If you work in California, your employer is required by law to pay your workers' compensation benefits. This benefit covers one event occurring at work such as hurting your back as a result of a fall, if you should experience a burn caused by a chemical spill, getting injured in an auto accident while on the job performing your regular assigned duties or other job-related injuries which occur while you are on the job.
Workers' compensation benefits are also due if you develop a disability or injury from repeated exposures at work. Examples of these injuries would be damaging your hand and the ability to use it in a typical fashion due to repetitive movements required from your job duties. Other examples would be psychological issues developing from the work you perform.
These injuries whether as a single event or from repetitive movement or exposure must be reported while you are actively employed. Workers' compensation claims cannot be filed after an employer terminates your employment or lays you off from work.
What are Workers' Compensation Benefits?
Temporary Disability Benefits
If you are unable to work due to an injury suffered on the job and it prevents you from performing your work responsibilities, you are entitled to payments while recovering. These payments will be made through workers' compensation program.
Permanent Disability Benefits
If you are unable to recover from an injury sustained while working at your job, you are entitled to payments. When your doctor confirms you are unable to recover from the damages you suffered from an injury at your employment, you are entitled to payments through workers' compensation insurance.
When you suffer from an injury while performing your work duties, your employer is required to help you recover. This help includes visits to the doctor and any treatments prescribed, as well as tests, medicines, equipment and any reasonable costs associated with travel to treat your injuries.
Supplemental Job Displacement Benefit
If you are unable to perform your job and find it necessary to be retrained for another position, Supplemental Job Displacement Benefit will provide you with a voucher to help pay for skill enhancement or retraining. This benefit is available when your employer does not offer you an option for another position, or you cannot return the industry where the injury occurred.
If you are involved in an accident at your workplace which results in your death, this program will make payments to your spouse, children, or other dependents.
Can I See my Regular Doctor and Still Receive Benefits?
In order to have the option of seeing your regular doctor when you sustain an injury at your workplace, you have to predesignate the physician. This procedure requires you to inform your employer in writing- the name and address of your personal physician or medical group.
Your employer must have this information in their files prior to you being injured on the job in order to use their services under Workers Compensation Program. To predesignate your physician:
Use form DWC Form 9783 which can be found at the Division of Workers' Compensation, or your employer may have one on file. If your employer has a contract with a health care organization, you will be required to use a different form.
Include this information on the form:
- The name of your employer
- A written statement that explains if you are hurt on the job, you designate your personal doctor to provide your medical care. List their full name, address, and phone number
- List your full name
- Sign and date the form
The physician you list must be a general practitioner, pediatrician, internist, OB-GYN, or a family practitioner. You are also able to predesignate a doctor of medicine or doctor of osteopathy if they have treated you in the past and have access to your medical files.
Chiropractors or acupuncturists cannot be predesignated. You can provide your employer with these doctors’ names in the same manner as a general practitioner before suffering any form of injury. By listing these doctors with your employer prior to sustaining an injury, you may be allowed to switch your treatment care to them after filing a claim. You would first be required to see a doctor chosen by a claim’s administrator, but can then request to switch back to your personal choice.
You can also predesignate a medical group if it is comprised of licensed doctors of medicine, offers and coordinates primary care and specialty care as well as mainly treats medical conditions not related to work injuries. This medical facility must agree in advance as well that they are willing to treat you for injuries or illnesses that could occur at your workplace. This agreement can be submitted in writing by having the physician, an employee of the physician or employee of the medical group sign the predesignating form.
You can only predesignate if you have health care coverage prior to sustaining an injury that is not related to work. If you do not have health coverage separate from your employer's program (if available), you cannot predesignate.
What if my Employer has a Contract with a Health Care Organization?
There are different rules to predesignate your personal physician if your employer has a contract with a health care organization. These care organizations are certified by the Division of Workers' Compensation to give you managed medical care if you are injured on the job. If your employer has a contract with a health care organization, they must provide you with a DWC Form 1194 within 30 days of your hire date for you to pre-designate your doctor.
This form will allow you to pre-designate your personal physician as well as your personal acupuncturist and chiropractor. This process does not require you receive prior approval; however, if you do not predesignate each time it is given to you, your employer can enroll you in the health care organization they have a contract with where you will be treated for job-related injuries.
What Happens If I am Hurt at Work, or Develop Work-Related Illness?
You have to notify your employer or someone in management as soon as possible if you are injured on the job, or develop a work-related illness. If the injury slowly develops such as tendinitis or loss of hearing, report it as soon as you are diagnosed.
By reporting the condition as soon as possible, you will avoid any delays in receiving compensation or medical care. If you do not notify your employer within 30 days, you take the risk of losing your right to workers' compensation benefits. If an injury occurs that requires immediate medical attention, call 911 or go to the emergency room. It is your employer's duty to ensure you have access to emergency treatment right away and may advise you where to go to seek treatment. When you are admitted into the emergency care unit, you need to tell them your injury is work-related.
If you or someone you are close to has suffered an injury on the job or developed an illness related to the work being performed, you are entitled to workers' compensation benefits. Employers and insurance companies may try to deny you these benefits and make claims you have not followed proper procedures. If you have been denied coverages, contact an attorney. Insurance companies have attorney's working for them, and you deserve legal representation to ensure you receive the benefits you deserve.
As a worker in the State of California, you are entitled to:
Your medical care being paid by your employer if you are hurt on the job even if it means you will be missing time from the position.
Even if you are a temporary or part-time employee, you are eligible for workers' compensation benefits.
If you are an independent contractor, you may still be covered by workers' compensation benefits.
Even if you are not a legal resident of the United States, you are still eligible for workers' compensation benefits.
It does not matter who was at fault for the injury, if it occurred at your workplace, you are entitled to benefits.
In most cases, you are not able to sue your employer for job injuries.
Your employer cannot fire you or punish you in any manner because you have had an injury at work. Your employer cannot hold it against you personally or through work-related consequences for filing a workers' compensation claim.
If you have found any of these conditions violated by your employer, contact an attorney. You are protected by law, and it is your employer’s duty to follow all regulations in place by the State of California to provide you with proper workers' compensation benefits.
How to File a California Workers' Compensation Claim
If you work in the State of California and are injured at your workplace, you should let your employer know right away, or as soon as possible. You should also seek medical attention immediately. When you are able to speak with your employer regarding the injury, they will provide you with a claim form to fill out for workers' compensation benefits.
Contact the California Department of Industrial Relations' Division of Workers' Compensation once you have filled out the form. Advise them of your situation and that the claim form has been submitted to your employer. Your employer is responsible for sending the claim to the proper insurance carrier. Under California law, you are granted up to $10,000 for medical treatments within one day after turning the claim form into your employer.
Workers' compensation insurance carrier will notify you within 14 days regarding your claim. They can deny, accept, or delay your benefits. If they delay your benefits, they will be conducting an investigation into your injuries. The insurance carrier is allowed up to 90 days to complete the investigation.
If you have not received a response from the insurance carrier after 90 days, or they deny your claim, you should contact a worker's comp lawyer to ensure your application is given proper consideration. A worker's compensation lawyer understands the legal process followed for your claim and will make sure you are given fair consideration.
What is an Independent Medical Review and When Can I Request One?
If a claims adjuster has determined your treatments are not medically necessary and denies your claim, you can request an independent medical review (IMR). You or your attorney can make this request if your treatments are denied completely or modified by the claim’s administrator. An IMR is a quick, non-judicial, independent medical review designed to resolve disputes regarding your medical procedures.
Maximus is an independent medical review organization designated by the AD (administrative director) to perform IMRs. This organization is comprised of medical professionals who have undergone rigorous qualification and conflict of interest standards. The costs of conducting an IMR are required to be paid by the claims administrator and are based on the nature of the dispute. These costs are significantly less than the price to resolve a conflict through litigation.
Only you or your attorney is able to request an IMR by submitting an application and mailing it within thirty days of the utilization review determination. The form DWC Form IMR along with a copy of your denial needs to be submitted. Check with your attorney on how and where to send this information. The administrative director (AD) uses these criteria to determine whether or not your dispute is eligible for an IMR:
- Did you fill out and file the form in a timely manner? They also verify you have signed the form and included a copy of the denial decision
- Do you have any previous requests on file for an IMR?
- Is there a dispute regarding the liability for an occupational injury present from the claims administrator?
- Is there additional information necessary in order to determine that the disputed treatment is eligible for IMR?
Having legal representation through this process is to your benefit. Filing for an IMR can be a confusing and stressful process. With the help of an attorney who understands the laws governing your workers' compensation benefits, you will work this process much quicker and easier. When your request for an IMR has been granted, you will receive notice within one day of the ADs finding of whether or review will be regular or expedited.
A regular review means your documentation must be provided to Maximus within fifteen days of the date designated on the mailed notification or within twelve days of electronic notice.
An expedited review means your documents must be given to Maximus within the next twenty-four hours following receipt of the notice.
Either notice received must include Maximus name and address, an identification of the medical dispute and the date their office received the DWC Form IMR-1.
Being injured on the job and having to seek medical treatments to heal if a difficult time. Let an experienced workers' compensation attorney help you with any legal conflicts that may arise so you can focus on improving your health. The attorney will understand the process and ensure you have all your documents ready and they are sent to the proper address with correct forms. You deserve this benefit and workers' compensation attorney will make sure your rights are protected.
Why Should I Hire a Workers' Compensation Attorney?
You will need all the advice possible if you've been injured at work, or begin feeling ill from a work-related condition. A California Workers' Compensation attorney will learn your specific and unique situation and know the best possible way to pursue the compensation you deserve.
Workers' Compensation attorneys will help you understand the worker's comp program, and how it will relate to your injuries or illness. To begin, you need to have full insight as to what your injuries are and how they will affect your ability to live and work. You and attorney will determine your specific situation, what your expenses will be to deal with treatments, whether or not you are considered disabled, and what your individual needs are as a result of this injury or illness.
Your workers' comp attorney will discuss your needs and advise you as to what can be expected from filing a claim. They will help you understand the process and let you know which laws and regulations will protect your rights to receive the compensation due you. Your attorney is able to research your employer and their insurance provider to determine how to calculate the rate of your temporary or permanent disability payments, so you know what to expect when your claim is filed.
Filing a workers' compensation claim sometimes affects the relationship you have with your employer. Your attorney can speak with you about this situation and tell you how it may impact you after the claim is filed. The tension or complications that may arise are not a reason for you not to file the claim. Talk with an attorney and discuss your options if this situation occurs with your employer and find out what your options are should you suffer any work discrimination at your workplace.
Workers' compensation laws can be difficult to understand. These benefits are governed by state workers' compensation acts and federal statutes, so if an employee is injured on the job, they are given fixed awards. The statutorily-prescribed awards will allow you, as an injured employee, to receive compensation without having to pursue legal action against your employer. There are different state acts in place depending on which state you work in, and different type of worker covered benefits, so having an attorney working with you through this process will significantly benefit you in understanding the process.
An attorney can represent you and help you to obtain your benefits. Should any dispute occur from your workers' compensation claim, your attorney can:
- Make sure you have all necessary medical evidence to present on your appeal
- Take depositions of medical experts and physicians regarding your medical condition and needs
- Conduct Discovery (interrogatories, write questions your employer or insurance carrier must answer, depositions or other necessary preparations for your defense in needing workers' comp benefits)
- Perform legal research relating to your case
- Draft findings of fact, pleadings, prepare motions, briefs, and other legal documents
- Litigate before workers' compensation judge
Your attorney is on your side. They have a full comprehension of the claims filing process and compassion for your injuries and the difficult time you are experiencing. Your attorney will represent your interests at any hearings that pertain to receiving your benefits and ensure you receive the proper medical treatments necessary to restore your health.
Is There a Los Angeles Workers Comp Attorney Near Me?
If you or someone you care for is facing difficulties with workers' compensation benefits, contact Workers Compensation Attorney Law Firm at (310)-956-4277. Our attorneys have the experience and knowledge working with the courts to ensure your rights are protected. As a workers' compensation attorney, we will help you recover compensation for injuries sustained on the job by seeing your medical costs are covered as well as lost wages.