No matter how safe a job is, accidents can happen. For instance, a truck driver can easily dislocate a shoulder when carrying a heavy load, or a nurse can hurt her back when lifting a patient. A construction worker can also be hit by falling objects or slip and fall. All these dangers present a significant risk to employers.

Workers who incur injuries while on the job should file a lawsuit against their employers. This could result in expensive and messy legal battles for both parties. That’s why worker’s compensation insurance exists. There are a lot of factors that come into play when seeking compensation through this insurance program. At The Workers Compensation Lawyer Law Firm, we are committed to ensuring that all our clients receive the compensation they deserve. Please schedule an appointment with us today and learn how we can help you.

How the California Workers Compensation System Work

All workers in California are required to have workers’ compensation insurance. Many business owners in California believe that general liability insurance can cover workers’ compensation claims, but this isn’t true. General liability only covers bodily injuries claimed by third parties, not by people working in a business and are hurt while on the job. That’s why employers in California must purchase workers’ compensation to comply with state laws and protect themselves from being sued by their employees.

Employers can buy workers’ compensation from a private insurance company or state or State Compensation Insurance Fund. Even though private insurance companies work under state regulation, employers prefer using the State Funds.

The amount of coverage that a particular business needs depend on several factors that include:

  • The company’s industrial classification
  • What type of work that the workers do
  • The number of employees
  • History of work-related injuries

As an employer, you can rely on a commercial agent or broker to purchase workers’ compensation from a private insurer and provide information on State funds and self-insurance.

When you are hurt on the job, you should provide a workers’ compensation claim within one working day after reporting the injury. Your employer should then complete the form and return it to the employee within one working day. Next, the employee should forward the claim form and the accident report to the claim administrator for processing. The employer should authorize a maximum of $10,000 for appropriate medical treatment after receiving the employee’s claim. 

A doctor should evaluate the injured employee and send a report describing the workers’ medical condition to the claim administrator. This will help decide whether the employee should return to work or not. The report will also confirm whether the employee needs to change his or her working schedule, equipment, assignment, or a change of the working conditions. Therefore, any work that the employer assigns to the injured employee must meet these requirements.

Under California state insurance laws, failure to have workers’ compensation is a crime. A misdemeanor is punishable by a minimum fine of $10,000, imprisonment for a maximum of a year, or both. The state also issues a maximum of $100,000 for an illegal or uninsured employee. Additionally, if an employee is hurt or gets sick working for an uninsured employer, the employer pays all bills related to the injury or illness.

Workers’ Entitlement Under Workers’ Compensation Law in California

The following is an outline of the benefit entitlements injured workers can receive in California. All these payments are non-cash benefits and tax-exempt, different from other insurance benefits like unemployment benefits.

Medical Treatment Costs

Medical treatment costs include expenses related to the medical treatment covered by the workers’ compensation program. They include costs for medical evaluations, surgery, and treatments. It also includes fees for using medical aid devices, transportation costs, and the cost of prescription drugs.

Apart from that, as of 1st January 2016, California workers must be reimbursed for traveling to medical appointments according to the IRS mileage rate of 54 cents per mile.

Temporary Disability Payment

Temporary disability payment covers the time that a worker stems off from work due to an injury. The costs cover two-thirds of the average weekly wages, with a state-mandated weekly maximum, based on the day of the injury. It only lasts for two years after the date of the injury. This is up to 105 weeks within five years unless the worker suffered one of the following conditions, which extends the payment to 240 weeks:

  • HIV
  • Hepatitis B or C
  • Amputation
  • Certain eye injuries
  • Severe burns
  • Chronic lung disease
  • Pulmonary fibrosis

Permanent Disability Payment

Permanent disability payments reimburse workers who incur injuries that affect their ability to return to a job or participate in their careers. The compensation amount depends on the permanent disability rating. Permanent disability ratings depend on the type of injury sustained, workers’ occupation, the doctor’s restriction, and the workers’ age. You can receive permanent disability payment from anywhere between four weeks to 14 years, depending on the disability rating.

Life Pension Payments

Workers who are severely disabled, particularly those who fall between 70% and 99% of a permanent disability rating, are entitled to life pension payment. This is a small weekly payment that’s paid along with the weekly permanent disability payment. It lasts for the rest of your life.

Vocational Retraining Costs

Vocational retraining costs or the Supplemental Job Displacement is a type of entitlement available for workers who can no longer return to their previous working capacity and were not offered modified or alternative employment by their employers. This entitlement guarantees a $6,000 voucher for education-related training acquired from a state-approved school. The voucher can cover your tuition fees, books, and fees.

Death Benefits

Death benefits are entitlements owed to spouses or dependents of a worker who dies out of work-related injuries. It covers expenses like burial expenses and other related costs.

How Workers’ Compensation Benefits Are Calculated in California

As stated earlier, workers injured in their work are entitled to two-thirds of their pretax gross wages. However, the state has set a maximum allowable amount of $1,215.27 per week for the total disability. This amount is adjusted annually, but there is a minimum amount eligible to be paid. The minimum amount published by the California Department of Industrial Relations in 2018 was $182.29.

Some companies provide a Disability leave with pay program, although the law does not require it in California. This program makes up for the salary difference to receive your entire income when you were injured on the job. Under this program, the company adds money to what the state pays to get your total salary.

When calculating your regular wages, the company usually divides your salary by 52. Therefore, if you make a yearly salary of $52,000, your weekly compensation would amount to $1,000, with a maximum benefit of $666.66 under the full benefit of 2/3 of the pretax gross wages.

Under the “disability with leave pay” program, an employer would make up the remaining $333.34 every week. The state would pay $666.66. There’s no tax withheld on the $666.66; that’s in this example. If you suffer permanent disability, you might be eligible for a Supplemental Job Displacement Benefit that consists of a voucher of up to $6,000 in compensation for your vocation skill training. You will also be eligible for a maximum of $10,000 to compensate for your hospital expenses, medication, physical therapy, and doctor’s office visit, whether your claim is accepted or denied.

An Overview of Workers’ Compensation in California

The main reason for California’s workers’ compensation is to offer fast payments and medical treatment after incurring an injury from a workplace. Here is a close view of the process for workers’ compensation claims that you should follow. 

Notifying the Employer of Your Injuries

Compensating a worker starts with a notification to your employer of work-related injuries or health conditions. You should write the notification and sign it along with your attorney, or anyone acting on your behalf.

A verbal notice would obligate the employer to provide the claim form, but filling a signed form is much better.

It’s crucial to notify your employer within thirty days after the injury to avoid losing your compensation right.

There are chances that your employer received the notice of your injury in one way or another, although a written notice would be the best idea. For instance, if a foreperson or a supervisor witnessed the injury and reported the injury to the employer, the employer cannot deny the claim since the injured worker didn’t make a claim. The employer should provide the claim form, regardless of whether the employee reported it or not.

It’s not recommendable for workers to depend on their employers’ knowledge about a particular injury to secure the compensation claim. Writing a formal notice after incurring the injury is the safest practice rather than making assumptions.

Nevertheless, failing to make a timely notice doesn’t bar an injured worker from receiving compensation even when your employer was misled about the injury. So, even if you notify the employer thirty days after incurring the injury, you might still receive your benefits even if the delay didn’t prevent your employer from investigating your accident.

Notice for Cumulative Injuries

Some injuries take time to occur. For instance, repetitive stress injuries that occur from repeated motions warrant a compensation claim. Additionally, some occupational illnesses might result from repeated exposure to toxic elements. These injuries are referred to as cumulative injuries.

It can sometimes be difficult to identify cumulative injuries thirty days after the cumulative injury occurred. However, California courts simplify the definition of a cumulative injury date as:

  • The date which you first incurred an injury
  • Knew that the disability resulted from an employment

Please note, the definition of “suffering an injury” isn’t similar to “suffering disability” in this context. In this context, “suffered disability” refers to “compensable disability.” this means that it led to the loss of wages or was permanent.

Therefore, you should report your cumulative injury within thirty days after realizing that the injury would have become permanent or caused you to lose your work.

You should seek legal help if you’re bringing a worker’s compensation claim for a cumulative since these claims are usually complicated.

Employer’s Responsibility to Provide a Claim Form

As stated earlier, an employer should provide a claim form after learning about the work injury. However, the employer should provide the form if the injury couldn’t allow the injured worker to work during the regular shift and require further treatment apart from workplace first aid.

The employer must accompany the notice proving that the worker is eligible for compensation. The employer can use mail or provide these forms in person. The statement accompanying the form should include the following:

  • The procedure you will use when collecting the workers’ compensation benefit
  • Details about the kind of compensation benefits available
  • A brief explanation of what will happen to the form once it’s filed
  • The institution or person that you can seek treatment for your injuries
  • The responsibility of the treating physician
  • The right of changing your physician
  • How you should seek medical treatment as you await the claim to be returned
  • How you can protect yourself from discrimination

Practically, employees learn about their employer’s injuries immediately they occur and provide the claim form. The thirty-day time limit is not an issue since most injured employees receive the claim and return it before the thirty days expire.

Completion of the Workers’  Claim Form

You must fill in the “employee” section of the compensation claim form to complete the process. When your employer doesn’t provide you with the form, you can download it from the Division of Workers’ Compensation Website. You can also find the form from your lawyer.

You must fill in the form with the following information:

  • Your name, social security number, and address
  • An email that you’ll be receiving notices about the claim
  • The date and the exact time that you incurred the injury
  • An address of the place where you incurred the injury
  • A detailed description of the injury and how it affects you
  • Your signature

Most of the information that you’ll provide is accurate, but some can remain ambiguous. For instance, when you want to answer about your cumulative injury, it’s unclear when the injury occurred. You should seek advice from your attorney before you write down anything about this kind of injury.

Even so, it might be difficult to give accurate information about an injury before you see a doctor. Therefore, the best thing to do is write down the body parts that are injured.

Return the Claim Form to Your Employer

You’ll be completing the compensation claim filing process if you deliver it to your employer. Your employer will then fill out the “employer”  section form and later submit it to the claims administrator. The administrator is usually someone from the state’s workers’ compensation insurer or a private insurance company.

As an injured employee, you should keep a copy of the filed claim form provided by your employer.

It’s crucial to provide the claim form to your employer in time. Submitting it within thirty days of an injury means that it’s submitted on time.

Apart from that, the claim assures that you are entitled to seeking compensation benefits if your employer doesn’t provide them.

Once you submit the claim form, you prompt 90 days. The claim’s administrator can accept or deny your claim without needing to overcome the presumption that your injury is compensable. If the employer doesn’t deny liability to the injuries within ninety days, the Workers’ Compensation Division assumes that you incurred a compensable injury.

This presumption prevents an instance where the insurer assumes that your injury isn’t work-related unless there’s evidence disapproving of this assumption.

Please note, if you disagree with the treating physician whether a particular injury should be compensated or about a specific medical issue, you can seek an assessment from a Qualified Medical Evaluator.

You have the right to seek an evaluation from the QME only if you have filed the compensation form. That’s why you should file these forms with your employer as soon as possible.

Discussing your Settlement

Usually, state insurance firms pay medical treatment and temporary disability payments without involving the court. Similarly, you can settle a disability benefit without holding a hearing. However, this is common when a worker has legal representation. A judge must approve the settlement before it’s made. You can seek two main types of settlement. This includes:

  1. Stipulation with Rewards

Under stipulation with a request for a reward, you will agree on a weekly benefit with your employee, as ordered by the judge. Your employer will also continue paying for your medical treatment.

  1. Compromise and Release

In a compromise and release, your employer will pay a particular sum of money in place of your weekly benefit. In that case, the employer will not provide further compensation to treat your injuries. 

Most employers usually agree to pay a favorable settlement under this option. Even so, it’s wise to seek legal help before you settle on a compromise and release benefit.

When you have cumulative injuries claim against two employers, you can settle using this form of settlement with one of the employers and pursue the stipulation with a request for a reward with the other.

Appealing a Workers’ Compensation in California

An injured employee can ask a judge to resolve a compensation dispute when negotiations don’t work. All proceedings associated with recovering workers’ compensation payments are made before the WCAB or Workers’ Compensation Appeal Board.

You must apply with the WCAB after one year of:

  • When you incurred the injury
  • The end of your treatment
  • The last time you received your benefits

In cases where your employer provides the required benefits like temporary disability payments and medical treatment, the adjudication will be tolled since the employee can reasonably presume that their employer isn’t disputing their benefits. However, the one-year limitation period cannot be tolled when the employer denies your claim or rejects responsibility for the injury since you don’t have to presume that your claim isn’t disputed.

Exchanging Evidence

Both disputing parties can engage in a discovery process to prepare for a hearing. You should complete the discovery process before the settlement conference. However, the disputing parties should at least try settling the case before declaring that they are ready.

The Appeal Board usually sets a thirty-day settlement conference before both parties declare their readiness. The thirty-day window encourages a settlement rather than heading to the court. If the parties don’t settle, the workers’ compensation judge will take over the case.

Preparing and Filing the Pretrial Statements

The employer and worker will file a pretrial statement if the settlement conference does not work. The pretrial report provides the following information to the compensation judge:

  • The specifics of the dispute
  • The proposed permanent disability ratings from both parties
  • Exhibits that each party intends to present as evidence
  • The testifying witnesses

The hearing must take place within seventy-five days after filing the Declaration of Readiness. The judge will consider evidence about the disputed issues. The evidence should contain the following:

  • Testimony from you
  • Testimonies from other witnesses
  • A report from the QME
  • Hospital records
  • Reports of other doctors
  • Reports from vocation experts
  • Other documents that guarantee a standard of admissibility

The appeal board might ask you to be examined by a QME if this would help resolve disputes about your medical issues.

Reviewing the Decision and Determining Whether to Appeal

The judge will look into the evidence and decide whether you incurred a compensable injury and the benefits that you should receive. The judge should issue the decision within thirty days, and the case will be considered “submitted” to the Appeal board.

You can review your case with the appellate court if your case seems appropriate. The appellate court will not necessarily go against the case but will determine whether the appeal board misapplied any California law while making its decision.

The review process is subject to all legal procedures like using strict evidentiary rules and timing. You’re in a better position to prevail in this process if you hire an attorney.

Find a Workers’ Compensation Lawyer Near Me

Any injured worker faces a difficult time. It’s crucial to focus on recovery while your attorney seeks the proper compensation for your work-related injuries. Our attorneys at The Workers Compensation Lawyer Law Firm are here to help you. For more information, reach out to us at 424-501-9228 and schedule an appointment with us.