*FAQ applies only to California Workes Compensation Law
*All cases are unique and no results are guaranteed
I work as a secretary and I haven't had any injury that I remember but my wrists have hurt me for the last few months and have progressed to the point where I need to see a doctor, is this covered by Workers' Compensation?
Absolutely. The type of injury you have is called a cumulative trauma and is just as recognized and covered in the Workers' compensation system as if you were injured in a specific injury. Many jobs such as secretaries, receptionists, or anyone who uses a computer regularly develop repetitive wrist injuries such as carpal tunnel syndrome or elbow problems. Construction workers, engineers, and factory workers develop pain in their back, knees, shoulders, and hips over the course of their career. When these injuries finally force you to seek medical treatment and cause you disability then you have a valid Workers' compensation claim and should file for the benefits your years of toil have earned you.
This is common concern before filing a Workers' Compensation claim. If your injury is admitted by the insurance carrier, they will pay for your medical treatment as your claim progresses. If they ever wrongfully deny medical treatment that your doctor indicates you require, we fight that denial at the Workers' Compensation Appeals Board and attempt to get a Judge to order the medical treatment you require. If your case has been denied by the insurance carrier, their are still many doctor's who may be willing to treat you while we prepare to take your case to trial and fight for your benefits. If a doctor does agree to treat you and wait for the hearing, should you lose your case they cannot come after you for payment of their outstanding balance.
Truthfully, many insurance companies will deny your claim in the hopes that once denied you will go away and not bother them anymore. This is why getting an attorney who knows the Workers' Compensation system is so important. If your case is denied, you have a limited time to act to file an Application for Adjudication of Claim with the Workers' Compensation Appeals Board. Even if you are provided treatment, chances are your insurance company is doing what they can to provide you with less then you're entitled to by law.
This is illegal under Labor Code Section 132(a) and a violation of public policy which could open up the employer to increased damages in the Workers' Compensation forum as well as a separate civil action. Most employers have insurance to pay for claims and as such are not financially vested in whether you receive benefits owed to you under the law. Regardless of this fact, some employers may discriminate against you under the table but the majority of fair and reasonable employers understand the realities of Workers' Compensation injuries.
If you have been injured and cannot work while you obtain medical treatment for your injuries you are entitled to Temporary Disability which is paid at 66% of your current salary which is subject to a statutory maximum. You are entitled to Temporary Disability until you are Permanent & Stationary and able to return to some kind of employment. On some cases, there is also a statutory time limit on the length of time you can collect Temporary Disability. If you are found to be unable to return to any kind of gainful employment due to your work related injuries you may be entitled to Temporary Disability for life.
Permanent & Stationary is how the law defines your medical condition when your permanent condition has become as good as it is going to with current medical science or your willingness to proceed with treatment. Once Permanent & Stationary, your doctor rates your permanent disability condition and that rating is worth a certain amount of money. If you are not satisfied with that rating, you have the right to have another doctor rate your disability to obtain their opinion. Being Permanent & Stationary does not mean that you no longer require and are no longer entitled to medical care, it only means that the medical care you require is not expected to increase your overall permanent condition.
Once you are found to be Permanent & Stationary and had your disability rated, your disability rating has a monetary equivalent which is based upon a number of factors including your date of injury, age, occupation, and part of the body injured. Once calculated, you are paid Permanent Disability weekly until you've reached the maximum amount of Permanent Disability owed under your claim. Many insurance companies will attempt to have injured Workers' who represent themselves sign a stipulation for Permanent Disability below the real value of your claim. Although Workers' Compensation judges approve all settlements, they judge settlements based on what is "adequate" and not necessarily what the real value of your case is. It is for this reason that I cannot recommend an attorney highly enough.
I am receiving Permanent Disability payments weekly but it isn't really enough money to make a difference in my life, is there any way I can obtain a lump sum settlement of the remainder of Permanent Disability owed to me?
There are two ways to obtain this. First, if you are willing to settle out your right to future medical care you can enter into a type of settlement called a Compromise & Release. A Compromise & Release is the type of settlement insurance companies prefer because it allows them to close your claim forever. You settle out any and all benefits owed to you by the insurance company. Because you are doing this, you can obtain cash up front for the value of your Permanent Disability plus the value of your future medical care. The more medical treatment you require for your injury the more value an insurance company will provide to buy out that medical care. Provided you have an alternate source to pay for your health care such as health insurance, this can be a good option.
The other option you have is to request an advance of your Permanent Disability. This is entirely within the discretion of the Workers' Compensation Judge to grant based upon a number of factors. If you require this, you should contact an attorney.
If I believe I require medical treatment as a result of a work injury or from repetitive stress I incur at work, what should be my first step?
Call an attorney and make an appointment. Your Workers' compensation claim can be won or lost from the first paper you file. It is imperative you obtain professional knowledgeable advice immediately so you and your attorney can plan the best possible course of action for filing your claim. Of course, we would love for you to call us but even if you choose to go a different route we highly recommend you contact an attorney as soon as possible.
Call an attorney immediately. You have a limited time to file an Application for Adjudication of claim with the Workers' Compensation Appeals Board. Many insurance companies deny injuries as a matter of course. Do not give up on benefits owed to you because an insurance adjustor wants to save money for her company. Many denied claims are found to be compensible by Workers' Compensation Judges.
I am intimidated by the legal system and don't want to be in a long protracted fight just to get medical treatment and disability benefits which are owed to me, is it worth it for me to contact an attorney?
The Workers' Compensation system is an administrative system designed to be informal and friendly to injured Workers'. You don't need to feel intimidated about coming to the board for your hearing. There are no juries, no big courtrooms, and no observers. The only people present are those directly interested in your case where we tell your story to the Judge. After reviewing the medical records and listening to your story, the Judge decides if your injury is work related. While the process can be time consuming to develop the medical record and complete your treatment, you should not pass on the enormous benefits available to you out of fear.
Of course you can and many injured Workers' do, but after 10 years of experience I wouldn't recommend it. I've participated in this system from both the injured Workers' and insurance company side and in my experience the majority of injured Workers' will do far better if they have an attorney representing them. While informal, the system has evolved considerably since it was enacted in California in 1913 by the Boynton act. Only someone who spends their career practicing in the field, studying the case law, and keeping track of the constantly changing statutes provides you with the best opportunity to succeed in winning your case. In my opinion, in most cases, the additional money you will obtain by having an attorney represent your interests more then makes up for the cost of the attorneys fees which get deducted from your portion of the settlement, but of course each case is individual and will be judged on its own merits.
Hiring a Workers' compensation attorney shouldn't cost you a penny up front. The current standard rate to hire an attorney is 18% of your Permanent Disability benefits. Should the insurance company deny your claim for Temporary Disability and we need to fight to obtain them, a judge may also award 18% of those benefits as attorneys fees. Additionally, should we need to pursue penalties against the insurance companies for failure to provide benefits to you in a timely manner a separate attorney fee can be award by the Judge to be paid by the insurance carrier, which is separate and distinct from any penalty you may be awarded. In some instances, 18% of any penalty payment received could also be awarded as an Attorney fee. All Workers' Compensation Attorneys fees must be approved by a Judge. Each attorney will have an individual retainer agreement, so please read the one you sign carefully. Most attorneys fees will be paid when you get paid the benefit we have fought to obtain for you.
I already have an Award which includes future medical care and the insurance company refuses to provide me any additional care. Can an attorney help me?
I don't know if they all can, but we certainly will. An Award which includes Future Medical Care is for life and only if the defendant's can show that your need for treatment is not related to your work injury should your treatment be denied. Again in this situation, you will not owe any attorneys fees until your case is resolved and in these circumstances your attorneys fees could be paid separately by the insurance carrier. Additionally, should your permanent disability condition have worsened since the time of your Award, we may be able to reopen your claim and obtain additional Temporary Disability or Permanent Disability. There is a limited amount of time in which your claim can be reopened so if you believe your condition has worsened, it is imperative you contact an attorney immediately.
Workers' compensation fraud laws make it a felony for anyone to file a false or fraudulent statement or to submit a false report or any other document for the purpose of obtaining or denying workers' compensation benefits. Anyone caught performing these illegal acts will be prosecuted. If convicted, the person can face up to 5 years in prison and/or up to a $150,000 fine.