The simplest type of worker’s compensation claim involves injuries that heal fairly quickly and without lasting effect on a worker’s employability. Workers’ compensation claims can be distinguished by the significance of the injury to the affected employee and the corresponding benefits provided by the employer’s insurance coverage. Injuries taking longer to heal or resulting in permanent damage can require more complex analysis to determine what workers’ compensation benefits should be paid and for how long. Diefer Law Group, PC represents employees injured at work and helps to secure the workers’ compensation benefits they are entitled to. For a free case evaluation to find out what workers’ compensation benefits you may be able to collect call (888) 301-7795.
When Workers’ Compensation Insurance Is Available
The law in California states that when employees suffer injuries on the job, employers are responsible for the damage without regard to fault. But the extent of employer liability is limited by statute as long as there is compliance with state insurance requirements. Under workers’ compensation laws employees are only entitled to recover for their economic losses. There is no compensation for non-economic injuries such as pain and suffering or emotional distress.
In exchange for less potential liability, all California employers having one or more employees must either purchase workers’ compensation insurance or get permission to self-insure the cost of employee injuries. Employers who fail to obtain the proper insurance can face possible jail time and fines in addition to lawsuits by injured employees.
Benefits Provided by Workers’ Compensation Insurance
The benefits provided by workers’ compensation will depend on the injury experienced by the employee and how the injury is expected to affect the employee’s ability to work. The simplest kind of workers’ compensation claim may involve only medical expenses and perhaps some lost wages. Injuries that are more debilitating may trigger additional payments over longer periods of time.
There are six basic types of benefits provided by workers’ compensation insurance according to the California Department of Insurance (CDI):
- Medical expenses – Employees are entitled to medical treatment that is reasonable and necessary for their injuries. Guidelines advise doctors of appropriate treatments for particular work-related injuries and specify the duration of treatment.
- Temporary disability – Wage replacement benefits are paid to employees who cannot return to work within 3 days of injury. The benefit amount can replace up to two-thirds of lost wages. Benefits are paid for a limited number of weeks and over a limited total time period from the date of injury.
- Permanent disability – Benefits for permanent disabilities are determined by factoring in the extent of the disability, the age of the employee, and the employee’s occupation. Benefit amounts are subject to maximum limits.
- Job displacement supplement – Up to $6,000 is available for education expenses necessary for employment retraining.
- Return to work supplement – A $5,000 one-time benefit is available for employees receiving permanent disability benefits who experienced a disproportionately large loss of earnings as a result of their injury.
- Death benefits – A benefit of up to $10,000 for reasonable burial expenses. Support payments to surviving dependants starting at $250,000 for the first dependent and continuing if necessary until the youngest minor’s 18th
What to Do After Being Injured on the Job
The California Department of Industrial Relations (DIR) advises employees to report employment-related injuries to employers as soon as possible after the injury occurs. An employer has one business day after an injury is reported to provide the employee with a workers’ compensation claim form. The claim form needs to be completed as soon as possible as a completed form is required before any benefits can be paid.
The employer will forward the completed claim form to their insurance administrator. A new claim will be opened and an investigation of the circumstances leading to the injury will be conducted. Within one day of receiving a workers’ compensation claim, the administrator must authorize up to $10,000 in reasonable and necessary medical care expenses. The medical expense allowance must be granted even though there has been no determination whether the claim will be accepted or denied.
Acceptance or Denial of a Workers’ Compensation Claim
When a workers’ compensation claim is accepted an employee may receive medical treatment that is reasonable and necessary to treat the injury. In California, the medical treatment given by workers’ compensation doctors must be scientifically proven to heal or provide relief for work-related injuries. Guidelines for acceptable treatment protocols can be found in California’s Medical Treatment Utilization Schedule. Approved medical care may be limited by the number of times a treatment can be given or by the duration of the treatment period.
Employees who have their claims or medical treatment denied have the right to challenge those decisions. An employee whose claim is denied can petition the court and have the claim reconsidered by a judge. If a treatment recommended by an employee’s doctor is denied, an employee can request an Independent Medical Review (IMR) to determine medical necessity.
How to Find Out if You Have the Simplest Kind of Workers’ Compensation Claim
The simplest type of workers’ compensation claim will probably not have any issues about whether or not the injury is work-related and the claimed injuries will be of a type that will resolve without causing long-term impairment. Medical expenses will be agreed upon and not expected to be ongoing. The outcome of an employee’s injuries can be determined with reasonable certainty and a full or near-full recovery is anticipated.
There is nothing to be lost by taking advantage of a free consultation offered by an employment law attorney that practices workers’ compensation law. Employees need to understand how the workers’ compensation system works in order to understand their rights and responsibilities regarding covered injuries and available benefits. For employment law and workers’ compensation claims in southern California, Diefer Law Group, PC can put 60+ years of combined legal experience to work for you. Get the information that can help injured employees obtain the maximum available workers’ compensation benefits. Contact Diefer Law Group, PC at (888) 301-7795.
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