Workers Comp Lawyer Serving Vista, CA
Also Serving San Marcos, Escondido, Oceanside, and Surrounding Areas
The workers’ compensation process is frustrating. If you know the laws you can file a Declaration of Readiness to Proceed (DOR) and go to court to get the judge to Order the insurance company to compensate you correctly or provide the medical treatment you need. Some of the basic work comp laws can are discussed below.
Labor Code Section 5401
Employer Must Provide Injured Worker With a Claim Form
Your employer must provide you with a workers’ compensation claim form within one day. Once you are injured, you must give written notice to your employer as soon as possible. The claim form is a legal document and has legal implications. California Labor Code Section 3600a10 says you may get nothing if you were terminated from your job before filing a workers’ compensation claim.
A workers’ comp lawyer will help you fill out all claim forms, attend all hearings and conferences, and answer your questions about the workers’ compensation insurance system. Often, an employer does not comply with the law, and the insurance companies will take any advantage they can. Here are some important laws they must follow.
Labor Code 5402
Employer Has 90 Days To Accept or Deny Your Claim
Your employer has 90 days from the time you submit your claim form to decide whether to deny or accept your claim. Denial of your workers’ compensation claim would get you no benefits, and you would need to choose to file an appeal. Many employers deny a claim and hope the injured worker will not appeal the denial. However, if they do not timely deny the claim, it will be presumed to be accepted by the courts.
Labor Code 3600
Employee Gets Benefits Even if Totally at Fault
Workers are entitled to most benefits even if the worker was totally at fault for the injury. Your employer may try to say you can't get care if you made a mistake, or they did not do anything to cause the injury.
Other times, an employer might say you are not an employee but an independent contractor not entitled to any benefits. We see this all the time and have successfully shown injured workers called contractors are employees and should get workers’ compensation benefits even if there was no employer negligence involved.
Labor Code 4610
Utilization Review of Workers Comp Treatment
Utilization Review is the process by which the insurance companies deny medical treatment. When your doctor wants to provide some form of treatment, he will send a request for authorization to the insurance company.
The insurance company is supposed to be on a strict time limit to respond and send the RFA over to a utilization review company. This is a company hired by the insurance company to review the request under medical guidelines to determine whether the requested treatment is reasonable under the circumstances.
If you received a letter in the mail denying some form of treatment, this came through UR. There are then time limits for appealing the UR decision to the independent medical review. We work to make sure these deadlines are not missed and will drag insurance companies to get the judge to order the insurance company to comply with the law and provide requested treatment.
Labor Code 4656
Temporary Disability Benefits
An injured worker may receive temporary disability benefits of 2/3 regular salary for up to two years. However, to receive these payments, a primary treating physician must state that you are unable to work or have restrictions that your employer cannot provide. That is why it is important to treat with a sympathetic physician to injured workers and not look to make friends with insurance companies.
There are many exceptions where the injured worker is denied this benefit or the insurance company underpays the injured worker. Temporary disability benefits stop when a doctor states that you are permanent and stationary. This is a turning point in the life of a case. However, a doctor often will say that someone is permanent and stationary even though more treatment, even surgery, is required.
You may need to get second opinions from a panel qualified medical evaluator and even ask for supplemental reports to use as evidence in court.
Labor Code 4656
Permanent Disability Benefits
Permanent disability benefits begin when the treating physician states that the employee is permanent and stationary. This stops the TD payments and begins PD payments. Unfortunately, the permanent disability payments will be deducted from any final settlement amount where the TD payments typically are not. As such, it is important to keep receiving TD rather than PD. Insurance companies want to switch you over as quickly as possible.
Permanent disability is usually paid in a lump sum payment upon settlement of the case and is calculated using a complex system used to rate each injured body part. This is done by having a doctor provide a percentage of impairment for each injured body part.
The work comp lawyer has enormous input into this calculation. It is a complicated process that should not be left to anyone who has not undergone specific training and knows how to rate the AMA Guides doctors prescribe impairment. It is also necessary to address each body part, which is difficult to do because the insurance company will try to limit the body parts allowed in the claim.
Our staff will fight to get treatment for all body parts to get the treatment you need and increase the permanent disability rating. Our work comp attorney has years of training and experience to ensure the doctors correctly utilize the AMA Guides and ask tough follow-up questions to keep the doctors on point.
Labor Code 4659
Suppose the impairment from the injuries is combined to reach as high as 70% permanent disability. In that case, 1.5 percent of the average weekly earnings for each 1 percent of disability above 60 percent is to be paid during the remainder of the injured worker's life, after payment for the maximum number of weeks specified in Labor Code Section 4658 has been made. Average weekly wages shall not be taken at more than $515.38.
Labor Code 4600
Medical Care and Procedures for Injured Worker
The workers' compensation insurance must provide all medical treatment, medications, procedures, and therapy necessary to the injured worker. You have the right to select a doctor, and we will help you choose the most suitable.
We Are Here To Help
There are many more laws in the Labor Code that are important. Feel free to call and ask a friendly attorney what laws can be used to help you. Workers Comp Lawyer, PC is a professional corporation, all rights reserved to Workers Comp Lawyer, PC, the information provided is not legal advice. Please consult an attorney to determine what laws apply to your case.