Workplace injuries can be catastrophic, sometimes even life-altering. Despite advances in safety equipment and workplace standards, there continues to be hundreds of fatal occupational injuries in California each year. Fortunately, employees can file under their employer’s workers’ compensation policy to recover the losses they will suffer as a result of their injury.
California law provides extensive protections for workers in Fresno and elsewhere who may be seeking to file a claim. At the same time, employers and their insurance companies have the right to deny claims, initiate lengthy inquiries, or offer benefits far lower than what is needed to restore all the damages suffered.
Singh Ahluwalia Attorneys at Law can represent you during your workers’ compensation claim to increase the chances that you will get the maximum amount of benefits available. A workers’ compensation lawyer in Fresno can assist you throughout the course of your claim, and we are also available to help when your claim has been denied, and you wish to appeal the decision. In many workplace accident injury cases, we can also identify negligent third-parties responsible for the harm inflicted upon you.
You will receive our representation at no up-front cost, and your first consultation is always free and 100% confidential, with no obligation to work with our attorneys after. Schedule your free initial case review today when you Call (559) 878-4958 or Contact us online.
How a Fresno Workers Compensation Attorney Can Assist With Your Claim
Most workers’ compensation claims move fast. Before you know it, the initial settlement offer is there, or you’ve already received a denial. While both situations are an excellent opportunity for an experienced workers compensation attorney to step in and help review your claim, the truth is that it is often best to start the claims process with an attorney at your side.
As part of filing your claim, you will be asked to submit a document stating the reasons your injury occurred. This document may include a description of the workplace accident that caused your injury, or it may ask for a description of when your symptoms first emerged. Further, you will be asked to submit any documentation of your initial treatment and then attend an examination by an approved physician within your employer’s insurance provider care network.
These early stages of a claim can be fraught. Often, benefits are denied or severely reduced based on the context of the injury accident report or the findings of the initial exams. Employees are likely to have their symptoms and pain downplayed, and the physician presiding over their case may make an overzealous estimate as to when they can return back to their full duties.
Engaging with a workers’ compensation lawyer in Fresno at these early stages can enable you to submit an accurate injury report that avoids common mistakes. Our firm can also assist you with finding the best care, in compliance with your employer’s insurance requirements. Providing ample evidence and a thorough medical analysis increases the chances of receiving all or most of the benefits available for your given prognosis.
Your attorney will have years of experience filing workers’ compensation claims, while this may be your very first one. With their knowledge and familiarity, they can not only communicate effectively with insurers but reduce your burden throughout the process.
When Can I File a Workers’ Compensation Claim in Fresno?
Workers’ compensation insurance provides benefits for all employees who have been injured within the scope of employment. These benefits are supposed to be available regardless of how frequently you work and what your job duties are.
Importantly, workers’ compensation benefits are available whether your injury was caused by:
- A single incident, resulting in an acute injury
- Multiple incidents, resulting in cumulative injuries
- No specific incident, stemming instead from the repetitive stress of motions required by their job task
What Is the Scope of Employment?
The “scope of employment” refers to any time when the employee is performing job duties. That can include injuries that occur when the employee is performing a requested task but is not necessarily “on the clock.” For example, if an employee is asked to run by an office supply store on their lunch break and gets into an accident, this incident may technically be considered as within the scope of employment.
The employee may not be considered to be operating within the scope of employment during times when they are:
- Commuting to and from work
- At work early or late and are not performing job duties
- On break off-site and not performing tasks requested by the employer
- On a work trip but not engaged in a scheduled activity or at a location they were required by their duties to be at
- Performing horseplay or getting into workplace conflicts
- Under the influence of alcohol, drugs, or other substances
Additionally, employees are not eligible for workers’ comp benefits when they are found to have intentionally caused their injuries or otherwise committed fraud in connection with their reported injury.
Workers’ Comp Claims Should Not Involve Questions of Fault
Unless your injuries were intentional, you cannot be denied workers’ compensation benefits simply because you could have prevented your own injuries by taking certain hypothetical measures. Likewise, you do not need to prove that your employer was negligent or otherwise at fault for the circumstances that caused your injury.
A workers’ compensation plan is there for workers any time they are hurt, period. If your employer or an insurer is trying to avoid providing coverage because of questions regarding the cause of your injury and who is at fault, refer immediately to an experienced Fresno workplace accident lawyer.
What Is Needed to Submit a Workers Comp Claim?
Submitting a workers’ compensation claim is easy, thanks in large part to processes standardized by state government agencies like the California Department of Industrial Relations (DIR).
When you have been hurt, be sure to follow the steps below to maximize your chances of receiving all of the benefits you need to recover:
- Seek medical care. Stop working immediately if you feel notable pain, are bleeding, or are otherwise impaired in your job duties. Go to an ER or a clinic at the next available moment.
- Report the injury to a supervisor or superior. You are expected to report your injury (or the first detection of symptoms) within 30 days.
- Reach out to a workers’ compensation lawyer. They can assist you with the remaining steps.
- File a workers’ compensation claims form DWC-1 along with any other paperwork needed.
- Keep seeing your doctor, and follow their instructions. Restrict activities as required, and take all prescribed medications. If you wish to visit your own doctor, or you disagree with their assessment, refer immediately to your attorney for guidance.
- Ensure you are receiving all the benefits you expect when you receive their initial statement of benefits offer. Decline the offer if it fails to cover what you need.
- Appeal your claims decision if it was denied or if you did not receive the coverage you needed based on a final decision by the insurer.
- Consider long-term benefits for disability, and identify any other liable parties with the help of your Fresno workers comp attorney.
The California Division of Workers’ Compensation (DWC) offers regular workshops in English and Spanish for assistance and answers to any questions you may have.
What Benefits Can a Fresno Workers Comp Attorney Help Me Retrieve?
One appreciable aspect of workers’ compensation plans is that they must all offer the same standard set of benefits in order to ensure that workers are not left responsible for the costs of a workplace injury.
Benefits fall within one of five main categories:
- Medical care coverage for your initial treatment costs and any continuing care
- Temporary disability benefits or partial replacement of wages lost while you heal
- Permanent disability benefits if your injury leaves you permanently unable to return to the same work duties
- Supplemental job displacement benefits that can help pay for the costs of education, training, or other forms of skill enhancement in order to transition to a new career
- Death benefits paid to immediate family and dependents in the event of a fatal injury
My Boss Says I’m Not an Employee and Can’t Get Workers’ Comp Coverage, What Do I Do?
Workers’ compensation insurance is supposed to provide coverage for all employees, including employees-in-fact. Certain independent contractor positions may qualify as employees-in-fact because of their industry, their job duties, or the nature of their relationship with their employer.
California’s DIR takes the misclassification of employees very seriously. Employers could face penalties for misclassification, including restoration of any wages or benefits withheld as a result of misclassification. If an employer does not have workers’ compensation coverage available for employees misclassified as independent contractors, the employer may be directly liable for the associated costs of an injury. In other words: they open themselves up to an injury lawsuit!
If your employer is saying that you are ineligible for coverage or if there is any other form of uncertainty regarding the availability of workers’ compensation benefits, you can refer to a Fresno workers’ compensation lawyer and also contact the Fresno DWC office directly for information and assistance.
Can I File a Lawsuit to Recover the Damages I Have Suffered?
If your employer provides workers’ compensation coverage, they are immune to liability in most circumstances. The only exceptions are when the employer:
- Does not have the legally mandated insurance coverage
- Manufactures a product that caused an injury within the scope of work duties
- Violently assaults you, or otherwise supports an assault upon you
- Commits fraud in an attempt to cover up the injury or to avoid paying benefits
- Commits an intentionally harmful act, endangers worker safety through criminal activity, engages in patterns of gross negligence after repeated warnings, or commits other extreme behaviors leading to the injury
- Removes guards from a power press or fails to install them, leading to a machinery-related injury (see power press exemption)
You can, however, potentially file an injury claim or lawsuit against another third party whose negligence or defective products caused your injury. Such actions can help the injury victim recover damages not covered under their workers’ compensation settlement.
Since workers’ compensation benefits are often limited to certain caps and categories, a third-party injury claim can be extremely beneficial in the event of a catastrophic injury that leads to excess costs.
Examples of third parties who may be liable for your injury costs, in part or in full, can include:
- Passenger car drivers and other motor vehicle operators who caused an accident
- Negligent third-party contractors, such as janitorial teams
- Primary contractors delegating work to your employer
- Manufacturers of dangerous products or equipment
- Manufacturers of toxic substances that caused an occupational illness
- Property owners who neglect repairs or safety requirements
- Any other third-party whose lapse in care led to your injury
Your Fresno workplace injury lawyer can help you consider the possibility of filing a claim in addition to (or sometimes in lieu of) a workers’ compensation claim.
How Much Time Do I Have to Submit a Workers’ Compensation Claim?
There are a number of deadlines to keep in mind in order to ensure that your claim is processed efficiently and not denied based on procedural grounds.
- You have 30 days to report the injury to a supervisor, starting from the date it first occurred or was first discovered.
- Your employer is supposed to approve coverage for appropriate medical treatment within one day of receiving your claim form, so that necessary care is not delayed.
- The insurer has 90 days from the receipt of your claim and all other needed paperwork to respond, or the injury may be presumed to be covered.
- You have one year from the date of the injury or the discovery of the injury to file a claim, provided you meet other obligations for timeliness.
Note that you may “be entitled to an increase in your payments if your employer fails to pay your indemnity payments” in a timely manner, according to the DWC.
Can I See My Own Doctor for Treatment?
If you have predesignated a doctor prior to your injury, you are able to have them treat your injuries immediately after their occurrence or discovery.
Employers can select your treating physician, especially when they require care to be provided by a group of pre-approved physicians in a medical provider network (MPN) or healthcare organization (HCO). After your first visit with an MPN physician, you are free to select another provider in the network. You are free to select your own physician within an HCO at any time.
For coverage that does require care to be administered by an HCO or MPN, the claims administrator presiding over your claim can select a physician to provide treatment for the first 30 days. After that period, you may select your own doctor.
Work With a Fresno Workers’ Compensation Attorney Who Will Fight for You!
Workers often feel intimidated or uncertain when dealing with the claims process after a workplace injury. While they have many rights, they may feel overwhelmed by the paperwork. They may also have an employer they feel is acting contrary to their best interests.
Singh Ahluwalia Attorneys at Law can provide you with an experienced, compassionate workers comp attorney in Fresno to represent you throughout the course of your claim. We have years of experience fighting back against denials and appealing decisions that fail to meet the medical and financial needs of our clients.
When you have been hurt at work, turn to the attorney team with a reputation for helping those who feel up against the system. We have assisted thousands of immigrants and other individuals in asserting their full rights to seek justice, fair treatment, and repayment of the damages they have suffered.
Reach out to us to schedule a free case review, where we will provide you with guidance and discuss your options for proceeding with a workplace injury claim. Call (559) 878-4958 or Contact us online to schedule your free appointment with a Fresno injury lawyer near you.
