If you suffer a work-related injury, you may be eligible for Workers’ Compensation Benefits. Many issues regarding these benefits are unclear to most employees, making it challenging to benefit fully after a work-related injury. At The Workers Compensation Lawyer Law Firm, we take it upon ourselves to help you understand all the facts about these benefits to make the process easier for you. For instance, you deserve to know how much money you could expect in compensation after a particular injury, the kinds of benefits that could be available for you, and what you can do or not do to receive maximum compensation.
Therefore, if you or your loved one has incurred a work-related injury, let us guide and help you through the legal process for a favorable outcome. We have extensive experience handling issues like this throughout Los Angeles that could help you win your claim.
The Workers’ Compensation— Overview
The workers’ compensation is a mandatory state insurance program that consists of payments made to employees who incur an injury or disability while discharging their duties. The federal government has workers’ compensation insurance for its employees, but each state has a separate but similar insurance program. It is essential to know the state laws governing programs like these to determine whether or not you are covered in case of a work-related injury.
Workers’ compensation is an insurance program purchased by employers to cover work-related illnesses and injuries. The law provides a detailed guideline on how employers should buy this insurance coverage. In some cases, injured employees receive compensation regardless of fault. Since the program is a type of insurance, employees are allowed to claim compensation in the place of suing the employer for the injuries.
What are Your Rights?
If you have been injured at work, it is vital to know your rights to protect yourself against violation. Your rights as an injured employee are covered under the California workers’ compensation law. They include:
- Your right to file a workers’ compensation claim without receiving retaliation from your employer
- Your rights to appeal if the insurance company denies your claim
- Your right to receive medical care and other benefits that are covered under the workers’ compensation program
- Your right to have legal representation from a competent workers’ compensation lawyer— you need guidance and help to navigate the legal process. Your attorney will also advocate for you.
- Your right to choose a doctor or switch doctors if you feel that the doctor recommended by your employer is not serving you well
Eligibility for Workers’ Compensation
The workers’ compensation insurance program aims to ensure that injured employees receive adequate compensation to cater to medical expenses and other needs resulting from job-related injuries. Fair compensation ensures that the employees receive the much-needed medical treatment and care to return to work in good time. However, it is not always as easy as it might sound. That is why you need proper legal guidance and help to file a successful claim. First, you must determine whether or not you qualify for these benefits.
In most cases, most work-related injuries are under the workers’ compensation program in California. It means that most employees are covered and are eligible to receive payment in case of an injury or illness. However, some exceptions are worth noting if you are about to file for compensation:
Injuries that occurred outside the working environment
Remember that workers’ compensation insurance only covers work-related injuries. Therefore, you may not receive compensation for any injury that occurred outside of work. However, you might be eligible for a payment if you are injured while performing a job-related duty out of your usual working environment. For instance, while running an errand in town or making a delivery.
Self-inflicted Injuries
Self-inflicted injuries are not covered under the workers’ compensation even if they occurred within the working environment. They also include damages incurred due to an illegal act or a violation of the company policies. Your employer will have a team of investigators hired to determine the cause of your injury if he/she suspects that the injury was not work-related. However, an aggressive workers’ compensation lawyer might find a loophole through which he could help ensure that you have received the compensation you deserve.
Injuries sustained when working while intoxicated.
The workers’ compensation insurance doesn’t offer compensation to employees who sustain work-related injuries for working while intoxicated or under the influence of illegal drugs. If it is established that you were intoxicated at the time of the accident, the assumption might be that the injury was out of your recklessness and not due to an unsafe working condition. In that case, you might forfeit your right to file for compensation.
Other factors will also count in determining your eligibility to collect compensation from the workers’ compensation insurance program.
For instance, you may not be allowed to file for compensation if you prefer to file a suit against your employer for a work-related injury. As previously mentioned, injured employees receive workers’ compensation in place of filing a lawsuit against their employer for their injuries. You cannot do both. Therefore, if you prefer to file a suit against your employer, you will not be allowed to file a compensation claim. But remember that when filing for compensation under the workers’ compensation insurance, the liable party for your injuries won’t affect the claim, as is the case with legal suits. It is advisable to seek proper legal advice to make the right decision.
Also, note that compensation will depend on the kind of employee you are. You could be excluded from compensation if you are an independent contractor, owner of a business, a volunteer worker, employee in private homes working as cleaners or babysitters, a farmworker, a railroad worker, or a maritime worker. However, it all depends on your situation and whether or not your employer has purchased the coverage for you. If you fall under any of these categories, you might want to discuss them with your lawyer first before filing your claim.
Lastly, your compensation under the workers’ compensation insurance will depend on whether your employer has purchased the insurance coverage for you. Note that some employers in California are excluded under this program, especially those that only have a few employees. In that case, you will be allowed to file a suit against your employer for compensation if you feel that your employer or a co-worker’s actions were somehow negligent in resulting in your injury.
Employers are bound by law not to forbid injured employees from pursuing compensation for a work-related injury. It will be illegal for your employer to threaten you with termination or other consequences if you seek compensation for your injuries. Your employer could also retaliate against your action. If that happens, you are free to file a discrimination suit against him/her.
Benefits Available Under the Workers’ Compensation Program
After establishing your eligibility to receive workers’ compensation for your work-related injury, it is crucial to determine the kinds of benefits you might receive under this program. The workers’ compensation insurance aims to provide compensation for all injuries incurred after a work-related injury. Therefore, the kinds of benefits you could receive will depend on the nature and extent of your injury.
Your compensation will mainly include medical benefits necessitated by the job-related injury. Your medical bills could consist of the emergency medical care you needed immediately after the injury, the drugs and treatment you received once at the hospital, and costs for rehabilitation care or any other treatment you might need after being discharged from the hospital.
Compensation will also include loss of income during the recovery period, costs of retraining for your current job, or training for another job after recovery, lost earning ability, especially in case of a severe injury that affected your ability to perform in your current job, and benefits for the surviving dependents in case the injured employee lost their life.
Workers’ compensation benefits are usually not available immediately after the injury. Thus, you might have to spend the money you have, or borrow some cash for your immediate needs, then apply for compensation once you are ready. Therefore, this compensation is more like reimbursement for all the expenses you have borne out of your pocket after the injury. Thus, it is essential to document all your expenditure after the injury to ensure total compensation from the insurance program. However, income-related benefits are usually two-thirds of your current wage (before your injury). The advantage is that these benefits are generally tax-free.
You must file your workers’ compensation claim within a month after the date of your injury, or at least the date when you discovered the injury. The insurance provider has up to three months to respond to your claim. If you do not receive a response within 90 days, it could mean that the insurer did not approve your claim. Thus, you might have to seek other alternative ways to recover compensation.
Note that you are eligible for medical benefits of up to $10,000 before the insurance company determines the status of your claim. You could also receive a bonus fee attached to your benefits if the insurance company approves your claim late. It could benefit you greatly to involve the help of an experienced workers’ compensation lawyer to ensure that you are not missing out on all these benefits.
Generally, the benefits you are likely to receive can be categorized under the following:
Medical Benefits
They include all medical-related expenses you will incur after the injury. They may include hospital bills, doctor consultation fees, cost of emergency services, transportation costs to and from the hospital and doctor’s appointments, and the costs of any over-the-counter medication you need during the recovery period.
Temporary Disability Benefits
In case your injury was severe, it might have taken you a few days or weeks to get back on your feet once again. During that period, you might have required care to cater to your day-to-day needs, including feeding, using the bathroom, and even sleeping.
Permanent Disability Benefits
The injury might have affected entirely your ability to perform primary duties. In that case, you will need everyday care to cater to your day-to-day needs. If you were your children’s primary caregiver, they would also need a carer to ensure that their life is not distracted even after your injury.
Death Benefits
They are usually given to the immediate surviving family of an injured employee who lost his/her life due to a job-related injury.
Job Displacement Benefits
Your injury might have rendered you incapable of performing at your current job. In that case, you might need to retrain once more to ensure that you can work as efficiently as before. If not, you might need new training to perform at another job if the injury has rendered you utterly incapable of performing at your current job.
Determining Whether You’re an Independent Worker
California law doesn’t include independent contractors under the workers’ compensation coverage. The law doesn't require employers to purchase coverage for independent contractors. The problem is that some employers take advantage of that to list their employees as independent contractors to avoid paying workers compensation premiums and payroll taxes for them. Thus, you might begin the application process for the benefits thinking that your employer has purchased coverage for you, only to realize that you have been an independent contractor all this time.
It is essential to first determine your employment status before beginning the process. Not all employees are sure whether they are independent or dependent contractors under state law. If you are listed as a permanent employee, you will be eligible for compensation. Also, you are not automatically disqualified from the application just because your employer has listed you as an independent employee. Your attorney will consider some factors to determine your status, then take the necessary action if you are a permanent employee and your employer has not purchased insurance coverage for you. These factors are:
- Whether your employer has direct control over the way you perform your duties
- If your employer can fire you from your job
- Are you paid according to the number of hours worked, or on a weekly or monthly basis?
- Is your paycheck subject to some deductions, like insurance premiums or payroll taxes?
- Does your employer control the number of hours you work in a day?
- Do you use your personal materials to perform your job, or does the employer provide everything, including the working space?
If you are an independent contractor, you will answer yes to most of these questions. For instance, you are in control of how you perform your duties if you are an independent contractor. Your employer doesn't dictate your performance as long as you can submit the desired results at the predetermined time. However, if your employer can fire you or requires you to work within a stipulated time, you are a permanent employee and eligible for workers’ compensation. It is advisable to consult with a competent workers’ compensation attorney if you are in doubt.
If it is established that you are indeed a permanent employee and your employer has not purchased workers’ compensation insurance for you, or the coverage your employer has purchased is not enough, the law allows you to file a suit against your employer. If found guilty, your employer could be convicted to jail and subjected to a hefty fine. You will also be able to file a suit against your employer to reimburse your medical costs and lost income due to the work-related injury you incurred.
Note that your employer has to purchase workers’ compensation insurance and pay monthly premiums. Your employer cannot force you to make payments for your insurance coverage; it must not be paid from your paycheck. If it happened, or your employer failed to inform you of your rights to workers’ compensation benefits after a work injury, you can pursue a legal suit against him/her.
An experienced workers’ compensation lawyer will understand all these legal provisions to advise you on your options adequately.
Are There Restrictions on Where You Can Seek Medical Care?
There could be restrictions on where you can seek medical care if you have incurred a work-related injury and would like to pursue workers’ compensation benefits. If your injury was severe, and someone had to rush you to an emergency room, you could go anywhere, but only for emergency medical services. Otherwise, you must receive treatment from a medical professional who your employer has listed under your workers’ compensation insurance. The medical professional must provide a detailed diagnosis with a comprehensive treatment plan. That helps demonstrate the need for the treatment you will receive and justify the length of time you will need to recover from your injury.
Your claim administrator, who is your employer, will also determine the physician and specialists whom you can see and consult for treatment.
As previously mentioned, your claim might take a longer time to be processed, which could delay your treatment. However, you are allowed to claim a maximum of $10,000, which your employer must approve, to ensure that you receive adequate treatment before you receive compensation.
The type of medical treatment you need will depend on the kind of injuries you have sustained. Your workers’ compensation attorney will be with you throughout the process to ensure that you receive the compensation you deserve. Your attorney will also ensure that you receive quality and on-time treatment.
Factors that Could Cancel Your Benefits
Your workers’ compensation benefits will run until you are completely recovered. Some injuries will take a few days or weeks to heal. In that case, you should be able to go back to work soon. Note that you will stop receiving benefits once you go back to work. That is because it shows that you are fully recovered and can now work for your needs.
However, you might need to continue receiving permanent disability benefits if you are still on treatment, even after going back to work. Some injuries take a longer time to heal completely. Otherwise, it will require a lifetime. If you can still engage in gainful employment with the disability, you are free to return to work. You will only receive compensation if you need to continue receiving medical treatment for the disability.
Workers’ compensation benefits are not enough to sustain you for a long time. The law has designed it like that to encourage injured employees to want to go back to work soon after recovery. Going back to work sooner will also help with your recovery. You will not lose more in wages in the long run. However, you might need your doctor’s consent to ensure that your injury will not worsen if you return to work sooner.
You may not be ready to return to your current job after recovery for personal reasons and accept another job offer. If that happens, you will forfeit your workers’ compensation. It is essential to seek the guidance of an experienced workers’ compensation attorney to determine the right action to take in any given situation.
However, it will be illegal for your employer to dismiss you after a work-related injury, even after showing signs of a quick recovery. If you cannot perform at your current job due to an injury, your employer could offer you a more suitable position. You can only refuse the offer if you do not wish to work for your employer again.
Find an Experienced Workers’ Compensation Lawyer Near Me
If you or your loved one has incurred an injury at work in Los Angeles, CA, it will benefit you to find as much information as you can find about the workers' compensation insurance program. That will prepare you for what is ahead and help you file a winning compensation claim. At The Workers Compensation Lawyer Law Firm, our competent team will be with you through the process until you receive a favorable outcome of your case. Our goal is to protect your rights, guide and advocate for you. Call us at 424-501-9228 and together, let us forge the way forward.