you are able to perform the duties with realistic accommodation.
If you are on temporary disability benefits, you are protected by law from being terminated or laid off. The only exception to this is if medical evidence shows that you cannot go back to your regular occupation or you must be replaced due to business necessity. The burden of proof is high on your employer and therefore, they may opt for a temporary employee instead of replacing you.
In California, there are statutes that limit workers' compensation claims. You can file a workers' compensation claim within one year of the injuries. However, this period can be extended in special circumstances. If you were below 18 years at the time of the injury, the one year period begins when you legally become an adult. If the injury resulted from repetitive stress, you can file a claim within one year of becoming aware of the injury. Additionally, if the original injury led to further injury, you can file a claim within five years from the date you were injured.
The Purpose of Workers' Compensation Law
Workers' compensation is an employer insurance plan that provides you with a quick and efficient way of receiving compensation for job-related injuries. Since you and your family can experience unexpected hardship caused by sudden loss of income, benefits from workers' compensation provide you with a way of paying bills and medical expenses during recovery. Workers' compensation is a no-fault process. This means that whether you or your employer caused the injury is irrelevant; if you were injured on the job, then you can claim workers' compensation benefits, except under some special circumstances. The system is a trade-off where you receive your benefits quickly through the workers' compensation plan, and your employer is protected from lawsuits.
Workers' compensation is a vital safeguard for you when you are injured on or as a result of your job. The laws governing workers' compensation are designed to provide you with fixed monetary awards if you are injured at work, without litigating your claim against your employer. The compensation laws also provide some protection to your employer and co-workers. They limit the amount you can recover from your employer and often prohibit you from suing your co-workers. You will be covered for your work-related injuries, regardless of who is to blame unless you can identify a third party who contributed to your injuries. Such third parties include manufacturers of machinery or products you use at work.
Generally, your employer will not be directly involved in your third-party claims. These claims are civil actions outside of the workers' compensation system. However, it is possible for your employer to recover compensation payments from the benefits you obtain from your civil lawsuit against third parties.
Workers' Compensation Process
Filing a claim for workers' compensation is a request for your benefits and not a lawsuit against your employer. It is similar to claiming for other forms of insurance benefits. If you are injured while working, you are eligible for workers' compensation benefits during your recuperation. There are definite procedures for establishing whether your illness or injury is eligible for compensation. Moreover, filing a proper claim follows certain procedures.
If you are injured and require emergency treatment, you must seek medical attention from your predesignated doctor or an authorized medical practitioner. If it is not an emergency, notify your employer immediately the injury occurs, before seeking medical attention. You must inform the attending physician of your symptoms and the job-related events that may have caused them. You must also describe your work environment and your job. Your doctor, also known as your primary treating physician, should be experienced in your type of illness or injuries.
You must give your employer a written and a signed notice of your injury within 30 days. If you fail to comply with this requirement, you risk losing your right to claim the benefits. If possible, retain a copy of the report for your personal records.
Your employer must provide you with a workers' compensation claim form within one working day of receiving the notice of injury. If your employer fails to provide you with the form, you can get one from an Information and Assistance Officer at the local workers' compensation office. Your employer is not obligated to provide you any benefits until the claim form is filed. Ensure that you fill out the claim form with a specific and complete description of your injuries. Include all your body parts affected by the injury, sign the ‘employee’ segment in the form, and keep a copy. Then submit the claim form to your employer by certified mail or in person. If you use mail, ensure you get a return receipt. Submit the form as soon as possible since a delay in filing the claim may cause delays in starting the benefits.
On receiving the claim form, your employer will complete and sign the ‘employer’ section of the form and is responsible for contacting the claims administrator. The claims administrator processes compensation claims on behalf of your employer. Your employer must send you a copy of the filled out and signed form within one working day after receiving your claim form. The claims administrator must determine whether to accept or deny your claim within a reasonable period of time. While your claim is pending, you may receive up to $10,000 for medical bills. Your injury is presumed to be covered if your claim is not denied within 90 days.
If your claim is approved, you will be eligible to receive payments for medical care and compensation for lost earnings.
If your claim is denied, the claim administrator will send you a written notice on the same. A claim denial occurs if the claim administrator believes that evidence of injury is insufficient, the injury is not work-related, or the injury is a result of another job. The claim may also be denied if you do not need medical care or if you can return to work.
You are entitled to challenge the decision and have a judge hear your case. You must observe the deadlines set for filing the requisite paperwork. You will be required to file an Application for Adjudication of Claim and attach essential documents, file a Declaration of Readiness to Proceed and notify your employer’s insurer. You must add a proof of service form in the notification. A mandatory settlement conference will be scheduled for your case. If your case is not concluded there, you will be required to prepare documentation detailing the disagreement, describing what will be presented at trial and names of witnesses who will be present. After the trial, if you disagree with the ruling, you can register a Petition for Reconsideration.
Who is Eligible for Workers' Compensation?
In California, your employer is required to take up workers' compensation insurance for workers who work in California regularly, even when the business headquarters are in a different state. Your employer can be legally self-insured or take up workers' compensation insurance from either the State Compensation Insurance Fund or a private insurer. Additionally, if you are a roofer, you must be insured even if you have no employees. California presumes you to be an employee so long as you work for an employer regardless of hours worked or being an independent contractor. Sometimes, it is possible to get a waiver for independent contractors.
There are, however, some categories of people not covered. They include deputy clerks and deputy sheriffs, anybody offering services in return for sustenance or aid, people officiating at amateur sports events, people employed as domestic employees by a parent, child or spouse, and volunteers in non-profit recreational camps or ski patrollers.
Injuries Covered by Workers' Compensation
Workers' compensation covers all injuries you may incur while performing duties on your employer’s behalf in both onsite and offsite locations. The injuries could result from a one-time event or from repeated exposure while working. Work-related injuries must be connected to your employment condition or requirement. They include pre-existing conditions accelerated or aggravated at the workplace such as back injuries from lifting heavy objects or falls. In addition, you may claim compensation if you contract respiratory ailments from exposure to toxins, or suffer burns from chemical use.
Other injuries include traffic accidents while on duty, injuries from repetitive motions, injuries during lunch hours, breaks and during work-sponsored events, injuries in company premises, and some psychological injuries sustained while on the job. In case alcohol was supplied at a work-related event, injuries may be regarded as work-related. If your employer is not properly insured and you sustain an injury, the Uninsured Employer’s Benefit Trust Fund will pay your compensation benefits, then recover the money from your employer.
There are some exemptions to injuries covered by workers' compensation. Injuries that you report after you receive a notice of termination, injuries caused by ‘acts of God’ and those sustained while running personal errands are not covered under workers' compensation. Self-inflicted injuries and injuries sustained while intoxicated are also not covered. If you were violating company policy or the law or were not on the job, compensation will be denied.
Benefits Receivable From Workers' Compensation
Workers' compensation benefits cover authorized, reasonable medical care necessary to treat or relieve the burden of job-related illness or injury. This includes doctor visits, hospital services, medical equipment, medicine, x-rays, lab tests, among others. Under some compensation plans, you may be required to visit the company physician for the first 30 days. Thereafter, you may submit a written request to choose your own doctor. However, it is possible to pre-designate your personal physician in writing, only if you have a health cover for medical conditions unrelated to work.
The compensation also covers temporary disability payments, as replacement income for wages lost during your recuperation. You are eligible for temporary disability benefits if your doctor says you cannot perform your normal work duties for over three days, if hospitalized overnight and if you cannot earn your usual income while recovering. Wage replacement is set at two-thirds of your average pre-tax wage for a maximum period of 104 weeks and is paid out at two-week intervals for the entire period of your eligibility. If you suffer some specific acute conditions, you could receive temporary disability benefits for up to 240 weeks within five years from the date you were injured. You cannot receive more than the weekly maximum or less than the weekly minimum set by law. The benefits are tax-free and are not subject to union fees or retirement fund contributions.
Once the doctor verifies your inability to work, you start receiving your temporary disability benefits from the claims administrator within 14 days. The claim administrator must also explain in writing how the benefits were calculated. If you return to work and receive wages equal to or higher than your usual income, the benefits will stop. However, if you still experience wage loss, you will continue to receive temporary partial disability benefits. When your temporary disability benefits end, the claims administrator must send you a letter within 14 days after your last payment. The letter should explain why the benefits are ending and detail all the payments you have received.
In case of delays in determining your eligibility for compensation, the claims administrator must send a delay letter explaining why you cannot receive the payments within 14 days, the information they need to determine your eligibility and when a conclusion will be made. Even after sending delay letters, if the claims administrator does not send you a letter of denial within 90 days after you filed a claim, your claim will often be considered approved.
If you suffered measurable, partial, permanent, or total mental, or physical impairment or restrictions, you are eligible to receive monetary compensation for your permanent disability. The total amount is spread over a specific number of weeks. For a permanent total disability, you are eligible for permanent disability benefits till death. The specific amount is determined based on the severity of your injuries or disability, occupation, age and income at the time the injury occurred.
If you are working for your employer at 85% of your wages at the time of the injury, or 100% from another job, a workers' compensation judge must approve your settlement before you receive the benefits. If you were on temporary disability, you should receive the first permanent disability payment within 14 days after the terminal temporary disability payment. If you were not receiving any benefits, the first permanent disability payment should be made within 14 days after the claims administrator is informed of your disability. Permanent disability benefits are paid every 14 days after the first payment. The payments end when you reach the maximum set by law or you receive a lump sum.
For both temporary disability and permanent disability benefits, the claim administrator must pay an additional 10 percent for any delayed payments. If the claim administrator cannot provide reasonable excuses for the delays, you could be awarded penalties of up to 25 percent of each late payment, up to a maximum of $10,000. This penalty is only applicable if you filed a claim form within the set timelines.
If your injury results in permanent partial disability or your employer does not offer you modified, substitute or regular work within 60 days after the claims administrator receives a Physician’s Voucher Report, workers' compensation will provide supplemental job displacement benefits. The benefits are in form of a voucher to cover skill enhancement, retraining or both. The voucher is offered by the claims administrator within 20 days after the expiry of the period your employer has to offer you regular, substitute, or modified work. The voucher is valued at $6000 regardless of the extent of your permanent disability. A maximum of $600 may be used for a vocational counselor or placement services by a licensed agency. $500 may be used for undocumented miscellaneous expenses and a maximum of $1000 on computer equipment.
Your skills will be evaluated and you will participate in choosing a public or any eligible training school and a new occupation. If there is a change in your work status while you are receiving workers' compensation benefits, you must notify your employer and insurer immediately. Failure to report can adversely affect your right to receive the benefits.
Workers' compensation also covers death benefits to your children, spouse and other dependents if you are killed on the job or die from a work-related illness. Death benefits cover reasonable burial costs up to a maximum of $10,000. The death benefits continue up to when the youngest minor dependent turns 18 years. Disabled minors receive benefits throughout their life, based on total temporary disability rates. Death benefits are computed based on the number of your dependents.
Workers' Compensation vs Civil Lawsuit – Which Path Should You Choose?
Workers' compensation substitutes for lawsuits against employers. In case of work-related injuries, you are automatically entitled to workers' compensation and your employer is equally protected from a lawsuit from you. You are entitled to the benefits regardless of who was at fault.
However, if your injuries are a result of your employer’s deliberate disregard for your safety, you may opt to file a lawsuit for an intentional tort in a civil court. If you are successful, you may regain a greater monetary award than from a workers' compensation claim. You may also be able to seek punitive damages, attorney’s fees, mental anguish, and pain and suffering. Intentional torts include assault, battery, fraud, false imprisonment, conversion, and trespass. Torts that involve emotional distress include defamation, invasion of privacy and intentionally inflicting emotional distress. Most importantly, you cannot file a lawsuit against your employer after filing for workers' compensation benefits.
Even after claiming your worker compensation benefits, it is possible to file a lawsuit against a third party if your injuries were caused by defective equipment or products at work, or by someone else who is not your employer. If you are successful, you may have to repay the worker compensation benefits you received to your employer or the insurance company. Alternatively, the insurer and your employer may be enjoined in the lawsuit to recover the benefits directly.
Consult a Workers' Compensation Attorney Near Me
The process of filing a claim for your workers' compensation may be lengthy and taxing especially if you are nursing injuries. At The Workers Compensation Attorney Group, we simplify the workers' Compensation process for the workers in the Orange, CA area. Call us at 888-888-8888 and we will file the claim on your behalf and ensure you receive your full benefits as soon as possible.