FAQ: Workers' Compensation
- How do I get workers' compensation benefits?
- What's the difference between a Workers' Compensation claim and a Civil "third party" case?
- The insurance company is providing all benefits. Should I wait to hire an attorney?
- How long will the employer be responsible for my medical treatment?
- Can my employer terminate me while I am out on disability?
- What happens if my doctor releases me to light duty work but my employer refuses to offer light work?
- What types of settlement are available?
- What is the amount of attorney fees in workers' compensation claims?
- My doctor has declared my condition to be permanent and stationary. What does this mean?
California workers who are injured or become ill because of work have the right to receive workers' compensation benefits. Unfortunately, many workers find that they lose their rights, are denied the benefits that they are entitled to, or learn that they aren't getting all of their workers' compensation benefits.
As soon as a worker knows or suspects that they have a work related injury or illness, they should immediately report it to the employer. Within one day after the injury is reported, the employer must give the worker a claim form. Waiting to report an injury or illness can cause a delay or denial of workers' compensation benefits.
After the worker completes and turns in a claim form, if an injury causes temporary disability, the first payment of temporary disability indemnity shall be made not later than 14 days after knowledge of the injury and disability. In the case of a dispute, the employer has the right to investigate the claim. If the claim is not denied within 90 days from the date the claim is filed, the injury is presumed compensatable.
The injured or ill worker should never be off of work without a written off work order from the treating doctor. It is important that the doctor advises the employer of the worker's disability status.
A claim which is not filed until the worker has been notified that they are being terminated is not valid under California law unless it can be shown that, before the notice of termination, the injury had already been reported to the employer, or that there is evidence of the injury in the employee's prior medical records.
In California, the injured or ill worker has the right to representation by an attorney. A specialist in the field of workers' compensation law will guide a client through the maze of statutes and regulations that control the case. Consulting a workers' compensation attorney costs nothing. If an attorney takes the case, the fee will generally be 9-12% of any settlement or award at the end of the case.
Unfortunately, many injured workers wait until it is too late, or a crisis has occurred, before they consider hiring an attorney. The injured worker should consider the following facts:
- The insurance company's interests are not the same as those of the injured worker.
- The workers' compensation system is highly complex, with many procedural requirements and time limitations.
- The insurance company has attorneys who represent their interests regarding the extent of your workers' compensation benefits.
If an injured worker retains an attorney, there is no charge for the interview or for any services along the way. The attorney fee is 9-l2% of any settlement or award at the end of the case (the fee may be l5% in complex cases). If there is no settlement or award at the end of the case, there is no fee. Therefore, the fee will not be any higher if the attorney is retained at the beginning of the case.
Injured workers usually consider retaining an attorney if they feel they are at a disadvantage in dealing with the insurance company, or any time that benefits are being denied. An injured worker should also consider having an attorney when they are going to have a need for continuing or lifetime medical care, or if they are going to end up with a permanent disability.
If the injury was caused by the negligence of someone other than the employer or a co-employee, an injured worker should consult with an attorney as soon as possible following an injury. In that case, an injured worker may have the right to bring a personal injury action in addition to a workers' compensation claim. There are strict time guidelines in which a claim would have to be brought. Merely because a person is continuing to receive workers' compensation benefits does not mean that the statute of limitations against the negligent party does not run. As a result, it is extremely important that an attorney be consulted in those types of cases.
There is no time limitation on the provision of medical treatment. The employer or their insurance company is required to pay for medical treatment within certain guidelines to cure or relieve from the effects of the industrial injury. This treatment is required to be continued for as long as it is medically necessary. This can be for months, years, or even for the rest of the injured worker's life.
It is extremely important that the injured worker be treated by a physician who will be reporting for the injured worker rather than for the employer. If the injured worker does not know a suitable free choice physician, a workers' compensation attorney should be consulted for a list of suitable physicians in the appropriate medical specialty.
The law in California states that it is illegal to terminate or in any manner discriminate against a worker as a result of their industrial injury. If such conduct occurs, the employee may have their compensation increased by one half up to a maximum of $l0,000.00, plus costs up to $250.00, reinstatement on the job, and reimbursement for lost wages and work benefits.
Proceedings under Labor Code Section l32(a) for these benefits must be instituted by filing an appropriate petition with the Workers' Compensation Appeals Board within one year from the date of the discriminatory act or the date of the employee's termination. Failure to file the appropriate petition with the Workers' Compensation Appeals Board within the proper time period will most likely prevent an injured worker from pursuing such a claim. Not every act by an employer is found to violate Labor Code Section 132(a). There are several exceptions in which the employer's actions against the employee are not found to violate the law. For example, it has been found not to be discriminatory if the employer's conduct was necessitated by the realities of doing business.
The issue of whether an employer's actions constitute a violation of Labor Code 132(a) is a highly complex and technical legal issue.
Therefore, if an injured worker believes that they have been wrongfully terminated or discriminated against, they should consult with an attorney to be advised as to whether sufficient facts and evidence exists to successfully pursue such a claim.
What happens if my doctor releases me to light duty work but my employer refuses to offer light work?
Often a treating physician will release an employee to limited kinds of work before the healing period is over. If the employer does not provide work within the doctor's restrictions, the worker is considered to be temporarily disabled from their usual and customary occupation and disability payments will continue.
If the worker returns to modified work, but at less hours, or less pay than prior to the work injury, the worker may be entitled to temporary partial indemnity on a wage loss basis in addition to the worker's earnings during this period.
If the partially disabled employee refuses an offer of modified work, the refusal may be the basis for terminating payments of temporary disability indemnity.
If the doctor releases the injured worker to modified work on a permanent basis, then the employer must either provide work within the restrictions, or provide vocational rehabilitation benefits to assist the injured worker in finding other work in the labor market.
There are two ways to resolve a workers' compensation case.
The first type of settlement is called an Award. The Award differs from other types of legal settlements in that the insurance company may continue to be responsible for lifetime medical care to cure or relieve from the effects of the industrial injury. Therefore, this form of settlement is favored by injured workers who will need a significant amount of future medical care, and are concerned as to who will be responsible for the medical bills. In addition, the injured worker is entitled to a monetary award for any permanent disability they may have. The monetary award is payable weekly over a period of time. The greater the degree of disability, the longer the payments continue.
The second way to resolve a case is called a Compromise and Release. In this form of settlement, the injured worker receives a lump sum of money, but the case is over for good, and the injured worker is not entitled to any future medical care. There can only be a Compromise and Release if both the injured worker and the employer or insurance company agree to settle on a specified amount. If there is no agreement, then the injured worker is entitled to an award. In an award, the injured worker has the right to reopen the case for new and further disability within five years from the date of the award.
An experienced workers' compensation attorney can advise an injured worker as to which form of settlement is appropriate under the circumstances. In the case of an Award, the attorney works to make certain that the injured workers' access to appropriate future medical treatment is preserved, as well as obtaining a monetary award. In the case of a Compromise and Release, the attorney negotiates the highest settlement amount possible.
There is no charge for the initial consultation in a workers' compensation claim. Attorney fees are payable on a "contingency basis." This means that if there is no recovery there is no fee. The attorney receives a percentage of the settlement or award at the end of the case. If a person chooses to be represented by an attorney, the attorney fees will be deducted from the settlement at the end. Attorney fees normally range from 9-l2% of the benefits awarded. The actual amount of the attorney fee will depend upon the complexity of the case. In complex cases, the fee may be l5%. The fee has to be approved by the Workers' Compensation Appeals Board.
If the attorney also represents the worker before the vocational rehabilitation unit, there may also be a fee in connection with this representation. In that case, the employer or insurance company generally withholds l2-l5% of the vocational rehabilitation maintenance benefit as attorney fees. At the conclusion of the rehabilitation process, the Workers' Compensation Appeals Board judge determines whether the attorney receives all, part, or none of the monies withheld.
There are no other fees or costs charged. If the injured worker makes a complete recovery, and therefore receives no settlement or award, there is no charge for the attorney's services.
Permanent disability is that degree of disability or impairment that remains after the employee has reached the point of maximum healing. A permanent disability may be partial or total. If a person suffers a permanent partial disability, the person is entitled to a permanent disability rating and award even though he or she may be able to return to work.
Permanent disability ratings are provided under the law in the form of money payments, the amount of which depends on a number of things, including the injured's age, occupation, the part of the body injured, and the extent of the disability. The rating can range from l% to l00% depending on how the permanent disability affects the injured worker's ability to compete in the open labor market. A total disability for any type of work carries a l00% rating. Some of the more obvious examples of total disability would be the loss of both arms, both legs, or the lost of sight of both eyes.
The weekly rate at which permanent disability payments are made varies, depending on the date of the injury, and the extent of the permanent disability. A person who is permanently totally disabled with a rating of l00% is entitled to receive their temporary disability rate for life.
For permanent partial disabilities that occur between July 1, 1996 and December 31, 2002, the injured worker is entitled to receive payments up to a maximum of $140.00, $160.00, $170.00, or $230.00 depending upon the percentage of disability. For injuries that occur in 2003, the maximum benefit is payable at either $185.00 or $230.00 per week, for injuries in 2004 the maximums are $200.00 or $250.00, and in 2005 the maximums are $220.00 and $270.00 depending upon the percentage of disability. The number of weeks of payments are determined by the percentage loss of the injured workers working capacity. The greater the disability, the longer the payments are made. For permanent disability of 70% or more, in addition to the normal payments, the person is entitled to a small life pension.
Payments for permanent disability are payable in addition to any payments that the injured worker may receive for temporary disability, and are over and above the cost of medical care. These payments are made after the injury becomes permanent and stationary, or the last date of payment for temporary disability.
Substantial problems may occur in determining the amount of permanent partial disability payable to the injured worker where there is a pre-existing disease or impairment to the same part of the body which has been injured. Disputes often arise regarding how much of the disability is due to the injury, and how much is due to the pre-existing condition.
In early 2004, much of the state's Workers' Compensation law, especially with respect to permanent disability benefits, was changed in a large set of laws pushed through the state legislature by then new Governor Schwarzenegger. The interpretation and application of these laws continues today. RKM Workers' Compensation lawyers continue to study and advocate ways in which injured workers can still receive the benefits due them, even under the new law.
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