If you have been or think you may have been injured while on the job for your employer, there is an entire workers’ compensation system in place in California, that your employer and his insurer must legally comply with, that is intended to take care of just such situations. Not every injury nor every type of worker is covered under this system - but almost all injuries, in fact, are. If you neglect to file a claim and pursue fair and full compensation, you are only hurting yourself financially and needlessly making your life more difficult.
At Workers Compensation Attorney Law Firm in Los Angeles, handling any and all manner of workers’ comp claims (the whole process from start to finish) is our number one practice area. We can also assist you with related matters, such as non-workers’ comp covered railroad injuries or lawsuits that go beyond what workers’ comp will pay - but helping you navigate California’s workers' compensation insurance process is, without a doubt, our core area of expertise.
Understanding California’s Workers’ Compensation System
The number one obstacle to getting compensated through our state’s workers’ compensation system is the complexity of the system itself. The sheer volume of regulations governing how, when, and how much an injured worker is compensated is a hopeless maze to the uninitiated. And when your employer, his insurance company, and his lawyers want to “save money” by reducing or denying legitimate claims, an individual injured worker would have a hard time effectively fighting back.
That's why you need a skilled workers' compensation attorney with deep experience across the full range of relevant practice areas fighting on your side. The system, after all, exists for the benefit of workers, not to protect insurers and employers against paying their rightful due. In California, most employers are required to buy workers’ compensation insurance from a state-approved insurer for all of their employees. There are some exceptions, such as for railroad workers who may have other forms of compensation available, but chances are, if you were injured while physically at work OR while off-site performing work-related duties for your employer - it’s covered!
Workers’ comp law provides for fixed monetary awards based on which type of injury is involved, how severe it is, to what extent it creates a disability, how long it puts you out of work, and how high the medical expenses stemming from the accident end up being. Workers’ compensation is a right and a convenience to employees. It normally means you don’t need to go through the process of actually filing a lawsuit against your own employer or a coworker - and this speeds up compensation, saves on court costs, and gives you more confidence you are going to be reimbursed. In certain high-risk occupations, like the construction industry, for example, this type of insurance is especially important. But it applies generally across the board and everyone appreciates it if and when they need it.
Filing A Claim VS Filing A Lawsuit
California workers’ comp law is a no-fault system. This means you can collect for compensation regardless of who or what caused the accident and injury. Even if you or a coworker were negligent - rather than your employer, you still are covered. On the flip side of this, you normally can’t sue on top of collecting workers’ compensation benefits. There are some exceptions to that, however, such as in cases of extreme, gross negligence or if you are filing against the manufacturer or defective equipment that injured you.
In effect, however, the general rule of thumb is that workers’ compensation coverage takes the place of a lawsuit against your employer or coworker. Thus, employers get a benefit out of paying for the insurance, while employees also benefit. When the system works like it’s supposed to, everyone is “taken care of” and the process of receiving needful funds to pay for medical bills and loss of income is streamlined and simplified.
Before the introduction of the present system, an injured worker almost always was forced to sue his or her own employer in the aftermath of a work-related injury - or else just bear it and never get any compensation. For employers with very few employees or in certain select industries or employment setups, that can still be the case. But today, filing a suit against an employer in California is rare unless it has to do with something other than an injury, such as a discrimination suit.
What Does Workers’ Comp Cover?
What is the scope of workers’ compensation coverage in California? As long as you are not in an exempt occupation or a company with a small number of employees, you are covered for a wide range of injury types. These include all of the following:
- Aggravation of a preexisting condition. Even if you already had a bad back, for example, if the performance of your job worsened the condition over time, you still have a valid claim. However, you do have to inform your employer of any preexisting conditions when you are first hired.
- Off-hours injuries. If you are at work, but on break, you are still covered. Those injured in a break room, workplace restroom facility, lunchroom, or even off-site at a company picnic or Christmas party can still file with workers' comp for full reimbursement as usual.
- Exposure diseases. If you develop lung cancer due to long-time exposure to asbestos or respiratory problems due to consistent workplace exposure to toxic chemicals, this is also covered. Gradually being affected by constant exposure to intense noise until you lose all or part of your hearing ability would be another example.
- Stress-related injuries. Sometimes, the strain of work duties takes its toll from day to day until the stress is just too much to handle. Long hours, few if any days off, extreme pressure, and chaotic working conditions may lead to mental or physical injury.
- Repetitive motion injuries. Making the same motions again and again in a factory setting or other work situation can lead to certain muscles being overworked and overstrained. This may lead to carpal tunnel, knee pain, strains and sprains, and other injury types.
- Sudden, accidental injury. This is what most normally think of when they think of filing a workers’ compensation claim - an injury suddenly arising from a specific one-time accident. It could be a slip and fall accident, getting a limb caught in dangerous machinery, contact with toxic and harmful chemicals, or a host of other possibilities.
However, note that there are some limitations on which injuries can be covered by workers’ compensation insurance. If the injury is deliberately self-inflicted or if it occurred because you were intoxicated with drugs or alcohol while at work, you will not likely collect any compensation. If a criminal activity led to your injury, then you can press charges and may not necessarily need to file for workers’ comp - though it could still be a possible route to take.
Most Common Workplace Injuries & Their Causes
Perhaps you are curious as to which injuries are most commonly the basis of a workers’ compensation claim and what are the usual causes of injuries that lead to such a claim being filed. Here is some data to that effect that is rather revealing.
Strains and sprains account for around 30% of all claims, cuts and puncture wounds for 20%, contusions for over 10%, fractured bones for 5%, and inflammations for around 5%. Eye injuries are also somewhat common in manufacturing plants and in the construction industry. Injury types that are less frequent but account for a large percentage of the money paid out each year by workers’ compensation insurers include dislocated joints, amputations, electrocution, traumatic injury to head or body, and injuries where multiple bones are broken at the same time.
What are the most common causes of work-related injuries? Handling materials account for about a third of all claims, slip, trip, and fall accidents for around a sixth, collision with or being struck by an object accounts for about a tenth, injuries related to the use of tools and equipment for 7%, and gradual injury via body trauma and strain over a period of time for around 5%. In the construction industry, fall injuries are especially common, while vehicle-related accidents are frequent in the oil and gas industry. Each occupation has its own set of special dangers and risks.
Steps to Take If You Believe You Have A Valid Claim
Don’t hesitate to reach out to us for assistance if you even suspect you may have a valid workers’ compensation claim! Don’t risk missing out on benefits that are rightfully yours and instead suffer financially. The first step is to report the injury to your employer, in writing. Get a copy of the injury record for your files if at all possible. Your employer should then offer you a workers’ comp claim form without delay - if necessary, ask for one, but you shouldn’t even have to under California law.
You may want to call a good lawyer even before filling out the claim form, but be sure to fill it out completely and with adequate detail so your claim won’t be delayed. Your employer is not obligated to process your claim until you fill out and turn in the claim form - simply telling your employer verbally is not enough. Upon receiving the form, the employer must immediately move to notify his workers’ compensation insurer of the claim.
Your insurer should immediately provide coverage for treatments you need right away, but they will still have an opportunity to decide to approve or disapprove the claim. If the insurance company denies your claim or tries to reduce it, you can file an appeal. Many times, there may be a dispute as to where the injury occurred or when, how severe it is, or what kind of medical treatment you really need. This is where the "clout" and expertise of Workers' Compensation Attorney is indispensable: we know how to fight back and ensure you receive all benefits you are entitled to, and we have a long track record of winning bigger settlements and faster than does our competition!
Options in Workers’ Compensation Settlements
The majority of workers’ comp claims get settled out of court. We are skilled at presenting evidence and arguments in your favor in a courtroom setting if necessary, but more often than not, this isn’t even necessary. The employer and insurer usually come around to reasonable terms once a skilled workers’ comp lawyer is “in your corner.”
But there are two major types of settlements you need to be aware of: stipulated finding & award VS compromise & release. If both sides are willing to admit that the proposed settlement amount is better than the likely outcome of a jury trial, then one of these two settlement options will be pursued.
The amount of compensation will be determined by adding up all medical bills stemming from the injury, including loss of income and pain and suffering, and considering the disability rating. The disability rating is a percentage that indicates how far a person was disabled by an injury. A permanent total disability would have a rating of 100%. Lost earning capacity, age, and severity of injury all play into the equation. Temporary disabilities can be covered too, but wouldn’t receive as big a claim as would permanent ones. To save time and money and avoid “bad press,” it is in the best interests of employers to comply with reasonable settlement offers - no less than it lies in employees’ best interests as well to settle out of court.
Stipulated Findings & Award
When all parties can agree to the appropriate disability rating, you likely will be looking at a stipulated findings and award style settlement. This entails a setting forth of agreed-upon facts (“stipulations”) to the presiding workers' compensation judge. This set of facts includes the disability rating, that the injury occurred at work or at least counts as work-related, and in some cases the degree to which work-related factors caused the injury as opposed to non-work-related factors.
Since both sides agree to these stipulations, the judge will not need to discern and decide upon them himself. He or she will simply accept them and make them the basis for the award to be granted. However, the judge can still reject the stipulations if he finds them to be unfair or out of order or if one side contests them. Employers seldom can successfully appeal any award based on agreed-upon stipulations.
The award, in this type of settlement, will generally be a specified dollar amount to be received by the injured party in two-week intervals for a specific period of time. In some cases, a lump sum amount or retroactive payments may apply instead of or in addition to the regular payments. When the injured employee faces financial hardship, especially one caused by the injury, an initial lump sum may be awarded, to be followed by biweekly awards.
When there is a permanent or long-term disability that will incur ongoing medical expenses for the foreseeable future, a stipulated findings and award settlement is usually used to ensure that the injured party can continue to pay all relevant medical bills and meet his or her living expenses. If disputes arise over whether certain treatments were really necessary, then that is a time when a lawyer may need to come to your defense down the road in such an agreement. Or, if your condition gets worse and you need additional care, you may have to renegotiate the award to ensure it truly meets your needs going forward.
Compromise & Release
The major alternative to a stipulation and award settlement is called a compromise and release. In this case, a specific total amount of money is decided as the appropriate compensation and then paid out in one lump sum. At that point, the whole case is resolved and finished. This eliminates the obligation of the employer or insurer to pay for any ongoing medical treatments, and thus, you should only seek this type of settlement when there is no reasonable reason to expect the injury will require a significant amount of unforeseeable future medical care.
The two parties can come to an agreement (“compromise”) on their own, but workers’ compensation court judge must still review it and approve it. If you are not represented by an experienced workers’ comp attorney, the judge may worry you are not getting your best deal and may decide against approving the compromise. A good lawyer will get you your fullest possible claim and not let insurance companies fool you with a take it or leave it low-ball offer.
It is important to make sure that the settlement stipulates exactly which injury is concerned. Some insurers and employers may try to deny future claims after a settlement otherwise, but only specified and directly related injuries are to be included in the agreement.
The chief advantage of a compromise and release settlement is that the injured party gets his or her reimbursement in full in relatively little time. This means you can pay needful bills without delay or invest some of the money so it bears interest while you wait for the proper time to spend it. You may also get a bigger overall settlement with this method, besides the fact that it brings closure to the whole issue. On the other hand, if your injury incurs future medical expenses that you can’t get compensated for because the claim is already done and finished, it is possible one could regret choosing a compromise and release form of settlement.
Which type of settlement to choose involves many complex factors related to your specific situation, both medically and financially. We at Workers’ Compensation Attorney have deep experience in assessing those factors and helping you make an informed decision on whether to opt for stipulations and awards or a compromise and release type of workers’ compensation settlement agreement.
What To Expect When You File Your Claim
In most situations, you will go through a three-step process in filing a workers’ compensation claim in California. You need to report the injury to your employer and obtain and fill out a claim form within 30 days of the date of injury. If the injury occurred due to cumulative trauma or stress, then the clock starts ticking on the date when you knew or should have known, that the injury both existed and was likely caused by your work activities. This normally happens when a doctor diagnoses your medical problem and indicates it is likely work-related.
The first step then is to report the injury, while the second one is to file an actual claim through your employer. These two steps should occur in quick succession as soon as possible following the injury. And your employer needs to give you a form to fill out within 24 hours of reporting the injury.
In most cases, you will also need to file an appeal with Workers’ Compensation Appeals Board, which technically is called “applying for adjudication of the claim.” You might get away with being a little late or stumbling initially a bit at the paperwork in the first two steps, but not in step three. If you fail to file your appeal properly by the deadline, you could lose your right to your claim. This is where relying on an expert workers’ compensation attorney is especially critical.
Searching For A Top-Tier Workers’ Compensation Attorney Near Me?
If you are searching for a top-tier attorney to handle your workers’ compensation claim in Los Angeles or anywhere in Southern California, look no further. We have successfully helped numerous past clients secure settlements they were fully satisfied with and we stand ready to do the same for you!