Workplace injuries are commonly associated with high-risk work environments, such as those in the construction industry. It is true that more than 20 percent of serious workplace accidents resulting in death are in the construction industry. Other known high-risk industries include utilities, manufacturing, maritime services and more. However, workplace injuries occur in all environments and may occur at any time. An office worker, for example, may slip on a wet floor or develop carpal tunnel syndrome.
If you have been affected by any type of workplace injury, you may face an extreme financial burden. Even something as seemingly minor as a data entry specialist being diagnosed with carpal tunnel syndrome may result in the need for surgery, physical therapy and time off of work. Serious injuries may require several surgeries, long periods of hospitalization, the inability to continue working in the same position and other financial impacts. If this is the case, you may need to be retrained to work in a new position or field. This can create an additional financial burden. Some injured workers also have PTSD or other emotional trauma from the incident that requires medical treatment.
You understandably need to obtain the full amount of compensation that you are entitled to when dealing with any type of workplace injury. Benefits may be available through workers’ compensation and a disability claim. Understanding how worker’s compensation and disability benefits differ is an important first step to take after being injured at work.
The funds available to you through workers’ compensation and disability benefits are limited. Furthermore, any funds received through workers’ compensation can impact the amount of disability benefits that you qualify for and your ability to file a civil lawsuit against your employer. Because your ability to obtain the maximum amount of benefits or compensation available to you is essential to your financial well-being going forward and even to your ability to obtain necessary medical care, you must proceed confidently and strategically.
The first step involves learning how worker’s compensation differs from disability benefits so that you can determine how to proceed while also obtaining the maximum benefits available as soon as possible. At the same time, you must focus on the implications of filing claims for these benefits and focus on timing restrictions.
Understand Workers’ Compensation Benefits
In California, employers are compelled to maintain workers’ compensation insurance regardless of the size of the business or the type of work environment. This means that you should be covered by a worker’s compensation insurance plan through your employer. This type of employer-paid insurance provides financial compensation for:
- Lost wages
- Job training or rehabilitation
- Partial, total, temporary or permanent disabilities
- Medical expenses related to workplace injuries
Some California workers are not aware that filing a workers’ compensation claim requires the mandatory relinquishment of the right to sue the employer for damages. Workers’ compensation benefits should fully cover all expenses related to the injury, but they do not cover punitive damages related to the employers’ negligence or significant pain and suffering. If you have a strong case for obtaining compensation in these areas, filing a lawsuit against your employer may be a preferred step over filing a workers' compensation claim. Your attorney can provide you with advice in this area during a consultation.
Filing a worker’s compensation claim initially seems like a straightforward, hassle-free way to obtain financial benefits for injuries sustained on the job. However, the claims process can be complicated and time-consuming. You must complete all required paperwork, and some paperwork must be completed within a specific time period. The Employment Development Department in California, as well as hospitals, physicians and other healthcare providers, involved all work together in various ways to assist with claims processing. Understand that this stressful feat must be accomplished at a time when you may be physically incapacitated and emotionally stressed.
The unfortunate reality is that overlooking an important step, missing a deadline or taking other false moves could have a negative effect on the amount of benefits awarded to you. In some instances, a workers’ compensation claim is delayed or completely denied because of the employee's efforts before or when filing the claim. For example, if you fail to notify your employer immediately after the injury occurs, claim processing may be delayed.
Understand that your employer is not necessarily looking out for your best interest. You should not take medical advice from your employer, and you should not feel pressured to back down from filing a claim. Furthermore, your employer cannot terminate your employment because you file a workers' compensation claim. Learning about your rights in a workplace injury situation will help you to avoid unnecessary financial stress.
The first step to take after being injured on the job is to seek emergency medical attention if needed. A serious, one-time event at work, such as a fall-related injury, may require a trip to the emergency room. Workers’ compensation also covers expenses related to injuries that develop gradually, such as hearing loss caused by a noisy work environment. For injuries that develop gradually, an urgent trip to the emergency room may not be needed. In this type of situation, the employer should be notified as soon as you determine that your health has been affected by a situation at work. If you fail to notify your employer about an injury for more than 30 days, your claim may be denied.
Understand that you are required to visit an approved medical facility for workers’ comp-related care. Your employer should immediately inform you about which facility to visit for emergency medical attention or for less acute healthcare needs. The only deviance from this is if you predesignate a hospital, healthcare center or medical professional before being treated. This is typically completed by providing the pre-designation details to your employer in writing. If you intend to use your own provider, it is best to notify your employer in writing before you are injured.
Some California workers assume that workers’ compensation benefits are only available for full-time workers. However, part-time and temporary workers may also qualify for this important benefit. Independent contractors could also obtain workers’ comp benefits in some situations. Be aware that workers’ compensation benefits may be paid in a lump sum amount through a settlement, or each individual expense filed against the claim will need to be approved and paid for by the provider.
Depending on the type and severity of your injuries, you may be recovering from head trauma or internal injuries. Perhaps you must receive multiple surgical procedures in the weeks after your injury accident. Filing a claim when these or other similar circumstances are present can, unfortunately, be challenging. This becomes even more stressful if your claim is unjustly denied. More than that, you must understand how a workers’ compensation claim affects disability benefits and eliminates the ability to file a personal injury lawsuit against your employer so that you do not take an unfortunate step that limits your ability to obtain the full amount of compensation possible going forward.
Explore Disability Benefits
When you are injured at work, workers’ compensation benefits provide financial benefits for related expenses if you file a claim in a timely manner. These are expenses that your employer is financially responsible for per state law. However, some people are injured outside of the workplace, and they are unable to do their jobs because of those injuries. Worker’s compensation insurance does not provide benefits for situations like this, but you may qualify for disability benefits through the Employment Development Department in California. The qualification requirements for disability benefits are significant, and they include:
- Obtaining a physician’s signature on the claim documents attesting to your medical disability
- Being unable to work in your normal position for at least eight workdays
- Losing wages because of a disability sustained on the job
- Being actively employed or verifiably searching for a job when the disability period begins
- Beginning treatment through a licensed healthcare provider within eight calendar days after the date of the disability
- Continuing to remain in the care of an approved healthcare provider while obtaining benefits
- Filing a disability claim between nine and 49 days after the disability begins
The state’s disability benefits are available for up to 52 weeks as needed, so this is a temporary disability program. You may also qualify for disability benefits through the federal Social Security Administration. To qualify for disability benefits through the Social Security Administration, documentation of your severe condition must indicate incapacity for at least 12 months. This includes significant inability to complete basic tasks, such as sitting, walking, remembering, standing and lifting. Understand that the Social Security Administration's disability program also provides benefits for those who are severely incapacitated by conditions such as depression and anxiety, which may have developed as a result of the workplace injury event.
When you compare disability benefits against workers’ compensation benefits, be aware that workers’ compensation benefits could extend for several months or years depending on the circumstances. Typically, benefits cease once the condition is determined to be either stationary or permanent. Once the diagnosis of a disability has been made, you may file for disability insurance through the state or through the Social Security Administration. However, the transition of benefits from one source to the other is not seamless. You should be prepared for some financial stress during this transition period.
In addition to receiving direct compensation from a workers' comp claim, you may settle to receive lump sum compensation through workers’ compensation benefits. You are not required to settle for lump sum benefits, and if you do, you are not permitted to obtain additional compensation for the same injury. Because of these limiting factors, you should carefully review a settlement offer with your attorney before acceptance.
On the other hand, through the state’s disability insurance and through the Social Security Administration’s disability program, you may receive ongoing financial benefits throughout the rest of your life in the event of permanent disability as long as you continue to meet the requirements for eligibility.
Many people who have been injured on the job want to know if they can file a workers’ compensation claim and receive disability benefits at the same time. Generally, workers’ compensation benefits take precedence. This means that you may only receive disability benefits on top of worker’s compensation benefits when the amount of disability benefits that you qualify for exceeds the amount of workers’ compensation benefits you receive. In this case, the disability benefits amount would be reduced accordingly.
Know When and How to File a Workers' Comp Claim
As you can see, workers’ compensation benefits in California impact your ability to receive disability benefits. In addition, filing claims for both of these types of benefits can provide you with essential compensation needed to pay for related medical expenses and to make ends meet while you recover. Compensation may also be an essential component in your life for many years after the event in the case of a serious injury or even for the remainder of your life.
The workers’ compensation claims process begins when you notify your employer about your injury, and this step must be completed within 30 days of sustaining the injury. Understand that providing your employer with notification as soon as possible enables the claim to be processed expeditiously.
The claim form must be completed by both you and your employer. Your employer must provide you with the blank form in person within one business day or learning about your injury, or your employer must mail the form within this time period. If your employer fails to do so, you may obtain a copy of the form through the Department of Industrial Relations’ website.
You must complete all fields in the “Employee” section on the form. The next step is to give this form to your employer. You may hand the form to your employer directly, or you can send it via certified mail to obtain confirmation that your employer received it. Once your employer has completed the “Employer” sections on the form, your employer must send you a copy of the completed form and must also file the form with the insurance company. If you do not receive a copy of the completed form, understand that you are entitled to receive it upon direct request to your employer.
The insurance company should respond to you within 14 days after it receives the form to notify you about the status of your claim. However, the provider may need additional information before the claim can be approved or denied. Therefore, you should not expect to know firmly about the approval status within this 14-day period. In fact, it may take as long as 90 days for you to receive a final response. If the claim has not been formally approved or denied within 90 days of the date of filing, assume that the claim has been approved.
You do not need to wait for the workers’ compensation claim to be processed and approved to seek the medical treatment you need. While waiting to determine if the claim will be accepted or denied, you may obtain medical treatment with expenses up to $10,000. In addition, you may be entitled to increased indemnity payments if your employer excessively delays proceeding with its portion of the process. You may need to provide supporting documentation that clearly outlines the delays to obtain additional compensation.
If the insurance company notifies you that your workers' comp claim has been approved, you may receive a full accounting of the benefits that you will receive. For example, you may learn that your claim covers medical care and supplement job displacement benefits. You and your healthcare providers will then file expenses against the open claim indefinitely until the injury is resolved or until you have been medically diagnosed with a disability.
Each expense filed under the claim will be reviewed by the claims administrator. The administrator has the right to order a follow-up evaluation from a qualified medical evaluator before paying the related expense. In some cases, your attorney may need to negotiate on or discuss the disagreement to work toward an outcome in your favor.
Prepare for Significant Challenges After a Workplace Injury
If you have been affected by a workplace injury, you understandably may hope or assume that filing a workers’ compensation claim would be the only step required to obtain the compensation that you are entitled to. However, the claims process can be challenging in several ways, and you may continue to face ongoing challenges while the claim is active.
As important as it is to file a workers’ compensation claim as soon as possible, understand that you give up the right to file a lawsuit for negligence against your employer by doing so. Therefore, you must quickly explore this possibility with assistance from your lawyer. Your lawyer can tell you about the strength of a lawsuit case as well as the potential outcome and risks.
If you decide to forego a lawsuit and proceed with a workers’ compensation claim, you may run into several issues with the initial stage of the process. Some of the many challenges that you may face while filing a workers’ compensation claim include:
- Your employer fails to complete the claim form accurately or promptly.
- The insurance provider stalls unnecessarily.
- The claim is unfairly denied.
- The benefits awarded are not sufficient or are not inclusive of all expenses.
Once a claim has been approved, additional challenges can develop. These include:
Your administrator fails to approve claims submitted by your healthcare provider.
- Denied claims result in your inability to obtain needed treatments and services.
- The administrator may repeatedly refer you to a qualified medical evaluator, creating additional stress and treatment delays in some cases.
- Your condition may be ruled a temporary or permanent disability, but you may have difficulty obtaining benefits from disability insurance.
While benefits from a workers’ compensation claim may carry you through the recovery process and pay for all related expenses, this type of claim may simply be a stepping stone to a disability claim. With a disability claim, many similar challenges and delays can occur. Understand that these various challenges can create intense stress at a time when you may already feel overwhelmed by your physical pain and limitations, the incredible financial burden caused by the event, emotional trauma and more.
The ability to obtain needed compensation through the claims process is essential to your livelihood and your ability to pay for necessary treatment. This is compensation that you may be entitled to, but it can be unnecessarily daunting to walk through the process. Hiring a workers’ compensation lawyer early in the process is essential. A workers’ compensation lawyer may assist with the initial determination about whether to file a workers’ comp claim or to pursue a lawsuit. In addition, your lawyer can guide you through the claims process and represent your interests throughout your recovery to ensure that your rights are protected.
Consult with a Workers’ Compensation Lawyer Near Me
At Workers Compensation Attorney Law Firm serving Los Angeles and surrounding communities, we understand the complexities of the workers’ compensation process in California. More than that, we know how much is at stake with your claim, and our legal team is ready to support you and represent you throughout the entire process. With our profound expertise in workers’ compensation matters and our strong desire to serve our clients with integrity, we are the legal team that you need in your corner. To request a consultation with a workers’ compensation lawyer in Los Angeles, call us today at 310-956-4277.