Public employees are the employees who work for government agencies. The list of public sector employees is long, and they range from teachers to firefighters and even police officers. Due to the wide range of jobs in the public sector, there is an increase in the job risks that these employees could face. In addition, some public employees work in a hazardous environment and are more likely to suffer injuries at their workplace.

Workplace injuries range from minor cuts and bruises to more life-changing injuries such as traumatic brain injuries and amputations. All employers are required to have workers' compensation insurance to cover the expenses of employees who suffer injuries at workplaces. Although all workers are entitled to worker's compensation benefits, you may fall under a different set of regulations as a public worker.

Seeking compensation for work-related injuries may be challenging, especially when your employer denies your claim. At The Workers Compensation Lawyer Law Firm, we are ready to offer the legal counsel you need to navigate your claim in Los Angeles, CA.

Overview of Worker's Compensation for Public Employees

You are guaranteed coverage for injuries you suffer at your workplace under California Workers Compensation laws. For example, if an employee suffers an accident, they are entitled to compensation for the losses resulting from their injuries. Working as a public employee puts you in a different set of workers' compensation regulations. As a state or federal government worker, your ability to recover workers' compensation benefits may differ significantly from other employees.

Workers' compensation is an insurance program that pays for your expenses after sustaining a work-related injury. When you recover workers' compensation benefits, your employer cannot deduct the amount from your paycheck. Unfortunately, not all employees receive workers' compensation coverage.

If your worker's compensation claim is successful, you will recover compensation for the medical expenses you incur from treating the work injuries. Also, you may be compensated for lost wages and disability resulting from your injuries. In addition, some employees are covered by separate compensation laws of the United States.

Federal Employees

Federal employees enjoy different programs for workers' compensation. For example, the Federal Employees Compensation Act (FECA) allows you to recover benefits when you are disabled, or a loved one is killed while performing work-related duties. In addition, you may be eligible for FECA benefits regardless of the duration you have worked with the federal government.

State and Local Government Employees

If you are an employee of the state or local government, the State Workers Compensation Statutes will determine whether or not you are covered under state programs. In addition, you can learn more details of your coverage by checking out the posters in your workplace. The workplace posters provide details of your coverage and contact information for more inquiries on filing the claim.

State statutes often prohibit the payment of worker's compensation benefits to state officials. In California, you are considered a state official if you exercise a level of sovereign power. Additionally, public workers who put their lives on the line every day, like firefighters and police officers, have separate statutes that govern their workers' compensation claims.

Special Occupations

Some employees can bring claims for federal compensation benefits under the federal acts. For example, one of the unique occupations acts is the federal employer act which helps interstate transportation and railroad workers recover compensation for their on-job injuries. Also, employees involved in public works outside the United States are protected by the federal government.

Process of Filing a Workers Compensation Claim for Public Employees

A workplace injury can occur at any time and in any industry. Regardless of whether you are a public or private employee, the process of filing a workers compensation claim is the same, and it takes place in the following steps:

Reporting your Workplace Injury

The first step you must take towards recovering worker's compensation benefits is to report the workplace injury to your employer. Under California workers compensation law, you must inform your employer and file your claim within thirty days of suffering or noticing an injury. You must speak to your supervisor while following the correct protocol. Notifying your employer about the injury is not enough to recover compensation, and you must continue the process by filing an official claim.

You will need to file the following documents for your official claim:

  • DWC-1 claim form. The DWC-1 is a primary workers' compensation form where you must indicate your personal information and the basics of your injuries. In addition, you must show each type of injury and how it occurred. Your employer will then submit the filled form to their insurance company.
  • Application for Adjudication of Claim. You must file this form with the workers' Compensation Appeal Board. The application for adjudication claim form will need the information on your employer's insurance company.
  • Document cover sheets. You can print out a cover sheet, including forms from a DWC website.

You must file the DWC form within thirty days of noticing the workplace injury. Depending on the type of benefits you wish to recover, there are time limits that you must beat. For example, if your employer's insurance company provided insurance benefits, you would be required to file your claim within five years. However, if you wish to seek compensation benefits for a deceased loved one, you must do so within a year of the injury.

Seek Immediate Medical Care

When you suffer a work-related injury, your health and wellbeing should be your priority. Seeking immediate medical care is essential for your health and ensuring that you recover the compensation you deserve for your injuries. Even when your injury seems minor, it is crucial to have it checked by a physician.

The closer in time of your injury you seek the treatment, the less your employer will have room for doubt that your injury resulted from work-related activities. Conversely, failure to seek medical care could cause the injury to become worse and increase the amount of time you need to recover, affecting the scope of treatment as authorized by the worker's compensation laws.

If you suffer a workplace accident and need emergency services, you should go to the nearest emergency room. However, if your injury is not an emergency or has developed over time, it would be wise to follow the right channel for seeking medical care. In California, you can choose your doctor if you had designated a primary physician before the accident.

Doctors hired by your employer to treat work-related injuries may have a close, financially rewarding relationship with the employer. Therefore you must seek medical care from a doctor you trust. In addition, you need to seek medical care from an experienced and articulate doctor of your choice.

The physician who treats your work-related injuries will play a significant role in your worker's compensation claim. In addition to providing treatment and writing your diagnosis, your doctor may need to write a report indicating your condition and ability to return to work after the injuries. Obtaining treatment from a doctor who is not licensed increases the risk of losing your medical bills benefits.

Even with advancements in medical technology, the doctor will always rely on your symptoms and pain level to diagnose. This will be the case, especially when you suffer soft tissue injuries that cannot be verified through x-rays. Therefore, it is crucial to communicate with your doctor while following these guidelines:

  • Be as accurate and honest as possible. When you explain your symptoms to the physician, you need to be truthful. It would be best if you did not downplay or exaggerate the symptoms, and you can lose your credibility by attempting to lie to the doctor.
  • Avoid speculations. If the doctor asks a question and you do not know the answer, you should not speculate. Also, it would be best if you did not admit to full recovery until you feel so.
  • Do not leave anything out. Regardless of the severity of your symptoms, it would help if you did not leave anything out when describing your injuries. Although some injuries may be minor, failure to treat them could cause them to become more severe.

Workplace injury may occur during a single event like an accident or gradually happen. Therefore, you should start the workers' compensation process as soon as you notice the injury. Also, navigating the worker's compensation process would be easier when you seek the guidance of a skilled attorney.

File Your Claim

When you report your injuries to your employer, they will provide a DWC-1 form which you fill and must be submitted to the insurance company. Then, an insurance adjuster from your employer's worker's compensation insurance company will contact you for the following stages of your claim. Finally, you must present your medical report to the insurance company, which will be a significant piece of evidence of your injuries.

If the insurance company disputes or denies your claim, you will need proper documentation of the steps you have taken and seek legal guidance. Also, you will need to complete several forms of the claim and continue with medical checkups. Following up with your doctor allows you to prove that your reported injuries were honest to the insurance company. In addition, since your medical care expenses will be covered in the claim, you will not need to worry about the quality of seeking expert treatment.

Resolving your Claim

Most workers' compensation claims are resolved through a settlement between the injured workers and the workers' compensation insurance. The two types of worker's compensation settlements include:

  • A stipulated finding and award. A finding and award form provides for your level of disability resulting from the work injury. This leaves an open payment that could occur in the future. The judge reviewed this type of settlement based on the degree of your disability and your doctor's opinion.
  • A compromise and release. The compromise and release close your worker's compensation case with a lump sum payment covering the estimated value of disability and future medical expenses. However, it is essential to understand that the compromise and release settlement is possible when you will no longer be working for the employer.

Special Benefits for Public Employees in California Workers Compensation

As a public employee working in law enforcement or firefighting, you can take advantage of the lower standards of proof to recover your worker's compensation benefits or receive unique benefits. For public employees, compensation for work injuries is governed by the section of government where they work. Some of the unique benefits that public employees could receive include:

Leave of Absence

If you are a public employee involved in active firefighting or police duty, you will be entitled to a year of fully paid salary instead of recovering temporary disability benefits. For public employees who are not in firefighting or law enforcement, you can recover temporary disability benefits that total a third of your weekly wage. The leave of absence for public employees will not apply to individuals working as mechanics, clerks, and telephone operators working in the law enforcement department. Also, retired, resigned, or public employees who have been dismissed will not receive these benefits.

Disability Retirement

If a public employee is permanently incapable of returning to work due to a job-related injury, they could benefit from disability retirement. For example, a state officer who suffers a substantial injury at the workplace may be eligible for disability retirement regardless of their age or the number of years they have served. To apply for disability retirement, you must be part of the California Public Employees Retirement System. You will apply for the disability benefits under the following situations:

  • While you are absent from work on military service
  • Within four months of working
  • While you are on leave of absence
  • When you are mentally or physically incapacitated

Presumption of Injury

Unlike other employees, public employees who engage in firefighting or police duty will not need to prove that these injuries are work-related:

  • Heart conditions
  • Cancer
  • Hernia
  • Pneumonia

If a firefighter or a police officer suffers from any of the above conditions, it is assumed that they are work-related. However, other injured workers have the burden to prove that their injury resulted from a work-related activity.

Death Benefits

If your loved one dies in the line of duty, you may be entitled to death benefits. The death benefits for a law enforcement officer are set aside for a spouse or children under twenty-two years. The amount you can recover in social workers' compensation death benefits will significantly depend on the deceased's salary percentage. Other public workers may only be entitled to compensation for burial expenses, often $1,000. Additionally, the surviving spouse or children of a firefighter or police officer who dies in the line of duty are eligible for health insurance benefits.

Denial of a Workers Compensation Claim

The workers' compensation program is one of the programs that provide social insurance for the workforce in the United States. Typically, your employer's workers' compensation insurance must cover any losses you incur from a work injury. However, the worker's compensation system does not honor all claims filed under this program. Some of the reasons why your compensation claim could be denied include:

  • Late filing of the claim. The first step towards recovering workers' compensation benefits is to report the injury to your immediate supervisor. Failing to report the injury within the first thirty days of noticing the injury could result in denial of the claim.
  • Filing a claim after the statute of limitation has elapsed. California workers' compensation law requires that you file your lawsuit within one year of the injury. Failure to file your claim within the specified time could result in its denial. However, there are exceptions to this statute that may include court schedules and that the court extends your case beyond the deadline.
  • Failure to seek immediate and proper medical care. Your employer's insurance provider may assume that your claim is false if you did not seek treatment for the injuries you reported. If you wish to seek workers' compensation benefits, it would be wise to seek immediate medical care and mention your injuries to the doctor. The doctor's report is often a crucial piece of evidence in your claim.
  • A conflict between your accident report and the medical report. The injuries you report to your employer at the beginning of your claim process should be similar to those indicated in your medical record. A conflict between these pieces of information could be viewed as an attempt to defraud and disqualify your claim.
  • Pre-existing injuries. When you seek compensation for on-job injuries, you may be required to present your medical records dating before the accident. If you have a pre-existing medical condition and try to blame it on your job, the insurance company will deny your claim.
  • You refused to take a drug test or failed it. California workers' compensation is a no-fault system. However, this clause does not apply to individuals injured while under the influence of drugs or alcohol. The insurance company can invalidate your claim if you refuse to submit to a drug test or fail it.
  • Filing a claim after job termination. If you file a workers' compensation claim after you are fired from your job, your claim could be viewed as retaliation towards your employer. However, if you believe that your employer fired you after learning your intentions to file a claim, you may have a legal ground to recover compensation.
  • Unwitnessed injuries. Insurance companies are not always eager to settle every worker's compensation claim. Therefore, filing a claim for unwitnessed damages could result in a denial.
  • Failure to fully and accurately fill the paperwork. When you seek damages in a worker's compensation claim, there are several documents that you must fill out and present to your employer or the insurance company. When filling the forms, you must clearly and adequately indicate all information regarding your injuries. If you present partially filled forms, you risk a claim denial.

Appealing a Workers Compensation Claim Denial

When the insurance company denies your claim to recover compensation for your on-job injuries, you will receive a deadline for appealing the decision. The deadlines to appeal such decisions are set, but the State must strictly follow. Therefore, as soon as you are notified of the denial, it would be wise to speak with your workers' compensation attorney to guide you through the appeal process.

The first step you must take when filing an appeal is to speak with your employer and their insurance provider to learn the basis for denial of your claim. This will help you be sure that the denial was not just a clerical mistake. If the reason for the rejection of your claim is not an error that can be easily corrected, filing an appeal could be a complicated process. The appeal process begins with meeting the judge, and the meeting must be arranged through the State workers compensation board.

As you prepare for your appeal, you will need to gather the necessary documentation on your injuries. Also, you should thoroughly review the information you provided for your initial claim. Denial of your claim should not be why you stop seeking treatment. If you end up paying for your treatment or incur other medical expenses related to your work injuries, it would be wise to keep the receipts. Your attorney will need all these documents to seek the appropriate reimbursement for you.

Find a Workers Compensation Attorney Near Me

The workers’ compensation scheme allows employees who suffer work-related injuries to recover compensation from their employers. When you are injured at the workplace, you must inform your employer and seek compensation from their insurance provider.

Often, public employees enjoy a separate set of workers' compensation regulations. Therefore, facing work-related injuries as a public employee is not only hard for your body but could also be emotionally draining as you seek compensation for your injuries from your government agency. In addition, figuring out what to do next after a workplace injury can be challenging, especially when recovering from your injuries.

If you are a public employee battling the workers' compensation system to recover benefits for work-related injuries, you will need the guidance of a competent worker's compensation attorney. Your attorney will help you gather the necessary evidence and file the paperwork to ensure you recover the compensation you deserve. If you are in the Los Angeles area, we at The Workers Compensation Lawyer Law Firm are here to help you. Call us today at 424-501-9228 to discuss how we can help you.