San Diego Work Injury Lawyer
San Diego Work Injury Attorney
Injuries at work can come with significant costs. There are medical bills associated with it, lost wages, and in some cases, the inability to work the same or any job due to the injury. If you or someone you know has been injured at work, then there is a way to get some relief. Workers’ compensation is owed to those who suffer a workplace injury in San Diego, CA. Unfortunately, that compensation is not always readily forthcoming from the insurance companies that owe it. This can mean that you need to fight for what you’re owed, but you don’t need to do so without help. At Diefer Law Group, we are ready to represent you and help you seek the restitution you deserve.
Work Injuries
A work injury that is eligible for workers’ compensation must fit within the legal parameters of what should be covered. The law requires that the injury “arise out of employment” and occur in the “course of employment.” This means that, generally, the injury must happen while you are considered to be at work. Injuries that occur during your commute to and from work, or during a lunch break, are ineligible for workers’ compensation. The stipulations also require that the injury be a product of a work-related activity. This means it must come from you performing the functions of your job. Things like horseplay, intoxication, or self-inflicted injury are not eligible for workers’ compensation, even if the injury occurs while you are at work.
Workers’ Comp Benefits
Workers’ compensation is a way to ensure that employees receive appropriate restitution for an injury that they incur while working. California law requires employers to pay for workers’ compensation insurance as a way to ensure that the funds for workers’ comp are available. The exact details of what workers’ comp will cover depend upon the needs of a particular injury. The kinds of things that workers’ comp covers include:
- Medical Bills – Treatment for the injury will be covered by workers’ comp. It’s worth noting that this typically must be treatment from a provider in the workers’ comp insurance company’s approved provider network.
- Disability – Missed wages are covered by workers’ comp but not entirely. Typically, around two-thirds of your regular weekly wages are covered, up to a maximum amount as determined by the state and updated yearly. The disability may either be temporary or permanent, depending upon the injury and its associated recovery process.
- Job Displacement Benefits – In some circumstances, the injury may require a change of career. If that’s the case, then the workers’ comp payments may cover training for a new career as well as access to job placement services.
- Death Benefits – If the injury was severe enough to cause the employee’s death, then qualifying family members may be entitled to benefits that cover things like funeral costs and lost wages.
How Long Workers’ Comp Lasts
The nature of the injury suffered will determine how long workers’ comp benefits will last. If the injury is one that you are not expected to fully recover from, there is a possibility that the benefits may be permanent. In most cases, though, the benefits will likely be temporary.
In the case of temporary disability benefits, the maximum for most conditions is going to be 104 weeks (two years). The benefits will generally continue until one of the following things happens:
- The injured employee returns to work.
- A physician says that the employee can safely return to work.
- A physician says the condition will not improve but is stable.
- The employee has received 104 weeks of benefits.
There are a few conditions for which the temporary disability benefits carry a maximum of 240 weeks instead of 104. They are:
- Chronic lung disease
- Severe burns
- Chemical burns to the eyes
- High-velocity eye injuries
- Pulmonary fibrosis
- HIV
- Acute and chronic Hepatitis B or C
The weeks available for temporary disability do not need to be taken consecutively but must be taken within a five-year period from the date of the injury. If you are still unable to work, you may qualify for permanent disability. Our lawyers at Diefer Law Group can help you determine if you qualify.
Workers’ Comp Settlements
Many long-term disability claims result in a settlement, which is the preference of the courts. Often, these settlements are worked out in a mandatory settlement conference, and a judge will not allow the situation to proceed to any other conferences unless good cause can be shown as to why the case must proceed. It’s important to have an experienced legal team in these situations, as they will be aware of what a reasonable settlement will look like and can negotiate for fair compensation for your future. There are two kinds of settlements that can be reached through a mandatory settlement conference:
- Stipulation and Award – This is where the insurance company and you agree on the details of a stipulated award and an ongoing arrangement for care for your injury. In these cases, the insurance company will cover any ongoing medical treatment that you require. You will be free to work at the same employer if arrangements can be made. The claim can also be reopened if your condition gets worse.
- Compromise and Release – This kind of settlement is an agreed-upon lump-sum payout. In exchange for the lump sum, your case is effectively closed. This means that it cannot be reopened if your condition gets worse, your job with your employer will be terminated, and you will be responsible for the payment for future medical treatment.
What to Do If You’ve Been Injured
The law doesn’t leave a lot of time for workers’ comp cases to be addressed. Therefore, it’s important that you act quickly if you’ve been injured at work. You’ll want to be aware of the steps that need to be followed in the immediate aftermath of an injury. They are:
- Your employer must be notified of your injury within 30 days of its occurrence.
- You will then most likely be sent to receive medical treatment from a provider that is pre-approved and a part of the network for your employer’s workers’ comp insurance.
- Your employer will provide you with a DWC-1 claim form, which you must fill out with a description of the accident and injury and return it to your employer.
- Your employer will pass the form along to their workers’ compensation insurance company.
- You should be notified of their decision within 90 days.
- Before you agree to anything final, you should talk with the team at Diefer Law Group to make sure that you are receiving everything you deserve.
- If you have a dispute or are denied a claim, you can file a claim with the workers’ compensation appeal board
90-Day Rule
Once your workers’ comp claim is submitted, the insurance company is required to respond with either an approval or a denial within 90 days. If they fail to provide you with an answer within the 90-day window, that triggers default liability, and the claim must be paid out to you. While it is possible to overturn this default ruling, it is a very rare occurrence. It can only be done with a ‘new evidence’ exception. To meet this exception, the evidence must meet three criteria:
- It must be shown to be relevant to your claim.
- It must be something that neither your employer nor the workers’ comp agent knew within the 90 days.
- It must also be something that neither your employer nor the workers’ comp agent could have discovered during the 90-day window.
Workplace Accidents Attorneys FAQs
Q: What Do Workers’ Comp Benefits Cover?
A: The specifics of what workers’ comp will cover in each case will be determined by the nature of that case. However, there are some general categories of compensation that are offered. They are:
- Medical costs related to your injury
- Temporary disability payment. This typically pays around two-thirds of your usual weekly wages, up to a $1,651 maximum. These generally last for 104 weeks but can go as long as 240 weeks for a few specific conditions.
- Permanent disability if you cannot fully recover from your injury
- Job training and placement benefits if your injury requires you to make a career change
- Death benefits for the family if the workplace injury or illness has led to the worker’s death
Q: What Would Disqualify a Work Injury?
A: The two conditions for a workplace injury to be covered by workers’ compensation are that it be an injury that arises out of employment and occurs during the course of employment. This means that it must be an injury that occurs at a time when you are considered to be at work, and the injury must have happened in the course of undertaking work-related activities. Some of the things that could lead to a legitimate denial of a workers’ comp claim include:
- An injury occurs in the process of commuting to or from work.
- The employee was intoxicated.
- The injury was a product of the employee engaging in “horseplay.”
- It was during lunch break.
- The employee started a fight.
- It occurred during a felony.
- The employee intentionally caused their own injury or death.
Q: How Do You File a Workers’ Comp Claim in California?
A: To ensure that you receive workers’ comp for a work-related injury in California, you need to be sure to follow the proper steps and procedures. The five steps are:
- You must notify your employer within 30 days of an injury.
- Your employer’s workers’ compensation insurance company has approved providers that you must use for medical treatment.
- A DWC-1 claim form will be provided by your employer that must be completed promptly and returned to your employer. In this form, you will describe the nature of the injury and the accident that led to the injury.
- Your employer will pass the form on to the workers’ comp insurance provider.
- You should receive word of your request being approved or denied within 90 days. If you are denied, then you may appeal.
California has a 90-day rule for workers’ comp claims where, if you don’t hear back within 90 days, the claim will automatically be approved and should be paid out. The only exception to this is if there is new evidence related to your case that was unknown and could not be discovered by your employer or the insurance company within that 90 days. It is also worth your time to contact a work injury lawyer who can help you get access to everything that you are owed.
Q: How Long Will Workers’ Comp Benefits Last?
A: The duration of workers’ comp benefits will be determined by
- The particulars of the injury
- A doctor’s assessment of when the employee may be able to return to work
- Any restrictions that they may have at work
Generally, temporary workers’ comp benefits last up to, at most, 104 weeks. However, in the case of a few specific conditions, such as severe burns or chronic lung disease, workers’ comp can last up to 240 weeks. The weeks need not be taken consecutively, though they must be used within 5 years. It is also possible to receive permanent disability benefits if the injuries are something that you won’t be able to fully recover from.
Get the Restitution That Your Work Injury Requires
It’s important to remember that the workers’ comp insurance company is not necessarily on your side. These are companies that are in business to make money, and what they pay out to you cuts into their profits. If the insurance company is attempting to shortchange you from the compensation you deserve, then it may be necessary to file a claim with the workers’ compensation appeals board. It’s important to allow a work injury lawyer to look at the particulars of your case before you sign anything with an insurance company. We have experience looking for situations where you may be owed more than you’re being offered. We can also help you with filing a claim and even appealing an initial ruling if needed. Contact us at Diefer Law Group to take a look at your San Diego work injury.
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