Workers Compensation

We always recommend that you report your injury immediately to your supervisor. If possible, written communication is best, so that we may have proof.  Should your employer fail to provide you with medical attention, we recommend that you immediately seek treatment with your primary care physician, urgent care, or the emergency room.  Please keep all receipts from your visits for reimbursement with the worker’s compensation insurance carrier.

We highly recommend that you report your injury immediately, and in writing if possible.  Often, when cases are not reported in a timely manner, the insurance company will deny your claim, leaving you with no medical treatment or benefits.

There are two types of injuries:
1) Specific injuries, where an employee injures him/herself from a specific incident. (Lifting a heavy box, falling, etc.)                   
2) Cumulative Trauma Injuries: injuries that develop over a period (Lifting heavy materials over a year long period, typing every day for a year, etc.) 

We recommend that you report the injury immediately after it happens or immediately when you have pain.  It is important to report the injury in writing, if possible.

There are two types of settlements available: 1) Compromise and Release and 2) Stipulations.  

A Compromise and Release is a lump sum settlement, which does not include open medical treatment.  Essentially, the one-time payment shall close the Worker’s Compensation case, and the insurance company ceases to have any liability for the injury. 

A Stipulations with Request for Award is an agreement to the percentage of Permanent Disability that an injured worker may have.  The percentage of disability has a monetary value determined by the State of California.  The value is then paid in bi-monthly installments until it is exhausted. However, unlike a Compromise and Release, this option leaves medical treatment open for the remainder of the injured worker’s life.

The biggest mistake that an injured worker can make is to assume that the insurance company is there to help you.  The harsh reality is that insurance companies are not, and they couldn’t care less about your injury.  It is imperative that you hire an attorney ASAP so that you can get the proper medical attention and monetary benefits that you are entitled to.  

Remember, the adjuster works for the insurance company, not you!

If you have sustained an injury, the insurance company is responsible for medical treatment, monetary benefits while you are unable to work, and monetary compensation for any permanent disability that you may have.  It is important that you have the right physicians for your case, as they will be determining several factors that impact the amount of money that you receive.

Attorneys will help you navigate the complex Worker’s Compensation system.  Attorney can assist you with the following critical tasks:

• Designating/locating the correct physician. Insurance companies will send you to a clinic, which will not provide any treatment other than pain medication.  Since the physician has a major role in determining the value of your case and whether your case is accepted or not, it is critical that you designate the right one.  Without firsthand knowledge of the insurance’s medical network, it is impossible to determine which physician is good for your case.
• Obtaining Monetary Benefits: Attorneys will assist you in ensuring that you are paid the monetary benefits while you are unable to work. Attorneys will review and monitor all medical reports to ensure that you are obtaining the proper treatment and benefits that you are entitled to.
• Obtaining a second or third opinion: Frequently, the medical reports for your case do not accurately detail the severity of your injury and/or disability. Attorneys are familiar with the medical guidelines that determine the severity of your injuries.  They can question the physicians on their opinion, request neutral medical evaluations, and even take the deposition of the physicians to ensure that the diagnoses you receive are accurate.
• Settlements and Trials: An attorney is well versed in the values of cases and can advise you as to what option is best suited for your goals.  Attorneys have extensive knowledge regarding the values of disabilities and medical treatments.  In the event the insurance company does not provide you with an acceptable offer, an attorney can set your case for trial. 

Attorney’s fees are 15% of all monetary compensation recovered.  If there is no monetary compensation, then the attorney does not receive a fee.  This ensures that we will fight for every penny that you are entitled to.

A deposition is an opportunity for the insurance attorney to gather information.  Generally, they will ask questions about your past, with an emphasis on prior injuries and/or jobs.  They will also ask background questions to verify the veracity of your answers. 

Do not be intimidated by the deposition, as you will have an attorney representing you at the deposition.  He/she will guide you as you go and instruct you when to answer and when not to answer.

Only cases that are accepted will receive Temporary Disability Benefits (monetary payments) from the insurance carrier.  If your case is denied, the only source for monetary payments while you are unable to work will be through EDD.  You may apply for State Disability Benefits through EDD if your doctor certifies you to be off work. 

An attorney can assist you in obtaining medical treatment if your case is denied, as most private insurance companies will not provide treatment once they learn that the injury was work related.  An attorney will gather the medical evidence necessary to litigate the denial of your case, and help you receive temporary disability benefits. 

The answer is dependent on the reason why your claim is denied.  There are many reasons why a claim may be denied, and each case is different.  Some reasons why your claim may be denied include the insurance company/employer claiming (1) you were not an actual employee; (2) you gave notice of your workers’ compensation injury only after your employment ended; (3) there is insufficient medical evidence to substantiate a claim; (4) your claim is barred by a statute of limitations; (5) your injury did not arise out of or in the course and scope of your employment, etc. We are sometimes able to request a hearing and go to trial on the issue of why your claim is denied asking the judge to determine whether or not your claim is compensable.  If a judge determines your case is compensable, you may be able to obtain benefits.

There must be medical evidence indicating you’re temporarily disabled for you to obtain Temporary Disability benefits.  In addition, most insurance companies will not pay temporary disability benefits if you are not treating with a doctor within the employer’s Medical Provider Network.  However, when an employer fails to provide medical treatment, leaving you to obtain treatment outside of the Medical Provider Network, TD benefits may still be obtained.

For cases that are accepted, the insurance companies will make it extremely difficult to obtain medical treatment.  Oftentimes, employers do not even respond to demands for basic information as to whom the workers’ compensation insurance carrier even is and many employers do not comply with the California requirement to register information regarding their workers’ compensation insurance carrier.  Once the insurance company is determined, we usually must demand information regarding their Medical Provider Network and where we can locate their list of doctors.  Once we have tried to locate a doctor, we are almost always unable to make an appointment without prior authorization from the insurance company.  Once authorization is obtained, an appointment is made. 

If your case is denied, an attorney can provide you with a doctor that will provide treatment on a lien basis.  Generally, private insurance companies will not provide you treatment once they learn that the injury is work related.  Therefore, it is critical that you obtain an attorney if your case is denied.

Just as it is difficult to even schedule an appointment with a physician, it is even more difficult to get treatment authorized.  We believe that approximately 90% of the requests for authorization for treatment, medication, etc., by the doctors are denied by the insurance companies.  If the request for authorization for treatment is denied and your claim is an accepted claim.  The issue can then go through the Independent Medical Review process to try to overturn the insurance company’s decision to deny the requested treatment. 

Should your Request for Authorization not be reviewed in a timely manner by the insurance company, an attorney can file for an Expedited Hearing to address the problem with a Judge.

When you are released to return to work by your Primary Treating Physician, Panel Qualified Medical Examiner, or Agreed Medical Examiner, you are usually provided with work restrictions, which take into consideration your injuries and the need to avoid reinjuring or causing further injuries. If your employer has available work within the work restrictions given to you, you should try to work with the work restrictions. 

Should your employer not offer you a job, you can be entitled to a Supplemental Job Displacement Voucher for retraining.  Hopefully, you’ll be able to find a job within your work restrictions.

Your employer should attempt to accommodate any work restrictions you may have and if they are unable to do so, you may qualify for a re-training voucher.  If your employer is not cooperating with you or you are terminated based on work accommodations needed, then our firm’s Employment Department may be able to assist further.

There is no set schedule that determines when your case is going to settle.  Moreover, offers to settle your case are controlled by the insurance companies.  Generally, a physician will declare you “permanent and stationary” prior to any offers being made, although that is not always the case.  However, there are many cases that settle prior to being released from care by a physician.  Attorneys can assist you in negotiating a settlement at any point in litigation. 

However, not every case will settle.  Some cases will proceed to trial for a judge to determine what you are to receive in your case.

It is difficult to estimate the value of a case during the early stages of the litigation.  Generally, the value of a case is determined by two things: 1) the Permanent Disability that results from the injury and 2) the future medical treatment that is needed.  These are determined by the physicians during your treatment.  Other factors that impact case value include: 1) monetary benefits owed for time off work, 2) non-industrial causes of disability (prior injuries, genetic factors, and/or injuries not related to work). 

However, as you continue to receive treatment, an attorney can give you an approximate value based on the current medical reports.

It depends on the needs in your case.  However, our attorneys spend most of their time out of the office fighting for our clients but have a support staff to assist them in answering your questions.  Our support staff is trained to answer many of the questions you have concerning your case and acts as a liaison between you and your attorney.  If your question cannot be answered at the time of your call, we will do our best to obtain the answer or resolution to the issue.  In addition, should your deposition be scheduled or any hearing in your case scheduled, you will have an attorney present with you.

Worker’s Compensation is designed to be a no cost system for injured workers.  Should you sustain a work injury, the Worker’s Compensation insurance carrier is liable for your treatment. However, many times, the injured worker pays out of pocket or has outstanding medical bills for emergency medical treatment that is needed.  An attorney will seek reimbursement for you.