Getting hurt at work can be frustrating and personally devastating, but it doesn’t have to mean losing money. With a workers’ compensation claim, you can seek benefits for all of your medical costs and partial replacement of the wages you lose while you heal. In cases of serious injury that inflicts a long-term condition or a permanent disability, your workers’ comp benefits can provide coverage for your ongoing medical costs and compensation partially making up any permanent difference in your wages.
Singh Ahluwalia, Attorneys at Law can assist you when you have been hurt at work. Whether you have already had your claim denied or have yet to start the process, we will provide you with a California workers’ compensation accident lawyer to assist you.
Learn about your legal rights and what you can do to maximize the compensation you receive during a confidential, free case review. Call (559) 878-4958 or contact us online to schedule your free appointment today.
How a California Workers Compensation Attorney Benefits Your Case
Many workers’ compensation claims go through without a single hitch. But, far more frequently, badly needed benefits are left on the table. The claim may be misprocessed or otherwise undervalued by the insurer. Or, the treating physician draws conclusions that run contrary to the patient’s own interests, such as by stating that their injury is less severe than it actually is.
The workers’ comp claims process can get complicated fast. With so much at stake hurt workers must have every advantage they can in the process. Hiring a workers’ compensation lawyer means you have an ally in the process: someone experienced in handling these types of claims and who knows what factors are most critical towards seeking all benefits that should be available.
When you work with an experienced workers’ compensation attorney at Singh Ahluwalia, you can know with confidence that your case is being handled according to established best practices. With extensive experience in injury law and workers’ compensation claims, our attorneys can assist you through every step of the process to increase your chances of obtaining the compensation you need.
Some of the ways in which hiring an attorney can benefit your California workers compensation claim include:
- Ensuring compliance with California law and standard procedure
- Seeking compensation from all sources, including not just workers comp but also potentially Social Security Disability or a third-party injury claim
- Evaluating denials and other assertions made by employers, insurers, doctors, Divsion of Workers’ Compensation (DWC) reps, and others for accuracy and tenability
- Calculating benefits fully and accurately so that you aren’t leaving anything on the table
- Negotiating aggressively during appeals, administrative procedures, and communications with insurers
- Serving you at all stages of your claim, helping you focus on recovery
Importantly, it is illegal in the state of California for an attorney to charge you up-front for any services rendered in direct connection to a workers’ compensation claim. Instead, attorneys must receive compensation from a portion of awarded benefits. This arrangement ensures you have someone to work for you no matter what your current resources are, and it also motivates your lawyer to work as hard as possible to maximize the size of your final benefits.
Benefits Available Under California Workers Comp Policies
Workers compensation policies in California are designed to provide a standard set of benefits, as dictated by the DWC.
Per California law, these policies must include the following:
- Medical treatments coverage (past and future)
- Mileage compensation for travel to care appointments
- Statewide average weekly wage compensation
- Temporary / permanent disability and supplemental job displacement benefit
- Return to Work Supplement Program (RTWSP)
The workers compensation system is designed to act as a generous resource for any workers hurt in the course of their duties. However, many employers and insurers will routinely deny claims as a matter of course. Their goal is to keep premiums low by minimizing benefits paid out for accidents. These parties may also try to severely limit the benefits available, even if you can prove you need and deserve them.
In cases where you are being denied benefits or aren’t sure of what benefits should be available for your specific injuries, reach out to an attorney who can assist you with the claims process.
Steps to Take After a Workplace Injury in California
The steps you take in the immediate aftermath of a workplace accident are critical for preserving the value of your claim. Know that these steps can be taken at the first sign of injury in any situation, meaning that if you had a delayed diagnosis and weren’t experiencing symptoms at the immediate time your injury likely occurred, you may still be considered in compliance with claims requirements for timely action.
Step 1: Seek Immediate Medical Attention
Seek immediate medical evaluation and treatment for any injuries you notice, even if it requires you to leave work. In most situations, you should report to the emergency department any time there has been an accident or incident. In cases where you are unsure if you are hurt or only noticed symptoms like pain later, you should still seek prompt treatment from an ER, clinic, company doctor, or your own physician.
Step 2: Report the Injury to Your Supervisor
As part of the workers compensation process, all workplace injuries must be reported to a supervisor or company administrator within 30 days. A failure to make a timely report is one of the primary reasons many workers comp claims are denied.
Ensure you retain a copy of your report for your own use.
Step 3: Receive a Diagnosis From a Company-Approved Physician
Your initial medical evaluation and treatment can be performed by a physician you currently see regularly or an emergency medicine/urgent care provider. After this initial appointment, your company or their insurer can request that you see a specific physician or a provider within their network. After your first appointment with a company-approved doctor, you can request to see a different doctor within your Medical Provider Network (MPN) or Health Care Organization (HCO).
For employers whose insurance plans don’t use an MPN/HCO, you may still be required to receive care from a doctor chosen by your claims administrator. After 30 days, you are eligible to transfer your medical case of your choice within a reasonable geographic area.
Step 4: Follow Doctors’ Orders, and Save Documentation
Regardless of what medical care provider you are using, you are expected to follow all doctor’s orders. That includes restricting activity, taking medications, using crutches or other assistive devices, making dietary changes, performing physical therapy, etc. Failure to adhere to your treatment plan can result in a denied claim or reduced benefits.
During your treatment, be sure to save all relevant documentation regarding your medical status as well as your expenses. Mileage to and from appointments can be included as benefits, for example, as can certain over-the-counter medicines or devices prescribed by your doctor. Save every document, and allow your attorney to determine what is vital to building the strength of your claim.
Step 5: Work With a California Workers’ Compensation Lawyer to Help File Your Claim
If you have not already obtained the services of a legal professional, strongly consider the benefits they can offer to your case. While this may be the first claim you have ever filed, your attorney will have handled hundreds — sometimes hundreds of thousands.
Working with an attorney allows you to protect your rights throughout the claims process. They can help you track claimable expenses, for example, and accurately document your diagnosis through a physician you can trust. An attorney helps you sort fact from fiction and assert your right to seek benefits to the fullest extent of the law.
Step 6: File a Claim Seeking All Available Benefits
Within a business day of receiving your injury report, your employer is supposed to provide you with a workers’ compensation claim form (DWC 1). Ensure that the form is complete, accurate, and includes line items for all the benefits to which you should be entitled. Your employer may also provide additional documentation with a claim, such as your prior medical evaluations performed by a company doctor.
If you have any questions or concerns, you can direct them to your attorney. You can also reach out to the California DWC Information and Assistance Unit. They provide workshops, recorded information, and assistance at their offices located throughout California. You can use the DWC website to search for a district office near you.
Step 7: Appeal and Negotiate Your Claim
Some workers’ compensation claims get approved without a single hurdle. However, many companies routinely deny claims or deny most available benefits. They expect employees to simply give up rather than fight back or question their reasoning. Rest assured that you can dispute findings and appeal any decisions made.
Before filing an appeal, be sure that you have assembled all of the needed documentation and are prepared to justify the benefits you are requesting. Many claimants will secure the assistance of an attorney at this stage, as their lawyer will help them prepare a case using the benefit of their experience and knowledge of state and federal workers comp laws.
Step 8: Pursue Long-term Benefits and Job-Term Benefits, If Applicable
In situations where someone has become permanently unable to return to their former duties, they are entitled to multiple forms of benefits to compensate them. Your physician will make a determination of impairment based on the Permanent Disability Rating Schedule (PDRS). This rating determines the modification to whole person impairment benefits you could receive.
Your physician will also help you determine if you are medically capable of resuming your former duties or if accommodations are needed. In cases where you will need to adjust job duties, change roles, or enter an entirely new career field, you can be compensated for the difference in your earnings. You will also be eligible to receive supplemental job displacement benefits, which help pay for the costs of education, training, and other steps needed to enter a new career field.
What Types of Accidents Are Eligible for a Workers Compensation Claim?
There are a number of considerations that affect whether a specific injury is typically covered by a workers compensation claim. These important concepts and terms are outlined below.
Scope of Employment
All accidents and injuries within the scope of employment should be qualified for coverage under workers’ compensation. “Scope of employment” refers to times when the worker is operating under company directives. This may include moments when duties are being performed “off the clock.”
For example, when an employee drives to a store to gather supplies during a lunch break at the request of a supervisor, and they get into an accident, this scenario still qualifies as occurring within the scope of employment. Likewise, employees going on trips out of town or out of state are technically under the scope of employment in most situations, except when engaging in activities wholly related to personal leisure or enjoyment.
Repetitive Stress
Note that injuries that occur as a result of repetitive stress should still qualify for workers compensation benefits. There doesn’t have to be a single incident that led to the injury, so long as the injury was caused in the course of work-related duties.
Pre-Existing Conditions
An employee may still be eligible for workers compensation benefits if they have a pre-existing injury or condition that is made worse through the course of their job duties. In these cases, the available benefits may be calculated as the difference between the costs of treating the condition after job duties made it worse compared to what it would have been had the injury not been exacerbated.
Similarly, if an injury was caused in part or made worse in the course of activities that are outside the scope of work, then the available benefits may be reduced.
Insurers and employers will frequently use these two areas — pre-existing injury and contributed conditions — to reduce the value of a claim or deny it entirely. Be cautious about protecting your rights, and secure a California workers’ compensation lawyer to protect you from tactics meant to unfairly deny you of the benefits you need.
Employee vs. Independent Contractor
Another frequent assertion made by employers is that an injured person is not, in fact, an employee but rather an independent contractor. Worker misclassification is common in California, and so California legislators and regulators have put systems in place to prevent employers from wrongfully misclassifying an employee.
Further, workers’ compensation insurance coverage may still be required for contractors in certain industries or operating under certain scopes. Employers failing to provide legally required compensation insurance could open themselves up to liability, meaning they can be sued directly for damages in many cases.
Employee Misconduct
Another common reason claims are initially denied is that the employer will allege that the employee’s actions placed them outside the scope of workers’ compensation coverage.
Some examples of common situations where coverage may not apply include injuries caused when the employee was:
- Intoxicated or otherwise under the influence at work
- Conducting criminal activity
- Operating recklessly well outside the scope of company guidelines
- Engaged in a violent assault they incited
- Committing egregious conduct, effectively operating outside the scope of employment
- Working for another person, company, or operation at the time of the accident
- Found to have inflicted their injuries intentionally
Again, employers will be fast to allege that any or all of the above applies to your situation, so be sure to protect your rights and hold them accountable for their allegations with the assistance of a knowledgeable workers compensation attorney in California.
Seek the Benefits You Need With a California Workers Comp Lawyer at Singh Ahluwalia
Singh Ahluwalia Attorneys at Law has built a reputation on standing up for the rights of disadvantaged communities. Employers often act as if they hold all the power in a workplace accident scenario, but the truth is that state and federal law gives workers of all stripes rights that demand they receive a fair chance at obtaining much-needed benefits.
Let us help you fight for your interests and do everything possible to secure benefits for all your losses. We can also help you identify other potentially at-fault parties, such as a third-party contractor at your jobsite, an equipment manufacturer, or a driver who hit you during the course of your work duties.
Reach out to our law offices today to schedule a no-cost appointment, where you will discuss the steps you need to take to maximize your chances of a successful claim. Schedule your free appointment with an experienced California personal injury lawyer when you call (559) 878-4958 or contact us online.
