Workers' compensation laws outline employees' benefits if they suffer work-related injuries. These statutes also define the procedures for obtaining these benefits. Under California laws, every business must have a workers' insurance policy. While injured workers merely need to file a claim and not necessarily file lawsuits against their employers, seeking legal aid is necessary to ensure you receive maximum compensation. If you need help filing a claim, turn to The Workers Compensation Lawyer Law Firm. We will review the circumstances leading to your injuries; educate you about the benefits you deserve and how to ensure you obtain them.
California has complex laws that define the injuries and illnesses eligible for compensation under the scope of your employment. Because the "scope" of work is a broad phrase open to interpretation, you should not automatically assume you are not entitled to benefits if an injury happens outside your workplace. A knowledgeable Los Angeles attorney can study your situation and provide personalized guidance on the best course of action.
Understanding Workers' Compensation Laws
Workers' compensation laws offer an essential safety net for the employees of businesses and companies in California. The statutes ensure that employees injured on the job receive financial awards without having to file lawsuits against their employers or coworkers.
Because workers' compensation follows a no-fault system, employees have coverage for work-related injuries, irrespective of whose negligence caused the damages. However, it is sometimes possible to file personal injury lawsuits, especially if a claim involves a third party.
For instance, you can file a workers' compensation claim and still file a civil action lawsuit against the manufacturer of the faulty machine that caused your injury. While some employees distance themselves from third-party claims filed by their employees, they may be involved when dealing with serious claims. This allows the employer and workers' compensation insurer to recoup payments previously made to cover an employee's damages.
California laws require even employers of one employee to have workers' compensation insurance. If they violate the law, an employee that suffers work-related injuries or illnesses can bring a civil claim against them and seek compensation.
Injuries and Illnesses Eligible for Workers' Compensation
Under workers' compensation laws, an employee is eligible for compensation even if they bear the fault for causing an injury or an accident. However, some regulations and limitations make some cases ineligible for compensation even if an injury happened within the work premise or site. Because not all cases are clear-cut, you must consult a dedicated workers' compensation attorney who can help you understand your eligibility for benefits.
Some of the injuries and illnesses that qualify for worker's compensation benefits include:
Workplace Injuries
You are eligible for workers' compensation if a skip, fall, or trip within your workplace results in severe injuries or death. The policy covers incidents inside the work premises or outside on the floors, sidewalks, walkways, or parking lot.
Moreover, you are entitled to compensation if an injury happens over time because of prolonged activities like lifting heavy items or standing for extended hours. Common concerns from engaging in certain activities for prolonged periods include back and neck pains, leg injuries, varicose veins, and knee and hip problems.
Also, based on your position in a business and the roles that come with it, you could be entitled to compensation if you suffer a stroke or heart attack. Some jobs can trigger medical concerns that lead to weight gain, hypertension, or even heart problems. It takes a knowledgeable attorney to study the specifics of your case and advise whether your injuries qualify for workers' compensation.
Burn Injuries
Burn injuries from workplace fires, explosions, or heating sources can cause severe pain, disfigurement, or death. These injuries are classified into four levels depending on the severity. While first-degree burns include minor injuries that only affect the first layer of the skin, fourth-degree burns are so severe that they can cause amputation or death.
You could need extensive medical care if you suffer injuries through thermal contact with a heat source, electrocution, or chemical burns. Unfortunately, it is typical for insurers to deny the need for crucial procedures that can help you regain your confidence after an incident. Your attorney can help fight for your best interests and ensure you receive benefits to allow seeking the degree of treatment you deserve.
Cumulative Trauma Disorders
If your job involves repetitive motion, any cumulative trauma disorder that causes concerns like carpal tunnel syndrome is covered under workers' compensation. Cumulative trauma disorders arise from ergonomics and overuse of particular body parts. They can cause severe injuries that often hinder employees from continuing their duties, even after treatment.
For instance, Carpal tunnel syndrome is caused by repetitive stress on the wrist. The condition's primary symptoms are pain and mobility concerns primarily caused by nerve issues. Depending on the severity of the problem, an employee can develop trouble maintaining proper posture at work and have issues gripping objects or typing.
You should file a claim if repetitive motion while enhancing work productivity has led to overuse injuries in any area of your musculoskeletal system. This is irrespective of whether a concern stems from a desk job or other duties like the regular use of a power tool. The most crucial step to ensuring you obtain compensation is to prove that an injury exists and your job caused it.
Injuries and Illnesses Stemming From Occupational Exposure
Also, any damages arising from the conditions under which you work are eligible for compensation. It could be health concerns related to exposure to chemicals, unfavorable temperatures, or high noise levels. These conditions include but are not limited to asthma, cancer, lung disease, allergic reactions, and hearing loss.
Assault at Work
If you are a victim of a violent crime at your workplace, you should file a worker's compensation claim. An incident can leave you nursing injuries after being shot, struck by an object, or physically attacked by a customer or a coworker. As long as you were not the initial aggressor during an incident, you are entitled to benefits to help you seek quality medical attention without further financial losses from missed workdays.
Auto Accidents
Workers' compensation also covers injuries outside the work site, provided an employee was on duty and fulfilling work-related errands. Therefore, you should file a claim for accidents when driving between work sites or on your way to work meetings or training.
Unfortunately, workers' compensation does not cover injuries caused by accidents during the usual commutes to and from work. Moreover, you are not eligible for compensation if an accident happens while running personal errands during a work-related tour. Before you can obtain benefits, your employer's insurer will confirm that you were driving within the course and scope of your employment.
If you have suffered injuries following an accident as you performed work-related duties, you can file a workers' compensation claim and a civil lawsuit against the at-fault third party.
Pre Existing Conditions Aggravated By Work
You could claim workers' compensation if you had a preexisting health concern aggravated by work-related duties or an injury sustained at work. The insurance will only provide benefits until your condition returns to its level before the aggravation.
You stand a better chance of obtaining compensation if you can prove that the following is accurate:
- You had a preexisting condition
- Work-related duties worsened the condition
- You require medical attention or sick days to recover from the aggravated medical concern
If your work has aggravated a pre existing injury, you must prove that:
- A current work-related injury has increased your disability, or
- The recent injury forces you to seek additional medical care, or
- You need a new treatment plan because of the aggravated injury
Psychiatric Injuries Stemming from Work
It is possible to benefit from workers' compensation for psychiatric injuries caused by or increased by work-related duties. For instance, you can file a claim if you can prove that you now suffer from depression because of enduring constant harassment from your supervisor.
Unfortunately, you do not qualify for compensation if you cannot prove that your job is the "predominant" cause of your psychiatric injury. The law also allows insurers to disqualify any damages caused by stress inflicted by acts of good faith. Furthermore, you are ineligible for workers' compensation if you only report psychiatric injuries after being terminated from your work position.
Injuries and Illnesses Not Covered Under Workers' Compensation
Workers' compensation policy providers always investigate claims before approving or denying them. The circumstances leading to your injuries or illness will significantly dictate whether you qualify for compensation. Generally, your claim can be denied if:
- You lack sufficient evidence to show that you suffered an injury
- You cannot prove that an injury was work-related
- Your injury was not enough to warrant any medical attention
- Your injury does not hinder you from performing your work duties
- You suffered injuries while disregarding safety procedures or company policies
Furthermore, workers' compensation does not cover the following:
Off-Site Injuries That Happen During Breaks
If you have breaks within a company's premises, it is possible to obtain compensation for injuries in the cafeteria or break room. However, if you go off-site for meals or rest breaks, any damages cannot be compensated under your employer's workers' insurance policy. The only exception is if you were off-site handling business-related errands.
After-Hour Injuries
You could still be eligible for compensation if an injury occurs within the work premises after you clock out. For instance, you can file a claim for damages suffered at the parking lot. Unfortunately, you do not qualify for compensation for accidents once you leave the business premises.
Off-Site Injuries During Recreational Activities
Workers' compensation covers off-site injuries within the scope and course of employment. However, it does not cover errands outside your work duties, including regular commutes to and from your workplace. Also, coverage does not extend to recreational activities or social events like happy hour, company picnics, or holiday parties.
If you have suffered injuries during a "work-related recreational affair," you can still obtain compensation. However, you must prove that attending the recreational event was necessary and your attendance benefited your employer. Workers' compensation does not cover events an employee attends voluntarily and solely for their benefit.
Injuries That Happen While Intoxicated
Workers' compensation policies categorically exclude injuries to employees intoxicated by alcohol or drugs. The laws consider these injuries non-occupational and ineligible for compensation. The only exception is if you can prove that the accident that caused your injuries were not your fault and you could not have avoided it even if you were sober.
You must not assume that you do not qualify for compensation merely because you were intoxicated during an accident. It is crucial to talk to an experienced workers' compensation lawyer who can consider your case's facts and provide guidance from a professional legal perspective.
Injuries Caused By Workplace Fights, Horseplay, or Practical Jokes
Workplace fights and horseplay do not fall within the course and scope of employment. Therefore, workers' compensation will not offer benefits for injuries that happen while making practical jokes within the business premise. The only exception is if you were an innocent bystander that got injured during ongoing horseplay by your coworkers.
Likewise, coverage does not extend to workers who get into altercations. The only exception is if you were the victim in a fight you did not provoke. You can also obtain benefits if a coworker attacks you as you perform or because you perform your duties. If the cause of a fight is not work-related, you are not eligible for compensation. For instance, your claim will be denied if you get physical over your preferred political candidate.
Workers' compensation laws are complex and have numerous rules and exceptions. If your employer's policy provider denies your claim, contact a skilled attorney for a thorough case analysis. Depending on the specifics of your case, you could still have a good winning chance if you file an appeal. Your best chance of winning the claim is to seek proper legal guidance and representation.
What Is My Workplace Accident Compensation Claim Worth?
Each workers' compensation claim is unique. Various factors will influence the level of benefits you are entitled to. These factors include:
- The severity and extent of your injuries
- Whether you have to stop working temporarily or permanently
- The chances of making a full recovery
Depending on the specifics of your case, you are entitled to the following benefits.
Medical Benefits
The law sets the minimum coverage requirements to ensure employees injured at work receive essential medical care. Workers' compensation covers up to $10,000 in medical bills, provided you have filed your claim. This is irrespective of whether the claim is still pending or will ultimately be denied. Under California Labor Code Section 5402, insurance companies have 90 days to notify claimants about denied claims. The law presumes your benefits are approved if you do not receive a notification within the allowed timeframe.
If you have suffered a workplace injury or contracted a disease because of your work environment, the medical benefits obtained must be sufficient to allow you to receive reasonably necessary treatments. Some of the bills covered include hospitalization, doctor, and prescription bills. Moreover, you should receive compensation to obtain the necessary medical supplies and equipment. Workers' compensation should also cater for up to 24 therapy sessions, which could involve seeking chiropractic care, occupational therapy, or physical therapy.
If you need treatments not considered medically necessary, you must seek authorization from the involved insurance company. The company will do a utilization review and either approve or deny a treatment recommended by your doctor. A competent attorney can help fight for your best interests by using the law to pursue the insurance company to approve the treatments you deserve to recover.
Temporary Disability Benefits
If you cannot resume working temporarily and have to miss work for three or more days, you are entitled to temporary disability benefits. These benefits will only replace a portion of your income when you cannot work because of a work-related illness or injury.
Like medical benefits, the laws also subject temporary disability benefits to minimums and maximums. These figures change over time depending on the state of the economy. For instance, the temporary disability benefits in 2019 ranged between $187.71 and $1,251.38 weekly.
Employees entitled to temporary disability benefits receive up to two-thirds of their regular income as they take time off to recover. These benefits remain available for a maximum of 104 weeks or two years.
Permanent Disability Benefits
If an injury or illness leaves you permanently unable to work, you are entitled to obtain permanent disability benefits. Your doctor must determine that your current state impacts your ability to work and has no chance of improvement in the future. The practitioner will also provide a report that will enable your insurer to give you a permanent disability rating that will be instrumental in calculating the overall value of your permanent disability benefits.
If the insurance approves your permanent disability benefits, you will receive up to two-thirds of your salary. However, the amount received will also depend on the minimums and maximums set by law.
Supplemental Job Displacement Benefit
Sometimes, an injury or illness arising from the course and scope of your employment can leave you partially disabled. While you could still work, your current health can hinder you from resuming your old position. The law allows your employer to offer a modified post within 60 days of receiving a doctor's report.
If your employer fails to offer a modified position, you are entitled to obtain supplemental job displacement benefits of up to $6,000. The money ensures you can pay for new training and certification, allowing you to transition into an alternative job where you can perform your duties despite the partial disability.
Death Benefits
If a workplace accident leads to the death of an employee, death benefits are available to the spouse and dependents of the deceased. These benefits help cover the funeral expenses incurred. The insurance company will consider numerous factors, including the age of the deceased employee and the factors that led to their deaths. Based on these factors, a unique formula is devised for calculating the death benefits that the qualifying beneficiaries can obtain.
What to Do If You Are Injured On the Job
Taking the proper steps after a work accident is essential to ensuring the insurance company approves your claim. If you are unsure about the appropriate procedure for filing a claim or need assistance, seek the help of an experienced workers' compensation attorney.
Generally, here is what you should do:
Report the Incident
You must report an accident to your employer immediately and mention the injuries you have sustained. Preferably, do it in writing and keep a copy of the report for future reference.
Complete the Claim Form
The law requires your employer to provide a claim form immediately after you report an injury or work-related illness. It is crucial to complete the form correctly to avoid the risk of a claim being denied or delayed. Keep one copy of the completed form and submit the original copy to your employer. The law requires your employer to notify the workers' compensation insurance company immediately after you hand over the completed claim form.
It is imperative to note the risk associated with taking your time to complete the claim form. Typically, any delays on your end can increase the risk of more delays from the insurance company. If disputes arise about the claim and your entitlements to benefits, you should contact a skilled workers' compensation attorney for reliable assistance. The expert will study your case and fight to defend your rights and best interests.
Find a Workers Compensation Attorney Near Me
Whether you work in an office building or a construction site, you risk sustaining an on-the-job injury or illness that requires medical attention. Some injuries can even leave you permanently or temporarily disabled. At The Workers Compensation Lawyer Law Firm, we understand how quickly bills can pile up after suffering injuries or illnesses while performing your duties. If a Los Angeles insurance company has denied your claim or you are unsure whether your case qualifies for workers' compensation, call us at 424-501-9228 for personalized guidance. We will be happy to offer a free consultation and answer any questions you have.