Workers Compensation Attorney Law Firm specializes in the field of workers' compensation, serving clients in and around the Los Angeles area. The attorney and legal experts at the firm are well-versed in California workers' compensation law and can handle compensation claim cases related to a work-related injury. When the employer is not taking good care of their workers’ compensation responsibilities, you should not delay in asserting for your rights through an experienced attorney.
What is Work-Related Injury Under California Workers’ Compensation Law?
The California workers’ compensation program protects injured workers by allowing them to file a claim for compensation against their work-related injury or illness. Regardless of who is at fault, an injured worker is eligible to receive workers’ compensation benefits if the injury comes under the category of injuries which can be compensated. The benefits under California workers’ compensation law may include:
- Medical benefits- as under Sec. 4600; paymentsfor treatment of work-related injury or medical condition
- Temporary disability payments- as under Sec. 4650, et seq.; expenses for wages lost during the injured employee’s recovery period
- Permanent disability payments- as under Sec. 4658; expensesfor permanent injuries and loss of earning ability caused
- Supplemental job displacement benefits or vocational rehabilitation- as under Sec. 4658.7; a voucher that helps cover costs related to requiredskill enhancements or job retraining
- Death benefits -as under Sec. 4700; payable to the dead worker’s spouse, children or other dependents that met an illness or injury caused on the job
The most common injuries that occur at the workplace include unexpected slips and fall injuries, repetitive motion injuries,burns or respiratory ailments due to regular exposure to chemicals, machine entanglement accidents, and injuries from traffic accidents. The types of injury risks may differ depending upon the company and industry. For instance, an employee working as an accountant in a firm will have a different set of injury risks than an assembly line worker who works at an auto manufacturing plant.Before you file a claim under the workers' compensation program, you must know if your injury qualifies as a work-related injury or not.
Does Your Injury Qualify as Work-Related under Workers’ Compensation?
If you are pursuingworkers’ compensation benefits, you will have to prove that the injury or illness caused is work-related. According to the Labor Code section 3600, any injury or illness “arising out of and in the course of employment” may be treated as work-related. In simpler words, if you were injured while performing your job, or got hurt doing activities for the benefit of your employer, you are eligible to receive workers’ compensation benefits for such injuries. For instance, if you hurt your back in a fall, got burned by splashes of chemicals on your skin, or met an accident while making work goods deliveries, your injury or illness caused is said to be work-related and you can seek workers’ compensation benefits.
Another aspect of work-related injuries is the repeated motion exposure at work, such as hurting your back, hand, or any other body part of doing the same job again and again. Examples include wrist injury due to typing or losing your hearing ability due to constant exposure to loud noise.
Workers’ compensation may also cover other injuries caused by your job, such as stress-related injuries and occupational diseases. All types of injuries must be communicated to the employer by the employee as soon as they occur, and illnesses as soon as they are diagnosed. As per the California law, an injury that is reported to the employer after the worker is notified of being terminated or laid off from the job may not be coveredunder workers’ compensation. Likewise, there can beother instances that may challenge the worker’s eligibility to seek workers’ compensation benefits. Employees may not be able to acquire compensation benefits under some situations as explained below:
- Injuries that occur during an employee lunch break, like spraining his or her ankle while walking down to a nearby deli to pick up lunch or going anywhere outside the workplace premises for personal work, may not be covered under work-related injury. Alternatively, if the injured worker was involved in an activity that comes under employee misconduct or outside the scope of his regular job, they are typically not covered under workers’ compensation coverage.
- Injuries sustained while at company events may or may not be covered under workers’ compensation, especially if the employer does not expect the employee to be a part of the off-duty event.
- Traveling on a business trip or driving a company vehicle are covered under workers’ compensation. However, injuries that occur while commuting to and from workare beyond workers’ compensation coverage.
- If an employee sustained an injury while violating a workplace safety rule or involved in something that is considered “employee misconduct," such as consumption of alcohol or illegal drugs at work, it prohibits the employee from seeking workers’ compensation benefits.
The next step towards any workers’ compensation claim is to determine whether you are covered or not.Firstly, the injured individual must be an employee, and secondly, the injury caused must have arisenout of or in the course of your employment.
Is Your Employer Required to Provide Workers’ Compensation?
Under the California workers’ compensation law, it is the responsibility of all employers and work situations, even with just one employee, to carry workers’ compensation and secure each employee’s workers’ compensation benefits.Therefore, all employers in California are obligated by law to purchase a workers' compensation insurance policy from a licensed insurer authorized to work in California. A choiceforpurchasing a workers’ compensation insurance policy is also available to some employers. It is to apply with OSIP (Office of Self Insurance Plans) for the self-insurance program.
Under OSIP, if the employer becomes self-insured, the employer’s assets will be used for coverage of all necessary obligations under the workers’ compensation program. In such a case, the employer doesn’t need to purchase an insurance policy from a private insurance agency. A self-insured employer assumes the risk ofoffering the workers’ compensation benefits to the eligible employees in place of paying a fixedpremium to an insurance company.
The employer has to attain authorization from OSIP to gain the status of a self-insured employer. It is, generally, given only to more prominent companies based on their asset value, their planning of delivering benefits, and their loss prevention plan. Even after providing the status of a self-insured (self-funded) employer, OSIP and DWC conduct periodic audits to ensure the employers are meeting the standards and requirements of the program. All self-insured employers are required to timely deliver benefit payments to the entitled employees to maintain their status of a self-insured.
For a self-insured employer, there exist certain reporting obligations regarding the handled on-the-job injury claims. As per the DWC, these employers are liable to submit an annual report which discusses the amount of the compensation claims filed, the total amount of benefits paid, list of all their indemnity claims, and others.
However, only workers classified as “employees” are eligible for such compensation benefits. To be defined as an employee, the worker must be directly employed by the company or work under an individual who does not hold the employment status of an independent contractor.All eligible employees are entitled to workers’ compensation benefits irrespective of the type of employment—full or part-time.For out-of-state employers, it is required for them to provide workers’ compensation coverage for any employees regularly working in California, or if you enter into a contract of employment.
Based on your state, there are certain types of workers, such as domestic workers, agricultural workers, undocumented workers, and seasoned workers, which may not be covered under worker’s compensation. However, California law has a provision for coverage of illegal immigrant workers under the workers’ compensation program. The amount of coverage offered under workers’ compensation may differ from state to state.
When You Do Not Qualify for Workers’ Compensation
If the injured employee’s employment status does not make him or her eligible for receiving the benefits under the workers’ compensation program, it does not necessarily suggest that the employer has no responsibility of his or her on-the-job injury. For instance, an independent contractor’s contract may mandate the use of arbitration for injuries and other disputes. Suing the employer, in place of claiming for workers’ compensation is also possible, but that is rare, and generally, not permitted.
There exist some alternatives to workers' compensation coverage. Some of them include:
- Federal Employees' Compensation Act, which covers non-military federal employees
- Federal Employment Liability Act (FELA), which holds railroad companies liable for worker’s injury, if found negligent in providing a safe work environment
- Merchant Marine Act (also referred to as the Jones Act), similar to FELA, covers seamen from injuries due to employer negligence
- Black Lung Benefits Act, which covers current and former coal miners disabled from pneumoconiosis (black lung disease)
- Longshore and Harbor Workers' Compensation Act (LHWCA), which covers specified employees working under private maritime companies
Employer Duties & Responsibilities
When an employee has sustained an injury at work, some strict procedures must be followed by the employer apart from providing lost wages and rehabilitation opportunities. The specifics of the laws may vary from state to state, but some general obligations apply across the nation.Both the employee and the employer must fulfill their essential responsibilities for a smooth and successful operation of the claim under the state workers' compensation program.
Employers are responsible for providing a safe work environment for their employers and must follow all the safety regulations to avoid workplace injuries in the first place. While it is the first and foremost responsibility of the employee to notify the employer of the caused job-related injury or illness, it then comes under the obligations and protocol as an employer to provide the injured person with a form (Form DWC 1) for filing a workers' compensation claim within twenty-four (24) hours or one (1) working day.The employer must also return a completed copy of the claim form to the injured employee within one working day of receipt.The employer must authorize the injured employer a sum of up to $10,000 for immediate emergency medical treatment to the employeewho has sustained an on-the-job injury, while the insurance carrier reviews the filed claim.Providing first-aid and medical care facilities are the prime responsibilities of any employer, whenever required. Furnishing further medical attentionto the injured employee, such as selecting a doctor, should also be made available by the employer.
The employer needs to create a First Report of Injury, or other similar documents, and forward the completed form to the claims administrator or workers’ compensation insurance company within one working day of receipt.Within the report, an employer needs to include all the possible details about the injury, including the level of injury seriousness, by talking with other employees who witnessed the injury, along with record statements and own thoughts. Any negligence in making the injury report from the employer’s end may be guilty of a misdemeanor, punishable by a fine.
When an employee is injured on the job, and the injury is classified as a permanent disability, your employer has to provide you with reasonable accommodations as part of an employer’s responsibility under California workers’ compensation regulations. In other words, if the disability obstructs your abilities to perform your work, the employer may have tomake special provisions for adjusting your working conditionsby providing suitable facilities.
The employer should inform the insurance company or claim administrator and comply with all further requests regarding any required information about the injured employee.It is also the employer's responsibility to provide needful details to the insurer's attorney if a claim is pursued. Even if the injured employee hasn’t given an official injury notice, the employer may still be obligated to provide the claim form as soon as the injury comes under their notice. The employer should stay in touch with the injured worker as well as the assigned doctor, and support him or her by providing all types of help within the workers’ compensation regulations.
Also, it is the responsibility of the employer, under workers’ compensation law, to report all work-related injuries sustained by an employee, even if the injuries were considered minor as well as injuries that needed a one-time treatment by the medical professional.
Employers should educate all the employeesof the employee’s rights and details of available benefits under their workers’ compensation program. The employer must also post required coverage notices, in compliance with worker’s compensation laws, in a clearly visible location at the job site. The notice must be posted in both English and Spanish languages and should specify all obligations and rights as per the workers’ compensation regulations. Failure to do so may lead to misdemeanor charges against the employer. Every employer is required to provide the newly hired employees withall information regarding the offered workers’ compensation coverage.
Employers Cannot Discriminate
It has been seen that employers often disapprove of employees who exercise their rights under workers’ compensation laws and the employees may be at the receiving end of one or the other form of discrimination at the workplace as a consequence of it. California workers' compensation laws protect injured employees from such retaliating employers through well-established rules under the workers’ compensation regulations. The state and federal guidelines prohibit an employer from discriminating, harassing, or unjustly terminatingthe injured employee.
The injured employee is allowed, under workers' compensation laws, to take civil actions against the employer for retaliatory discharge if he or she feels discriminated against or discharged in retaliation for seeking a workers’ compensation claim. While it is not mandatory for the employee to prove that the filed claim is the sole reason behind discharge from employment, he or she must put up a convincing argument against the jury to prove that the job termination was unfair and unwarranted.Under workers’ compensation laws, the injured employee is also protected against any form of discriminatory treatment, such as salary reduction or demotion from the job status before the injury.
The employer is also responsible for making sure that they do not violate any state-specific laws or rights of the injured employee.Once the worker is deemed physically capableof resuming employment after the injury, the employer must welcome the employee back to the workplace without discrimination. The employer can’t discriminate, terminate or penalize the employee for filing a claim – thiscould lead to further legal repercussions.
Employee injuries at the workplace happen, and it is almost impossible to prevent them in the future. While all accidents and injuries cannot be stopped from occurring, every employer should learn from past incidents and take all steps to reduce the risk of serious on-the-job injuries. Establishing strict protocols in the workplace and providing helpful tips for the new hires may help the employer forming a better workplace—that’s safe and healthy—for the workers.
What Happens If Your Employer Is Uninsured and You’re Hurt onthe Job?
Since all employers in California must carry workers’ compensation insurance by law, an insured employer with no such insurance in place can result insteep sanctions against the offending employer, including criminal prosecution, fines, and expensive litigation. In other words, carrying workers’ compensation benefits for all employees is the cost of doing business in the state and must be provided by all employers.
An injured employee is never good news under any circumstances, but when the employer doesn’thaveworkers’ compensation insurance coverage, the potential consequences may be extremely critical. Lackingto carry workers’ compensation insurance is deemed as a criminal offense that is liable to be punished by a personal fine of up to $10,000 or one (1) year in jail, or both - additionally, the state issues penalties of up to $100,000 against illegally uninsured employers.
When the employer is uninsured and has no funds to cover the workers’ compensation benefits and the resulting bills of the injured employee, the state usually steps in and provides the funding.The state's Uninsured Employers' Benefit Trust Fund (UEBTF)—a state-administered fund within the Division of Workers' Compensation (DWC)—may pay the benefits to workers who sustained on-the-job injury or illness while employedunder an illegally uninsured employer. The UEBTF typically places liens against the assets of uninsured employers to pursue reimbursement of expenditures.
Some uninsuredemployers may underestimate the seriousness of such a negative status due to ignorance of the state laws or believe that a quick settlement can be made later to end the process, but recent studies show that the average claim costs have been continually rising. There are some risks to any insured employer which can be threatening for the continued survival and feasibility of the firm. The uninsured employer may face the possibility of a business shutdown, the California Labor Commissioner may impose hefty fines on per employee basis, or the employer is presumed negligent and loses the legal defense of contributory negligence. In addition to this, an uninsured employer may be exposed to civil action by injured workers, criminal conviction, and personal fines.
Find a Workers Compensation Attorney Specializing in Work-Related Injury Cases Near Me
You will need the expertise and experience of a law firm like Workers Compensation Attorney Law Firm to understand and follow detailed rules and complex procedural guidelines within California’s workers’ compensationsystem.Our firm hasattorneys with in-depth knowledgeon how work-related injury compensation claims work under the workers’ compensation law. We have attorneys who can navigate you through the ins and outs of a work-related injury case and successfully get you the benefits promised under the program. They can argue in your defense as and when the need may arise, keeping your interest in mind above all else. Contact our Los Angeles workers compensation attorney at 310-956-4277 to discuss and get in touch with for a free, no-obligation consultation with our seasoned legal experts regarding your workers’ compensation case.