When Should You Hire a Workers’ Comp Lawyer?
Just because you’ve sustained an injury on the job doesn’t mean you should rush to hire a workers’ comp lawyer. Some claims are cut and dry and workers will have no trouble receiving the medical benefits and financial compensation they deserve. In other instances, however, injured employees will need the guidance and expertise of a workers’ comp lawyer in Orange County.
The claim is denied
Insurance companies will look for reasons to deny a workers comp claim. They may claim the injury wasn’t work-related or that the worker missed the deadline for filing the claim. Workers may appeal the denial through the state’s workers’ compensation system but would need a lawyer to guide them through the process of filing paperwork, gathering evidence, and presenting the case at a hearing.
The permanent disability rating is disputed
The majority of workers’ comp settlements and awards are for permanent disability benefits, which are calculated using a permanent disability rating. If the insurance company doesn’t agree with the rating determined by the worker’s physician, they may require the worker to attend an independent medical examination (IME) with a physician of their choosing. This physician will likely provide a lower disability rating and the insurance company will use this rating to lower the amount of benefits being paid.
The worker has a preexisting condition
Injured workers who have a preexisting condition may struggle to prove the injury was work-related. The insurance company will blame the injury on the previous condition to deny benefits.
Difficulty obtaining treatment
If an injured worker needs an expensive surgery, the insurance company may deny or delay the approval of the medical procedure. In these instances, an experienced workers’ comp lawyer will put the necessary pressure on the insurance company to approve the treatment.
The worker’s ability to work is impaired
Some injured workers will not be able to work again, even after completing treatment, meaning they’ll need the maximum amount of workers’ comp benefits.
The worker is receiving other government benefits
Injured workers who are receiving Social Security Disability Insurance (SSDI) benefits may see these benefits reduced if they start receiving workers’ comp benefits.
Upcoming workers’ comp hearing
If the insurance company refuses to give a fair settlement offer, the worker will need to present their case at a hearing. In these situations, it’s critical to have an experienced workers’ compensation lawyer who will fight for the worker’s rights.
California Workers Compensation – TTD
In the California Workers’ Compensation system, TTD is an abbreviation for “Temporary Total Disability”. TTD benefits are available to injured workers who are, according to a qualified physician, are temporarily unable to work as a result of their work-related injury or illness.
TTD benefits provide temporary wage replacement to workers for up to 104 weeks at the rate of 2/3 pay, subject to a certain maximum weekly rate.
To be eligible for TTD benefits, an injured worker must first report their injury or illness to their employer and file a workers’ compensation claim. The employer’s workers’ compensation insurance carrier will then investigate the claim and determine if the worker is eligible for TTD benefits.
It is important to note that the workers’ compensation system in California can be complex, and injured workers may benefit from seeking the assistance of an attorney who specializes in workers’ compensation law to help them navigate the claims process and ensure that they receive the TTD benefits to which they are entitled.
If you believe you may be entitled to TTD benefits due to a work injury or illness, contact us at 714-547-5025.
California Workers’ Compensation – Serious and Willful Misconduct of the Employer
Serious and Willful misconduct in the context of California workers’ compensation law refers to a reckless act or omission by an employer with a disregard for the safety of an employee.
Under California law, if an employee is injured as a result of Serious and Willful Misconduct (S&W) on the part of the employer, the employee may be entitled to 50% additional compensation beyond what they would receive through traditional workers’ compensation benefits. This additional compensation is known as a serious and willful misconduct penalty.
In order to be entitled to potential S & W benefits, the worker ( or dependent(s) ) MUST a special applicant with the Workers Compensation court BEFORE the 1-year anniversary of the date of injury, or the S & W claim will be barred by the Statute of Limitations.
To establish a claim for serious and willful misconduct, the employee must show that the employer had a reckless disregard for the employee’s safety and that the act or omission was a substantial factor in causing the employee’s injury. Often, an expert witness is necessary to prove the S & W case.
Examples of serious and willful misconduct may include an employer’s intentional failure to provide safety equipment or training, intentional disregard of safety rules, or intentional removal of a safety guard from machinery.
If you believe that you have been injured as a result of serious and willful misconduct on the part of your employer, you should consider consulting with an experienced California workers’ compensation attorney to discuss your legal options. We can be reached at 714-547-5025.
California Workers’ Compensation – Brain Injury
Workers’ compensation in California provides benefits to employees who suffer work-related injuries or illnesses. Brain injuries can be the most complex injuries a worker can suffer because it affects nearly all aspects of life. Loved ones can be affected by the injury as well, often providing care that the insurance company resists providing.
In California, can be any disruption in normal brain function caused by an external force, such as a blow to the head. Brain injuries can range from mild concussions to severe traumatic brain injuries (TBIs). Brain function can also be affected by pain, as well as medications are taken for a work injury. Chemical exposure can also cause brain dysfunction.
If you have suffered a brain injury while on the job in California, you should immediately report the injury to your employer and seek medical attention. Your employer is required to provide you with a claim form for workers’ compensation benefits within one working day of being notified of your injury and immediately provide the proper medical treatment.
Once you have filed a workers’ compensation claim, your employer’s insurance company will investigate the claim and determine whether or not to accept liability. If your claim is accepted, you are entitled to quality medical care for your brain injury, including specialist if necessary.
If your claim is denied, you have the right to appeal the decision. It is important to consider advice from an experienced workers’ compensation attorney who can help you navigate the appeals process.
If you have suffered a brain injury and need help navigating the complex workers’ compensation system, call us at 714-547-5025.
7 Tips For Staying Safe In The Workplace
Regardless of whether you work at a desk or operate heavy machinery, the workplace poses safety hazards that could lead to injuries. To stay safe and avoid injuries, here are a few tips every employee should keep in mind.
- Use equipment, machinery, and tools properly
Don’t think that you can figure out how to use equipment properly on the fly. No matter your experience level in the industry, it’s important to approach every new piece of machinery with caution. Take the time to learn how the equipment works and take the necessary steps to protect yourself and others.
- Report unsafe conditions immediately
If you see unattended machinery, loose cords, cluttered spaces, broken glass, spilled liquids, broken lights, or uneven surfaces, report these safety hazards to your manager or supervisor.
- Stay hydrated
Staying hydrated helps you stay alert and focused. Keep a bottle of water nearby to remind yourself to drink water regularly.
- Practice good posture
Whether you’re sitting for long periods of time or lifting heavy objects, it’s important to use the right posture. Use an ergonomic desk and keyboard to minimize strain on the wrists and arms. Remind yourself to sit up straight and keep the shoulders in line with the hips when moving objects. A habit of poor posture will strain the back, neck, and shoulders, leading to serious injury.
- Take regular breaks
Working nonstop may seem noble, but in fact it’s counterproductive. Without regular breaks, employees tend to get distracted, careless, and fatigued, which increases the risk of injury. Take short walks and avoid using your phone during your breaks.
- Be aware of surroundings
If you’re working in a busy environment with many moving objects and people, it’s important to look out for the following:
- Signage indicating hazardous areas and materials
- Emergency exits and procedures in case of a fire, flood, or earthquake
- Unsecure railings
- Items blocking hallways and passageways
- Avoid shortcuts
If you’re running behind schedule, you may be tempted to skip a few steps to catch up. But those steps could be the difference between safety and an injury. Don’t take shortcuts and always follow instructions for using tools and machinery.
3 Key Milestones in Worker Safety
The Industrial Revolution brought many changes to the workplace that accelerated production but also increased the risk of injury and even death. Dangerous work conditions led to the creation of workplace safety laws that continue to shape working conditions today.
- Employers Liability Law
The Federal Employers Liability Act (FELA) was passed in 1908 to protect railroad workers supporting the rapid expansion of the nation’s railway network. Under the law, employers could be held liable for worker injuries and death on the job. Employers were also required to compensate injured workers and their family members. However, employees were required to prove employer negligence to receive benefits.
- Workers’ Compensation
Workers’ compensation insurance was created in Germany in 1870 and spread across Europe in the late 19th century. The first comprehensive workers’ compensation law in the US was passed in Wisconsin in 1911. In 1948, workers’ compensation insurance was available in all states. The workers’ compensation system gave injured workers access to medical care and wage replacement benefits.
Today, workers’ compensation insurance is regulated at the state level and most employers are required to provide coverage.
- Safety Agencies
Throughout the 20th century, many government agencies and non-governmental organizations were established to monitor workplace safety and enforce compliance. The three main safety agencies in operation today are:
- The US Department of Labor (DOL)
The DOL offers resources and training for job seekers and retirees and sets wage standards. Its mission is “To foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.”
DOL oversees numerous offices, agencies, and program areas to fulfill its mission.
- The Occupational Safety and Health Administration (OSHA)
Part of the DOL, OSHA was established in the 1970s to enforce the Occupational Safety and Health Act. OSHA sets workplace safety standards and enforces policies to keep employees safe and healthy. The administration also provides training, outreach, education, and signage to employers.
- The National Safety Council (NSC)
This non-governmental, non-profit, member-driven organization promotes health and safety by providing safety training, conducting research, and offering tools to mitigate risk. NSC also engages in government advocacy across national and local levels to drive awareness and create policies that support workplace safety.
How To Build a Successful California Workers’ Compensation Case
If you’ve been injured on the job, taking the right steps is key to building a successful workers’ compensation case. An experienced workers comp attorney will guide you through the process and ensure you receive the benefits you deserve.
- Understand the basics of workers’ compensation.
In California, a workers’ compensation case primarily addresses physical injuries. Workers may receive benefits for mental and emotional injuries, but these cases (referred to as stress claims) are more difficult to prove and must meet stringent requirements. To receive benefits for a psychiatric injury, workers must:
- Have a mental disorder that has been diagnosed under acceptable procedures
- Have required medical treatment or experienced disability
- Have worked for the employer for at least six months
- Prove that actual events of employment were the predominant cause of psychiatric injury
- Obtain prompt medical treatment.
Workers with physical injuries must seek medical care right away. Neglecting early treatment may give insurance companies a reason to deny or fight a claim. Once workers have reported the injury to their employer, they may receive $10,000 worth of medical care regardless of whether their claim is approved or denied.
- Don’t skip medical appointments.
Claimants must show their commitment to receiving medical treatment and attend every medical appointment. Gaps in treatment will give the insurance company a reason to doubt the validity of your claim and the extent of your injuries. A consistent record of medical appointments will help build a solid workers’ compensation case.
- Set realistic expectations for case value.
An experienced workers’ compensation attorney will determine the value of your case and help you set realistic expectations. It’s important to understand that the California Workers’ Compensation system doesn’t give workers the full range of benefits available in the civil court system. Injured workers won’t receive compensation for pain and suffering or compensation for punitive damages.
- Choose the right attorney.
An attorney specializing in workers’ compensation will know the ins and outs of the legal system and help you secure the compensation you deserve. Before hiring an attorney, read customer reviews, schedule a consultation, and find out who will be handling your case. If you have any questions about your workers’ comp case, don’t hesitate to reach out to Thomas F. Martin, PLC.
The Top 7 Causes of Workplace Fall Injuries
An experienced work injury attorney has worked on many cases involving falls. Though there are numerous causes of workplace falls, the injuries workers sustain from a fall inevitably require medical attention and time off from work.
Recognizing the risk factors for falls in the workplace can help prevent these accidents and keep workers safe. Here are the top seven causes of falls in the workplace.
- Uneven floors
Uneven floors may be slightly angled, without any warning signs posted. In other cases, the sidewalk outside of a building may have sunk into the ground or risen up, creating cracks that could lead to an accident. Cracked tile floors with missing pieces could also lead to a fall.
- Loose cords
Loose cords from equipment and machinery pose a trip hazard that could lead to serious injuries affecting the back, hip, pelvis, spinal cord, and bones. Workers may suffer concussions, fractures, and even brain damage from just a few loose cords.
- Wet floors
Floors that were recently cleaned should have a caution sign posted, warning workers to watch their step. On the other hand, oil or other liquid spilled onto the floor should be cleaned as soon as possible to prevent falls.
- Insufficient lighting
Poor lighting makes it difficult to see steps, uneven flooring, and obstacles on the floor, increasing the risk of a fall. Employers need to make sure lighting is working properly in all work areas and install additional lighting where necessary.
- Obstructions
One common cause of falls is obstruction. Work injury attorneys often handle cases in which workers tripped over boxes, tools, and various containers.
- Rugs
Old, small rugs aren’t very sturdy and likely to become bunched up and create a tripping hazard. Workers can fall in bathrooms, storage closets, and hallways, and sustain injuries that require medical treatment.
- Improper footwear
Restaurants, stores, and manufacturing buildings are likely to have wet floors that increase the risk of a fall. Employers should ensure every worker is wearing slip-resistant footwear in these environments.
Choosing a Work Injury Attorney
Not every fall is preventable and in some cases workers can sustain serious injuries. Hiring the right work injury attorney is key to receiving the necessary benefits and compensation. Call Thomas F. Martin today for a legal consultation.
What to Expect From a Psychiatric Workers’ Comp Claim in CA
When we think of workers’ comp injuries, we generally think of physical injuries like broken bones, tissue damage, burns, and lacerations. But workers’ compensation also includes psychiatric injury, which is a mental disorder determined to be at least 50% caused by the workplace.
How to claim a psychiatric injury.
To obtain compensation for a psychiatric injury, an employee must:
- Show employment for six months or longer
- Prove that work activities or the work environment were greater than 50% of the cause of psychiatric injury
- Prove the injury was not a consequence of physical injury
If the psychiatric injury was caused by a violent act, then the employee must show that 35-40% was caused by work. In addition, the six-month requirement doesn’t apply to injuries caused by a sudden and extraordinary event.
Can physical and psychological injuries be combined in a claim?
A psychological injury cannot be caused by a physical work injury. An injured employee can only add a psychological claim to the original injury if it was due to a violent crime or a catastrophic injury such as paralysis, severe burn, amputation, or severe head injury.
What is the difference between an injury and a permanent disability?
If the worker has not sustained a psychiatric work injury, then they will not receive any medical treatment, temporary disability, or permanent disability. If a physician does identify a psychiatric injury in a worker, then the extent of disability and evaluation of non-work-related factors will be determined on a separate basis.
How a psychiatric claim is rated in CA workers’ comp.
In California, a psychiatric work injury is rated using the Global Assessment of Function (GAF) scale, which is then converted to a percentage and adjusted up or down using the Permanent Disability Rating Scale (PDRS). A GAF rating below 70 is considered a permanent disability.
What to expect during a psychiatric injury claims process.
To determine a worker’s eligibility for compensation, the insurance company will ask questions about the workers’ relationship with friends and family, medical conditions, sex life, past abuse, and trauma. An injured worker should decide if filing a psychiatric claim is worth answering questions on such personal matters.
Why CA Workers’ Comp Investigation Timeline May Change
The length of time it takes to investigate a workers’ compensation claim varies depending on the type of injury reported, the circumstances surrounding the accident, witness availability, the extent of the medical conditions, the availability of documentation, and the cooperation and availability of all parties involved.
California bill SB 1127 would reduce the investigation period for claims in which workers have a presumption of compensability to 75 days from the employer notification of the injury. In other claims, the investigation period would remain at 90 days.
Challenges With Workers’ Comp Investigations
The California Workers’ Compensation Institute (CWCI) conducted a study that found potential problems associated with reducing claim investigation time frames; these include:
- Litigated and denied claims require significantly more time to gather reports and documentation from outside sources. Only 49.2% of litigated claims that are eventually denied have a compensability decision at 75 days.
- Employers are currently liable for up to $10,000 of medical treatment for a claimed injury during the investigation period, regardless of the insurance company’s final decision. Reducing the time frame would reduce the amount of time workers whose claims are eventually denied have to receive $10,000 worth of medical care.
How Workers’ Comp Investigations Proceed
A workers’ comp investigation looks at video surveillance, online social media channels, interviews, and medical reports to determine whether the claim should be approved or denied. The insurance company’s claims team is checking to see if the injury is fake or exaggerated if the injury is job-related, and if the employee is still working.
Investigators will watch employees coming and going from home and doctor’s offices. In addition, they will review the injured employee’s online posts, tagged photos, status updates, and other online activities. Investigators will also interview employees over the phone or in person to see if the injury is valid and work-related. Workers’ comp claims teams may also interview the injured employee’s relatives, close friends, coworkers, and neighbors to learn more about the employee and identify potential fraud.
Legitimately injured workers don’t need to worry about the claims investigations process. Hiring an experienced work injury lawyer in Orange County, CA will help ensure they have a solid case and receive the compensation they deserve. Call Thomas F. Martin, PLC today to schedule a consultation.
English
Spanish