What Should You Do If Your Workers’ Compensation Claim Has Been Denied?
After a workplace injury, workers’ compensation benefits may be the only medical treatment and wage replacement resource available to you. If your claim is denied by the insurance company, you will not receive these benefits until the claim is resolved by a Workers’ Compensation Judge.
WHY WAS YOUR CLAIM DENIED?
Some reasons why a workers’ compensation claim is denied:
· Late or incomplete paperwork: Even when an injured worker completed the required paperwork, sometimes the employer does not. Following up on the claim status is usually a good idea.
· The severity of injury: Even if the injured worker reports an injury, the employer may not consider it “important” enough to tell their insurance carrier. Again, follow up!
· The “employer level investigation”: If you have received a letter from the insurance company that says “based on an employer level investigation” the claim is denied ( or some other excuse) even though you know it happened, it’s time to consider getting help.
If you have questions about your denied workers’ compensation claim, give us a call at 714-547-5025 for a free consultation.
3 Signs You Have a Solid CA Workers’ Comp Case
After you’ve been injured at work, the last thing you want to think about is legal matters. However, this is something that needs to be handled as soon as possible. An experienced work injury lawyer in Orange County will help make the process as seamless as possible so that you can focus on recovering physically and emotionally. Here are a few signs you’ve got a strong workers’ comp case.
1. You have a workplace accident report.
The employer is required to create an accident report and provide the injured worker with a copy. The accident report is used in the claims process to determine benefits eligibility and by the Orange County workers’ compensation lawyer to build a case.
The report details how the accident occurred, includes witness information, and plays a key role in helping the injured worker obtain the benefits and compensation they deserve.
2. You can prove employee status.
It’s important for an injured worker to prove they were an employee at the time of the accident. Their Orange County workers’ compensation lawyer will need copies of pay stubs and correspondence between the employee and the employer to verify employee status. The attorney will also need photos of the accident scene, time clock reports, and copies of witness testimony to support the workers’ comp case.
3. You have evidence of your injuries.
Injured workers will need to keep a record of their illness or injury, treatment, and actions following the accident. The Orange County workers’ compensation lawyer will need copies of medical records and bills, photos of the injuries, and doctor’s reports after every appointment.
This evidence will be used by the attorney to determine the value of your case, establish a link between the accident and the injuries, prove your willingness to pursue treatment, and increase your chances of obtaining a fair settlement.
Thomas F. Martin, PLC is an award winning work injury lawyer in Orange County, helping injured workers secure the compensation and benefits they deserve. Contact his office today to schedule a consultation and begin your journey to legal justice.
What To Expect When You Consult A Work Injury Lawyer
After a work injury, your time is more valuable than ever. Preparing in advance for the information and document that your attorney will need to file your claim will save you both time.
Documents to bring
The more prepared you are for the initial meeting with a work injury lawyer, the sooner benefits can be pursued. Try to bring the following:
- A brief description of your difficulties with the doctor assigned to you.
- A short description of your job duties
- Your most recent pay stub.
- The names of co-workers that may have witnessed your injury.
- The name of the work supervisor you reported your injury or condition to.
- The name and phone number(s) of the physicians you have seen for your injury or condition.
Discussion of the accident
Think carefully about how the injury or condition occurred. If machinery caused your injury, it is always helpful to have the name and model number of the machine. An Orange County workers’ compensation lawyer will ask you to provide as much detail as possible.
Questions to ask
When retaining an attorney, consider asking the following questions:
How long have you been practicing workers’ compensation law?
- Do you PERSONALLY handle my case, or do you rely on non-lawyers to handle court appearances and make decisions?
- Do you only practice work injury law, or do you try to manage other areas of law too?
- When was the last time you PERSONALLY attended a court appearance?
- How much time each month do you spend making TV and radio ads?
- Do you PERSONALLY negotiate settlements?
Next steps
Once the lawyer understands your potential case, they will let you know if they’re willing to represent you. When you retain a work injury lawyer in Orange County, you should feel confident you have the right lawyer for you.
The Role of a Work Injury Lawyer in Orange County
A work injury lawyer represents workers who have sustained injuries or an occupational illness. Their role encompasses a range of responsibilities that help to ensure the worker receives the benefits and compensation they deserve.
Determine Benefits Eligibility
Depending on the extent of the worker’s injuries, they may be eligible for the following benefits:
- Medical treatment
- Total or Partial Disability payment
- Permanent total or partial disability benefits
- Future Medical Care
- Job retraining voucher
Advise Clients on Workers’ Compensation Laws
A work injury lawyer in Orange County should be well-versed in California workers’ compensation laws and keep up with the latest changes to the system. An attorney recognized by other attorneys as ethical and knowledgable, such as Martindale Hubbell’s “AV Rating,” confirms a top attorney in the field.
Represent an Injured Worker
If you are qualified for the following benefits, an Orange County workers’ compensation lawyer will:
- Secure effective medical treatment for you, even if that means going to court to secure it.
- Thoroughly document the extent of your injury.
- Secure Temporary Disability payments so you can pay your bills while recuperating from your injuries.
- Document the extent of your Permanent Disability for the Judge.
- Secure the future medical benefits you are entitled to.
- Obtain a job retraining voucher.
- Enter into settlement negotiations to obtain a fair resolution of your claims.
- Conduct a trial if the employer refuses to pay the benefits you are legitimately entitled to.
A qualified Orange County work injury lawyer will serve as your “tour guide” through a complex system.
Key Skills And Knowledge
The more experienced an attorney is, the more likely they will be able to efficiently and successfully get you through your case. Look for:
- Does the lawyer practice many types of law or only workers’ compensation?
- Is the lawyer an administrator who does ads and supervises other lawyers and paralegals, or does the lawyer ACTUALLY APPEAR IN COURT routinely?
- Has the lawyer been recognized as an ethical and knowledgeable lawyer?
- Does the lawyer teach other lawyers how to represent injured workers effectively?
Injured workers should consider hiring a lawyer who limits the practice to workers’ compensation. Thomas F. Martin PLC has been a trusted name in Orange County workers’ compensation law for decades and has thousands of injured workers secure the benefits they deserve. Give Tom a call to schedule your free consultation!
Spinal Cord Injuries
The spine has 33 vertebrae, from the neck to the pelvis, with seven cervical (neck) vertebrae, 12 thoracic (upper back) vertebrae, five lumbar (lower back) vertebrae, five sacral (pelvic) vertebrae, and four coccygeal (tailbone or coccyx) vertebrae. Because the spinal cord connects the brain to the rest of the body, even slight damage to the spinal cord can lead to serious long-term health conditions and may severely impair motor skills.
Accidents at work can result in temporary, and even permanent, injuries to the spinal cord. Spinal cord injuries caused by slips and falls, falling objects, vehicle accidents, construction accidents and long term repetitive lifting motions may lead to partial or complete paraplegia or tetraplegia and severely limit a person’s ability to financially support themselves, and provide for their loved ones.
The Long-Term Effects of Spinal Cord Injuries
Complete paraplegia is a term physicians use to describe impairment in motor or sensory function, usually of the legs. Paraplegia can result from injuries to either the thoracic, lumbar or sacral regions of the spine. If all four limbs are affected by the injury this is referred to as tetraplegia (also commonly referred to as quadriplegia). Monoplegia is the medical term used when only one limb is affected.
Spinal cord injuries can also result in spastic paraplegia, resulting in sudden and uncontrolled movements of the affected limb(s).
Individuals that suffer a work injury that results in paraplegia or quadriplegia may experience complications, such as pressure sores, thrombosis, inflammation, nerve-related, and other health complications.
Symptoms of a Spinal Cord Injury
Individuals who sustain a spinal cord injury may experience the following symptoms:
· Numbness or tingling in the arms or legs
· Loss of function of the legs, feet, arms or hands.
· Severe pain in the neck and/or back
· Motor weakness
· Diminished coordination
· Loss of function of the foot (drop foot)
· Loss of bladder or bowel control
· Difficulty walking or maintaining balance
· Difficulty breathing
Permanent limitations may include:
· Bladder and bowel dysfunction
· Full or partial paralysis
· Difficulty breathing and/or need of respiratory support
· Infections
· Bedsores
· Pneumonia
· Chronic pain
· Headaches
· Mood swings or personality changes
· Sexual dysfunction
Important Steps to Take Immediately After a Spinal Cord Injury
To ensure maximum functionality and independence following a spinal cord injury, it is essential that a treatment and rehabilitation program be IMMEDIATE and customized to meet the unique needs of the injured worker. A team of professionals should be assembled, including physicians, nurses, and physical and occupational therapists.
Navigating the California workers’ compensation system following a spinal cord injury can be challenging for both the patient and family. An effective team of healthcare professionals is critical to optimize recovery, regain function, re-establish independence and may save delays and complications later.
It’s also important to consider retaining a workers’ compensation attorney to ensure the injured employee receives the appropriate medical treatment and compensation they are entitled to.
Injured Employees’ Legal Rights
Under certain conditions, employees who have sustained a spinal cord injury may have a legal basis to file an injury lawsuit against an employer or others that are responsible for the injury. A workers’ compensation lawyer can assist injured workers in documenting the potential liability of people and businesses that may have contributed to the accident or condition. Employees may have the following claims:
· Serious and Willful Misconduct. The employer was aware that the work conditions were unsafe and failed to take adequate safety measures.
· Inadequate or No Workers’ Compensation Insurance. The employer may be responsible for additional benefits even they have the workers’ compensation insurance required under California law.
· Third-party negligence. If a third party, such as another person or business, may be held liable for benefits IN ADDITION to workers’ compensation.
Why Hire Thomas F. Martin, PLC
Employees who have sustained a work-related spinal cord injury, or any other type of injury or illness, may be entitled to substantial benefits that cover the costs of medical care, physical therapy, transportation to care providers and wage replacement benefits. The harsh reality is that it is the job of a workers’ compensation insurance company to save as much money as they can on your claim. That’s why it’s so important to consider consulting with an experienced workers’ compensation attorney. The consultation is free.
Thomas F. Martin, PLC is a highly respected workers’ compensation attorney in Orange County, CA who has helped many clients obtain the benefits and compensation they truly deserve. If you’ve sustained a spinal cord injury, what many consider the best workers’ compensation attorney in Orange County, CA, Thomas F. Martin, PLC.
How To Know If Your Case Is Workers’ Comp Or Personal Injury
In California, individuals who sustain injuries in a home, public place, or workplace may have the right to pursue legal action. How the injury occurred and the location of the accident will determine the type of claim: personal injury or workers’ compensation.
Personal Injury
Personal injury cases are classified as either strict liability or intentional wrong.
- Strict Liability
Strict liability pertains to the consequences of the actions of a certain individual or party. For example, a car accident, faulty product, or an action that didn’t intend any harm or criminal intent could be categorized as strict liability.
Other types of strict liability include:
- Harm caused by owned animals
- Accidents due to negligence or carelessness
- Selling alcohol to minors
- Intentional Wrongs
Intentional wrongs can include obvious altercations between two parties; for example, a physical fight where the other party was liable. In such cases, it’s important to prove that one party intended to cause harm to the other.
Other types of intentional wrong include:
- Fraud
- Misrepresentation
- Defamation or slander
- Assault and battery
- False imprisonment
- Trespassing
Workers’ Compensation
Workers’ compensation claims refer to injuries or illnesses that are job-related. If an employee is unable to work as a result of a workplace injury, they can file a claim. Injured employees may be eligible for assistance with medical bills, lost wages, and psychological counseling.
An experienced work injury lawyer in Orange County could help injured workers determine the type(s) of compensation they are entitled to.
- Physical Injury Claims
Repetitive injuries, for example, are caused by doing repetitive activities such as bending or lifting, or as a result of improper workplace training. Common injuries caused by repetitive activities include carpal tunnel syndrome, neck and back strain, bulging discs, amputation, and nervous system damage.
- Mental Injury Claims
The workplace could also cause mental injuries such as anxiety, stress, and depression. These injuries may occur if the workplace is plagued by bullying, employee isolation, and threats of contract termination.
Injured workers should call the best Orange County workers’ compensation lawyer Thomas F. Martin, PLC to schedule a consultation and begin their journey to obtaining compensation.
Occupational Disease and Workers’ Compensation in California
Workers in a wide range of industries are at risk of sustaining specific injuries that could require extensive medical treatment.
Workers can also sustain injuries described as “wear and tear” or “cumulative trauma” injuries over time.
Specific Injuries
A specific injury occurs on a particular date and time, like falling off a ladder or lifting something that hurts your back.
“Wear and Tear” or Cumulative Trauma injuries / Occupational Disease
Physical injuries – Workers in occupations involving repetitive motions, like lifting, bending, or typing, may be at risk of developing “wear and tear” or cumulative trauma injuries. The symptoms can take weeks, months, or even years to develop. A physician should provide an opinion that supports a relationship between work duties and the condition.
Internal injuries – Other injuries and diseases can occur due to various exposures at the workplace. Exposure to periods of prolonged stress can contribute to high blood pressure, heart problems, or even aggravate diabetes, for example. Exposure to dust, chemicals, dust, or fumes at work can cause damage to the lungs. Unfortunately, workplace exposure can even contribute to certain cancers.
Hearing loss – A common injury for workers who work around loud noise, like airport workers, heavy equipment operators, farmers, ambulance drivers, manufacturers, and factory workers are all at risk. An explosion at work would be work-related as well.
Skin conditions – Rashes and thermal burns can be caused by exposure to harmful chemicals and lead to pain and scarring. Occupations at risk for these skin injuries include:
- Lab workers.
- Farmers who use pesticides.
- Working around radiation.
- Miners.
Brain injuries – Exposure to dangerous chemicals and even infections like West Nile Virus and viruses like Covid -19 can cause severe and lasting damage to the brain.
The above are only examples. If you suspect you have been exposed to harmful circumstances at the workplace, consider consulting with a work injury lawyer in Orange County to gather the evidence necessary to present to a workers’ compensation Judge.
How To File A Claim For Occupational Illness
Unfortunately, the California workers’ compensation system is complex, particularly when gathering evidence of serious injuries. To document a specific, cumulative trauma injury, or occupational illness, consider a free consultation with our Award-winning Orange County workers’ compensation lawyer, Thomas F. Martin, PLC.
For over 30 years, Tom has assisted injured workers to secure the financial and medical benefits they deserve.
What Every California Employee Needs to Know About Workers’ Comp
While the workplace has become safer over the past few decades, and worker injury rates have decreased, obviously injuries still occur on a daily basis.
The workers’ compensation system is complex, and a work injury lawyer in Orange County can be of assistance in navigating the California workers’ compensation system. Almost like your “tour guide” through the system.
Here are some general answers to common questions:
1. What is workers’ compensation?
Workers’ compensation is a form of protection for employees that employers must have to pay for workers that are injured on the job. Wage replacement benefits are provided as well as medical treatment at not cost to the injured employee.
2. What should I do if I’m injured at work?
A Worker who gets injured at work or sustains a work-related illness should tell their supervisor as soon as possible and fill out a claim form. Prompt reporting will help the worker gets the medical care and benefits they deserve. The employer should investigate the accident and immediately file your claim with their insurance company. Once the employer receives the completed claim form from the employee, they are required to fill out their portion of the form. Workers who need medical treatment should get it immediately.
3. Do I need to fill out the DWC 1 claim form?
Workers generally must complete the DWC 1 claim form to start the process of obtaining benefits. Otherwise, the employer may later say they didn’t know about the injury or illness you reported.
4. What kinds of benefits am I eligible for?
After reporting a work injury, a worker may be eligible for the following immediate benefits:
· Up to $10,000 in treatment while the claims administrator investigates the claim.
· Wage replacement benefits if a physician determines that injury prevents working, or the employer refuses to honor your work restrictions.
If the claim is accepted, injured workers may qualify for the following benefits:
· Continuing medical treatment
· Temporary disability benefits
· Permanent disability benefits
· Future medical care
· Supplemental job displacement benefits
· Other benefits required by law
5. Do I need a workers’ comp lawyer?
Injured workers should consider obtaining a free consultation with an Orange County workers’ compensation lawyer if:
· The physician assigned to the case is not providing appropriate treatment
· Treatment is being denied by the insurance company
· The employer or insurance carrier denies the accident or injury is work-related
· The employer doesn’t file the necessary paperwork on time
· It appears there will be permanent disability
· The settlement doesn’t cover all lost wages and medical bills
· They have a preexisting condition the insurance company is using as an excuse not to pay benefits
· They plan to file for Social Security disability benefits
· The employer retaliates against the injured worker even though the injury or illness is work-related
· Another person or company may be responsible for the injury
Your rights can be lost if a claim is not pursued promptly. Delays in making a claim may result in the statute of limitations barring the claim forever. Act promptly.
Common Challenges In Workers’ Comp Cases
When it comes to work injury claims, challenges are to be expected. Insurance companies don’t want to pay benefits and use many techniques to avoid paying them. Fortunately, experienced lawyers like Thomas F. Martin know how to navigate through those challenges and reach a positive outcome for their clients.
If you have a work injury, here are a few potential challenges a work injury lawyer in Orange County might help you with:
- Benefit delays
Disability benefits are often delayed at the beginning of a case. However, n injured workers’ bills don’t stop just because a worker is injured on the job. If you are taken off of word due to an injury, and the insurance company is not paying you temporary disability benefits, you may need to consult with a lawyer to find out your options. Sometimes a hearing before a workers’ compensation Judge is necessary. Penalties may be owed to you as well. An Orange County workers’ compensation attorney can assist you in resolving benefit payment delays.
- Difficulty obtaining medical treatment
Insurance companies usually insist on you treating with the doctor they assigned to you. Often, these doctors will be told by the insurance company that they can only treat you for the injuries that the insurance company “admits” were injured, and the rest of the injuries are ignored. For example, if you are seriously injured in a fall, and as a consequence of the extreme pain and sleeplessness you lose control of your diabetes, the insurance company is responsible for not only treating your work injuries but also getting your diabetes back under control. But often, the insurance company adjuster will refuse to pay for the treatment for diabetes because it was “pre-existing”. That’s the type of situation you may want to consult with an Orange County worker’s compensation attorney about to determine your rights and options.
- Employer retaliation after filing a claim
After a worker reports a work injury, employers may come up with all kinds of excuses to criticize a worker for “performance issues” like “working too slow”, or “not following the rules”. If it is determined that the employer is discriminating against the injured worker because of the report of a work injury, the employer may be violating the law, and additional benefits may be owed. An Orange County workers’ compensation attorney will know what kind of evidence is necessary to prove retaliation and obtain the benefits you may be owed.
- Disputes over preexisting injuries or conditions
One of the most common methods insurance companies use to reduce or deny workers’ compensation benefits is to blame a PAST condition or injury for the CURRENT disability the injured worker is experiencing. Even if the workers’ PAST injury or condition has fully recovered a long time ago, the insurance company will argue that the PAST injury is the reason for the current health challenges of the worker. If you are facing this type of challenge to your claim, an attorney can assist you in pushing back on this insurance company tactic.
- Disputing that you are an employee
Some employers, even rideshare and food delivery companies, create the impression that their employees are “independent contractors” so they can avoid paying for worker’s compensation benefits. However, the law in California requires that companies follow certain guidelines before a worker can be considered an “independent contractor”. If you have suffered an injury while you were working, and the company or its insurance company is denying you workers’ compensation benefits, you should consider consulting with an Orange County workers’ compensation lawyer to determine whether you were an independent contractor or employee.
WCAB’s “Grant and Study” Procedure Challenged As Unconstitutional and Unlawful
A group of injured workers has petitioned the Court of Appeal to determine whether the Workers Compensation Appeals Board (WCAB or Board) may legally grant itself indefinite extensions of time to issue final decisions regarding appeals from trial-level court rulings.
A party to a workers’ compensation case may appeal a trial-level ruling by filing a Petition for Reconsideration with the Board which is currently staffed by 6 Commissioners. The Labor Code requires that these appeals be decided by the WCAB within 60 days. However, in many cases the Board, following an unwritten, self-adopted policy and procedure, issues so-called “grant and study” orders which extend that time period indefinitely. In response to a recent public records act request, the WCAB provided data demonstrating that it has issued such “grant and study” orders in over 500 cases within a 3-year period alone, many of which remain undecided for years at time. While these cases remain in the WCAB’s “administrative limbo”, the injured workers involved in those cases are prevented from receiving the full range of workers’ compensation remedies and benefits to which they would otherwise be entitled. Employers and insurance companies are also prejudiced by the lack of finality.
On Friday, March 4, 2022, a petition for a writ of mandate was filed in the Court of Appeal, Second Appellate District. The petition requests that Court of Appeal find that the “grant and study” procedure is unconstitutional and unlawful, revoke all of the “grant and study” orders issued by the WCAB, and order the WCAB to provide a timetable within which it will render final decisions in all cases where such “grant and study” orders have been issued. This case is entitled Michele Earley, et al. v. The Workers’ Compensation Appeals Board of the State of California, et al., Case No. B318842, and has been assigned to Division of 8 of the Second District Court of Appeal.
Tom Martin, one of the co-signers of the petition in the Earley case said: “The California Constitution requires that the workers’ compensation system function in an “expeditious” manner, and the legislature passed laws to assure that. The system works best when injured workers and employers can get their disputes resolved as quickly as possible”.
Charles Rondeau, a co-signer of the petition explained: “As the data produced by the WCAB itself proves, the Board faces the daunting task of deciding a large number of petitions for reconsideration. Anecdotal information clearly suggests that the WCAB’s continued utilization of the “grant and study” procedure is that the Board lacks adequate resources to render final decisions regarding these petitions within the time limit established by law. While the workers’ compensation community can certainly empathize with the WCAB’s plight, the appropriate manner for the Board to address the situation is not to continue employing an ad hoc “workaround” which is impermissible under California statutes and which is inconsistent with the California Constitution that explicitly requires that the WCAB decide disputes “expeditiously, inexpensively and without incumbrance of any kind”. The “grant and study” procedure has been utilized by the Board for decades without a single decision by an appellate court directly addressing and definitively validating its constitutionality and lawfulness. The time has come for such a determination to be made and for the WCAB to seek sustainable, long-term solutions to the challenges which it is facing in rendering timely final decisions. This Petition provides an opportunity for the WCAB to explore and then implement such solutions.”
A copy of the petition filed in the Earley case can be found here:
For further information regarding the petition, please contact Mr. Martin or Mr. Rondeau.
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