FAQ

In some instances, it is perfectly okay to choose self-representation over hiring an attorney. For example, you could represent yourself if you have only suffered minor injuries that can heal entirely in days or a few weeks. Moreover, it is unlikely that an insurance company will dispute a claim that:

• Is caused by indisputably work-related injuries
• Is affordable to treat and doesn’t require extensive or intensive medical care
• Doesn’t require you to spend long periods off work
• Doesn’t cause permanent damage or injuries

Example:

If the weekend storm causes crack formation on the parking lot pavement and you accidentally sprain your ankle as you enter the office, this kind of accident will neither require extensive treatment nor extended periods off work. This is more so if your doctor only recommends ice therapy and a few days of bed rest.

In such a scenario, your employer and the involved insurance company are likely to be happy to cooperate and ensure you obtain compensation quickly and swiftly.

In some cases, you don’t just need the best workers’ compensation lawyer in Los Angeles, but you can benefit significantly from one. It remains imperative to lawyer up if:

Your Claim Isn’t Straightforward

Sometimes, it isn’t easy to establish whether injuries are work-related or not. This often creates grounds for insurance companies to deny claims. If your employer or insurance disputes your claim, it is best to hire a skilled attorney to represent you. The expert will help you gather evidence to challenge the argument of the insurance company. A workers' compensation attorney can gather proof to strengthen your claim by:

• Taking witness statements (depositions)
• Scheduling for an IME (Independent Medical Examination)
• Hiring expert witnesses

A Disputed Permanent Disability Rating

Permanent disability benefits are awarded based on the permanent disability rating assigned by the doctor treating an injured victim. Again, it is not uncommon for insurance companies to dispute the assigned rating. When this happens, the insurance company will insist on scheduling an independent medical examination for you, and the outcome is often a lower disability rating.

In such a case, you need a Los Angeles workers’ compensation attorney to help you convince the judge that your injuries warrant a higher injury rating. Without proper legal representation, you are likely to be left holding the short end of the stick.

A Preexisting Condition Heightens Your Injuries

Of course, the insurance company will point out pre-existing injuries or conditions on the body part that has suffered a work-related injury. You can expect them to blame the injury on the preexisting condition and even claim that you would not be injured if it were not for the concern in question. Such disputes are almost guaranteed to arise, especially if the claim involves an injury that developed gradually and not during one work-related incident.

Your Injuries Require Extensive or Intensive Medical Treatment

Serious injuries that require intensive or extensive medical treatment may also lead to:

• A need for expensive medical care (perhaps on-going treatment)
• Long periods off work (significant loss of wages)
• Possibility of having to change careers

In this case, the insurance company has to provide significant compensation. As expected, it is likely to deny your claim or delay approving it. You require an attorney who can make the necessary follow-ups on your behalf to ensure you receive compensation in a timely fashion. An ideal lawyer will also affirm that your workers’ compensation is equivalent to the extent and scale of your injuries.

The Insurance Company Denies Your Claim

If you choose to represent yourself when filing a claim and lose or the insurance company offers an unfair settlement, you can always file an appeal. The courts will schedule a workers’ comp hearing where you will need to prove your case. Think of this hearing like a mini-trial where your best chance of enjoying a suitable outcome is to have a proficient Los Angeles workers’ compensation attorney in your corner.

An on-the-job injury can leave you in more than just physical pain. You are also doomed to suffer financially because of the unexpected medical bills, not to mention that serious injuries can force you to stop working as you recuperate. Whether an accident just happened or someone else caused it, securing workers’ compensation can cushion you as you get back on your feet.

One of the most significant benefits of hiring a workers' compensation lawyer in Los Angeles is that the expert can make the difference between filing a successful claim and failing to secure the benefits you deserve. An ideal attorney can:

Increase Your Chances of Reigniting a Denied Claim Successfully

Obtaining workers' compensation is not always easy. Sometimes, insurers will review your case and look you straight in the eye while denying it or delaying approval. This is a bitter reality that makes it essential to seek a skilled and seasoned lawyer’s expertise.

The know-how of lawyers allows them to build a solid case that leaves insurers with no choice but to bend and provide fair compensation. Apart from gathering viable evidence about your injuries and treatment, the expert will also record depositions from coworkers and medical experts.

Improved Negotiations with Insurers

Insurance companies are in business. The lesser their compensation payouts, the better. One major challenge with self-representation is that insurance companies will always take advantage of your lack of knowledge in certain routine maneuvers.

Workers' compensation lawyers understand common arm-twisting tactics used by insurance companies. The professional also understands the challenges injured victims go through when they fail to secure reasonable compensation. That said, you have better chances of obtaining a favorable settlement if you hire an attorney who can’t cave in to pressure thanks to his or her understanding of what the law says you are entitled to receive.

Improve Your Winning Chances in Highly Complex Claims

Some cases have numerous complexities that make it worthwhile to secure the services of a lawyer. For instance, if your on-the-job injuries were caused by the negligence of someone else other than your employer, you may be entitled to a third-party negligence claim. A lawyer can handle both claims at once and ensure you maximize your benefits for each case.

Yes. The whole idea of having a workers' compensation system is to ensure those injured on the job receive benefits without necessarily proving who was at fault. However, workers who suffer from self-inflicted injuries are not eligible for compensation.

Example:

If John suffers major burns because he accidentally mixed the wrong combination of chemicals from poorly labeled containers, he still qualifies for benefits. This is irrespective of whether he is to blame for the incorrectly marked canisters or not. However, John will not obtain any settlement if the confusion can be pinned on alcohol consumption on the job or the use of illicit drugs.

There are more than a few good reasons why hiring a lawyer is worth it. Apart from helping you secure the highest amount of compensation possible, the expert will also affirm that your agreement’s wording is correct. This is one of the most notorious parts of seeking workers' compensation that can cause unforeseen problems, like denial or reduction of SSDI benefits (Social Security Disability Insurance).

Furthermore, an attorney can strengthen your odds of a favorable court ruling should your matter proceed to trial. Filing motions, gathering medical records, and chasing down witnesses is not easy, and even a simple claim can leave you buried under mounds of paperwork.

A lawyer has the skills to ensure that the efforts put into a case will not be in vain. The best part is that workers' compensation attorneys accept a “no win, no fee” agreement, also known as a contingency fee. They have a vested interest in winning your case, and this makes their hiring cost worth every penny.

Employers have a duty to ensure their workers are compensated fairly for illnesses or injuries suffered at work or when carrying out work-related duties. In Los Angeles, employers must follow protocols to safeguard quality medical care for employees who get hurt.

Before an incident occurs, an employer should:

• Obtain workers’ compensation insurance coverage from a reliable insurance company.
• Provide workers with information about their rights and the workers’ compensation insurance coverage they enjoy.
• Put up a poster about workers’ compensation within an area accessible by all employees.

When an employee falls ill or is injured at work, the employer should:

• Provide the injured worker with a DWC 1 form (workers’ compensation claim form) within 24 hours following an incident
• Submit the filled out form to the claim administrator if insured or provide about $10,000 for seeking medical services if self-insured.
• Inform you about your contested/ questionable workers’ compensation eligibility status within 24 hours following an accident.
• Modify or reduce your workload if need be to allow smooth recuperation from injuries

Self-insurance is when an employer is authorized by the DIR (Department of Industrial Relations) to assume liability for workers' compensation claims. The Self-insurance Plans available in California mainly appeal to large businesses.

Here are the conditions employers must meet to qualify for self-insurance:

• State approval to self-insure
• A net worth of not less than $5 million
• A net income of not less than $500,000 yearly
• A security deposit

As aforementioned, your employer has a responsibility to put up a post about workers’ compensation within an area accessible by all employees. The post will provide information that includes the name of the company’s workers’ compensation insurer and instructions on how injured employees can report injuries.

If this post is not available, you have a right to seek information directly from your employer. You can also visit the Self Insurance Plans website to establish whether your employer is self-insured.

The views of your doctor, employer, and claim administrator will determine when you should resume working. Your employer cannot demand that you return to work if your doctor recommends a few more weeks of rest.

It is usual for doctors to set certain restrictions that may limit the kinds of tasks you can handle even after your return to work has been approved. These restrictions will depend on the severity of your injuries and your usual job description. While it is necessary to heed your doctor, employer, and the claims administrator’s advice, it is unwise not to make your health your number one priority. Staying in close contact with the three is vital because you need to discuss various aspects, including:

• Your job description before injuries
• The medical concerns arising from an injury and how they affect your ability to work
• An ideal set of duties that you can handle as you recuperate

From a legal and moral standpoint, an employer cannot fire or punish you for pursuing workers’ compensation. It is also a violation of the law to fire or punish other employees who choose to testify on behalf of an injured employee. In short, your employment is not at risk as long as your injuries don’t deny you the ability to work within the company.

Your doctor should write a report to the claims administrator providing information about any work restrictions you may have because of your injuries. Therefore, your employer can offer:

Your Old Job

If your state of health following an injury doesn’t hinder you from carrying out the duties and responsibilities of your last position, then you may have your old job work. In this case, your wages and benefits remain as they were before an accident.

Your Old Job, With a Few Changes

If injuries suffered create health concerns that hinder you from carrying out some of your previous duties, an employer can still avoid paying supplemental job displacement benefits (SJDB) by offering you modified work. The modified work must be in line with the work restrictions recommended by your doctor. Moreover, you should earn not less than 85% of the wages and benefits you earned before an injury.

A New Job within the Company

An employer may opt to provide alternative work if your injuries make it unsafe to resume your old work position. Again, providing alternative work saves the employer from having to settle supplemental job displacement benefits. Similar to offering modified work, alternative work should pay a minimum of 85% of your previous wages and benefits before an injury.

You have a time limit of 30 days to accept or deny your employer’s job offer for alternative or modified work. After 30 days, an employer can withdraw the offer. Failure to respond to a proposal by either accepting or denying it strips you of the right to pursue supplemental job displacement benefits.

Yes, you can. Work-related illnesses, just like on the job injuries, are covered in your workers’ compensation system. For instance, you can file a claim if years of typing cause you to suffer from carpal tunnel syndrome. Similarly, you are eligible for compensation if you develop breathing problems caused by excessive exposure to the carbon monoxide emitted as you perform specific work-related duties.

Your employer’s workers’ compensation insurance plan and the nature of injuries you suffer will play the leading role in dictating the benefits you will receive. In Los Angeles, there are six types of benefits available. They include:

• Medical Care
• PD (permanent disability) benefits
• TD (temporary disability) benefits
• Supplemental Job Displacement Benefits
• Vocational Rehabilitation Services
• Death Benefits

If an injury causes permanent disability that forces you to change your work line, you are entitled to supplemental job displacement benefits. These benefits are only open to persons injured after Jan. 1, 2004, and their employers cannot provide alternative work or modify their current work positions.

The supplemental job displacement benefit is a nontransferable voucher that doesn’t exceed $10,000. It allows permanently injured workers to seek skill enhancement, educational retraining, or both to enable them to secure new jobs in alternative industries or work positions.

If a work-related accident causes a worker’s death, the dependents left behind may receive support under death benefits. These benefits are paid gradually, just like temporary disability benefits, although the collective amount will depend on the age and number of dependents involved.

The severity of your injuries plays the most significant role in establishing whether you are entitled to permanent or temporary disability benefits.

If an accident leaves you with a lasting disability that affects your working ability even after seeking medical treatment, you are entitled to receive PD (permanent disability) benefits. On the other hand, TD (temporary disability) benefits are designed to make up for any lost wages during the recovery period. The amount you receive will depend on whether you cannot work at all as you recuperate or you have to reduce your working hours.

TD payments end once you can resume working as usual. PD payments are typically made in a lump sum once a doctor confirms you have suffered a permanent injury. In this case, compensation for lost wages may not be covered in full, although your ability to resume working in the future will not affect your payout.

It all depends on your employer’s preferences, who has the authority to dictate the doctor you will see during the first appointment. Some employers allow employees to work with doctors of their choosing after the initial medical examination, as long as these practitioners are within a specified Medical Provider Network.

An employer’s insurer can request you go through specific medical exams offered by a QME. Usually, three qualified experts are provided, and you can choose one within ten days. If this time elapses and you are yet to pick a QME, your claims administrator can select one for you.

Usually, all the QMEs on the panel are paid by an insurer, which means their findings may not always be fair. If you find the report of a QME to be unfair or too different from your Independent Medical Examiner’s (IME) report, you need to consult with the best workers' compensation attorney in California. The expert can help you forward your case to the WCAB (California Workers’ Compensation Appeals Board) to increase your chances of benefiting from the appropriate kind of care and treatment for your injuries.

Unlike a QME who is selected solely by the insurer, both you and the claims administrator nominate an AME. This makes the report generated binding, and it can be used to settle disputes arising from a QME’s medical examinations.

This refers to the degree of permanent disability as per the level of permanent impairment and limitations caused by injuries or an occupational illness. Some of the aspects considered when determining the permanent disability rating include the occupation, age, and the affected future earning capacity of a worker.

In Los Angeles and California in general, all employers must have workers’ compensation insurance coverage. This is irrespective of whether they have one employee or an entire team of workers. The lack of an insurance policy can attract a fine of up to $10,000, one-month incarceration in county jail, or both.

It is necessary to seek legal advice from a workers’ compensation lawyer if you find yourself nursing injuries, yet your employer is uninsured. In this case, your employer has violated your rights as an employee as well as the set state laws. Your lawyer will discuss your options with you and help you obtain the much-needed compensation from your employer. You could also report your employer to the Division of Labor Standards Enforcement.

If the injuries sustained had nothing to do with your work-related duties and responsibilities, then you may not be eligible for workers’ compensation. However, if you suffered injuries while carrying out work-related errands outside the work premise, then you may still qualify for compensation. Consult with a Los Angeles workers' compensation attorney if you are unsure about your eligibility.

It remains imperative to report your injury immediately to your supervisor or employer. Because some injuries develop over time, it is always best to report an accident even if you don’t suffer any severe injuries.

In Los Angeles, injured workers should report incidents within 30 days. This allows the employer to conduct full investigations if necessary. Failure to report within this time limit could lead to automatic denial of your workers' compensation benefits. Upon reporting an injury, your employer will provide a DWC form that you should fill out to kick start the process of securing a settlement.

Yes. Injured workers should report incidents within 30 days. The DWC form you fill out can also serve as a written notice of your injuries as long as it is served within 30 days following an incident. The time limit rules are different when filing a claim for a work-related illness that has developed over time.

Yes. According to the statute of limitations in Los Angeles, California, workers must file a workers’ compensation claim within one year following a work-related injury. It remains crucial to understand that you also need to report an injury to your employer or supervisor within 30 days from the date of an incident. You must meet both deadlines to reduce the risk of your claim being denied.

DWC 1 is a claim form that allows you to document your injuries. Your employer has a responsibility to provide this form physically or via mail within one working day following an accident or discovering an illness. You can also download the form from the DWC website.

The law gives the claim administrator one working day to authorize medical treatment after receiving your completed claim form. During the period when a claim is under investigation, you should still have access to a maximum of $10,000 for seeking medical care. Talk to the management or your supervisor about the claim administrator’s delays and insist on receiving immediate treatment authorization.

Your employer’s insurer should respond to your claim in about 90 days. They usually respond earlier, especially when dealing with straightforward claims. All the same, you can assume your claim is accepted if you don’t hear from the insurer within the 90-day deadline. Meanwhile, you have a right to access a maximum of $10,000 for medical treatment, even as the insurer investigates your claim.

If your claim is denied or you disagree with the proposed benefits, you can always challenge these decisions through an appeal process. It is best to consider working with a proficient workers' compensation lawyer in Los Angeles who can fight to tilt the scales in your favor. You have a maximum of 20 days from the service date to file a notice of appeal.