What’s a Request for Authorization (RFA)? Understanding in Simple Terms
By California law, EVERY medical treatment recommendation of your doctor must be on a one-page Request for Authorization (RFA) and forwarded to the proper place for consideration by the claims administrator. From there, the RFA will either be approved or sent to a Utilization Review company which will ether approve or deny the request. Let’s break this process down for easy understanding.
Asking Permission For Treatment
An RFA is like asking for permission to get specific medical treatment, for example, medication, physical therapy, and even surgery. Your doctor fills out the RFA and sends it to the insurance company for review.
The Insurance Company’s Decision
Once the insurance company gets the RFA, they will decide whether they feel the treatment is necessary. If the claims administrator (adjuster) approves the requested treatment, the doctor can proceed with the treatment. However, if the claims administrator does not approve the treatment, the adjuster MUST forward the request to a Utilization Review (UR) company who will arrange to have a physician review the RFA and decide whether to approve or deny the requests. UR might ask for more info from your doctor. If the treatment request is properly denied, the physician cannot ask for the treatment again for one year – but there are exceptions to this rule.
Connect with Thomas F. Martin, PLC
Remember, if you’re ever confused about RFAs or facing challenges in getting the treatment you need and your doctor believes is necessary, you’re not alone. It is frustrating to face a situation where a physician licensed by the State of California to treat patients can’t do so because a UR doctor – who hasn’t even examined you – has denied the requested treatment. For over 30 years, Thomas F. Martin, PLC has fought to obtain the treatment that his clients want and need to heal from their work injuries. Don’t hesitate to reach out for assistance or call 714-547-5025 for a free consultation.
What To Consider When Your MPN Doctor Won’t Treat All Your Work Injuries
Imagine you get hurt on the job and your employer sends you to see a doctor from the insurance company Medical Provider Network (MPN). The doctors are supposed to provide treatment for ALL of your injuries, right? But what if they don’t? For example, what if the doctor politely ignores the “minor” injuries, or refuses to send you to a specialist? Even when a doctor wants to do the right thing, sometimes the insurance company refuses to authorize treatment that the doctor wants to heal you.
If you are faced with this situation, don’t worry, there are steps you can take.
Document In Writing The Treatment Failures
First, don’t keep these issues to yourself. You want to get healed and get back to work. Documenting the treatment failures will get everything out in the open so the issues can be addressed. It’s easy to ignore phone calls from you, so if a call doesn’t work, consider a fax or email so there is proof you tried to get the issues solved.
Ask for a Second Opinion
Sometimes a different doctor might have a different approach. You have the right to request another physician to treat you. Again, make the request in writing.
Get Legal Help
If things still don’t work out, you may have to obtain legal help. You can talk to an experienced lawyer who knows about workers’ compensation and how to get the issues resolved. They can guide you and make sure your rights are protected. They can pursue the treatment you need.
Contact Thomas F. Martin, PLC
Thomas F. Martin, an attorney with over 30 years of experience in California Workers’ Compensation law has a well-known track record of solving treatment issues for his clients. Getting in touch with him can give you some perspective on how to navigate the situation and ensure your rights are protected. Contact Thomas F. Martin, PLC if you would like to learn more about your medical treatment rights. Mr. Martin can also be reached at 714-547-5025.
Documenting Your Workers’ Compensation Case in California
Documenting your workers’ compensation case is not just about securing the benefits you are owed now; it’s also about securing your future. With an experienced workers’ compensation attorney by your side, you’ll be guided through the intricate process, ensuring you receive the benefits you deserve.
The California workers’ compensation system has jurisdiction to address physical, internal and psychological injuries sustained on the job either due to a specific injury or caused because of the nature of the work duties over time.
Immediate Medical Care
Employers are required to provide medical care for work injuries WITHIN ONE DAY. Reporting your injury or condition to your employer will trigger access to $10,000 worth of medical care while the claim is being investigated. It is essential to attend all medical appointments so your injuries and conditions can be fully documented.
When treatment is completed
California’s Workers’ Compensation system utilizes various grids and charts to determine medical treatment and compensation. In complex cases, an attorney familiar with the system may be helpful to you while you are recovering from your injuries and conditions.
Finding The Right Attorney
Your choice of an attorney can affect the outcome of your case. Consider:
- The years of experience
- Whether the attorney limits his or her practice to workers’ compensation.
- Whether the attorney actually appears in court, or uses non-attorney “hearing representatives”
For inquiries pertaining to your workers’ comp case, don’t hesitate to connect with Thomas F. Martin, PLC. With 30 years of experience handling workers’ compensation cases, and by limiting his practice to handling only workers’ compensation cases, you will be in good hands.
Understanding Workplace Safety: OSHA’s Impact and the Path Forward
When it comes to ensuring safe working conditions for workers, the inception of the US Occupational Safety and Health Administration (OSHA) stands as a cornerstone. With the mission of setting standards, enforcing regulations, and offering education and support, OSHA is an essential agency that ensures worker’s well-being, and has prevented countless work injuries and deaths.
A Journey of Progress
Over the last 50 years, OSHA has not only reduced workplace injuries and fatalities but also fostered a culture of workplace safety that has affect the lives of millions. Collaborating closely with the Bureau of Labor Statistics (BLS), OSHA’s approach to implementing safety measures is grounded in the dynamic nature of workplace hazards. By incorporating the latest data on workplace injuries and fatalities, the agency tailors its safety recommendations that reflect the real-world challenges faced by workers across industries.
Measuring the Toll: Recovery Times and Fatal Causes
The impact of workplace injuries is not only measured in numbers of incidents, but also in the days that workers need to recover. The BLS highlights the varying recovery periods for different injuries, shedding light on the journey back to health on average ( outcomes vary depending on the individual of course):
- Multiple fractures and injuries: 48 days
- Fractures: 32 days
- Amputations: 31 days
- Carpal tunnel syndrome: 30 days
- Tendonitis: 14 days
- Strains, tears, and sprains: 11 days
- Multiple traumatic injuries: 9 days
- Soreness or pain: 8 days
- Multiple sprains with injuries: 7 days
- Contusions and bruises: 5 days
- Heat burns: 5 days
- Lacerations, punctures, and cuts: 4 days
- Chemical burns: 3 days
Facing Fatalities: A Glimpse into Workplace Risks
Workplace fatalities underscore the pressing need for continuous vigilance for safety at the workplace by OSHA. For example, in 2018, the leading causes of death in the workplace were:
- Transportation accidents: 2,080 fatalities
- Violence and other injuries caused by persons or animals: 828 fatalities
- Falls, slips, and trips: 792 fatalities
- Contact with objects and equipment: 786 fatalities
- Exposure to harmful chemicals or environments: 621 fatalities
- Fires and explosions: 115 fatalities
Occupations at the Crossroads
Certain occupations carry a higher than average risk, with fatalities per 100,000 as follows:
- Agriculture, forestry, fishing, and hunting: 23.4
- Transportation and warehousing: 14
- Construction: 9.5
- Wholesale trade: 5.3
- Professional and business services: 3.3
Addressing the Vulnerabilities: OSHA’s Insights
OSHA’s ongoing analysis pinpoints employer violations contributing to job-related injuries, illnesses, and fatalities as follows:
- Poor fall protection
- Poor hazard communication standards
- Poor respiratory protection
- Unsafe scaffolding
- Unsafe ladders
- Failure to control hazardous energy
- Poor fall protection training
- Poor eye and face protection
- Unsafe machinery
- Poor machine guarding
- Improper use of powered industrial trucks
Navigating the Road to Recovery
For those who are injured in the workplace, the workers’ compensation claims process can be challenging. Unfortunately, the more serious the injury, the more complex the claims processing usually is, including making certain the cause of the injuries is carefully investigated. Obtaining prompt and effective medical treatment, getting specialists authorized and assuring your disability benefits are paid as they should be sometimes require the assistance of an attorney who handles workers’ compensation claims.
When you decide an attorney is necessary
Choosing a competent work injury lawyer in Orange County can be critical in securing the benefits you are legitimately entitle to. With over 30 years of experience, connect with attorney Thomas F. Martin to have your potential claims reviewed free of charge. Mr. Martin can be reached at 714-547-5025.
Workers’ Compensation: What You Need to Know
Workers’ compensation is like a safety net for employees who get hurt at work or become sick because of work conditions. Employers pay an annual insurance fee to an insurance company, and if something happens to an employee, the worker can get benefits like medical care and lost wages by filing a claim with the insurance company.
Who Can Get Workers’ Compensation?
If you got injured or got sick because of your job, you might qualify for workers’ compensation benefits. It doesn’t matter whose fault it is. In most cases, you can’t sue your employer for damages if you get workers’ comp benefits. Instead, the Workers’ Compensation Appeals Board (WCAB) deals with these benefits.
Who Needs Workers’ Compensation Insurance?
All employers in California with at least one employee must have workers’ comp insurance. They can get it from an insurance company or sometimes large employer insure themselves.
How to File a Claim?
Your employer should tell you how to file a workers’ comp claim with the workers’ compensation administrator. Make sure to follow the deadlines to protect your claims. You can fill out the employee section of the WORKERS’ COMPENSATION CLAIM FORM (DWC 1) and give it to your employer. They must fill out their part and give copies to their workers compensation claims company and you within one business day. You can also get help from a workers’ compensation attorney.
When Do You Need a Work Injury Lawyer?
If your injury is minor and you didn’t miss much work, you might not need a lawyer. But in some cases, a lawyer can help, like if your employer denies the claim, doesn’t give you treatment, or if you believe your injury will likely affect your work or life a lot. A lawyer can also help if you have questions about other benefits or if your employer mistreats you for filing a claim.
The Next Step
To make sure you get all the benefits you deserve, it’s best to talk to a workers’ comp lawyer. You can contact attorney Thomas F. Martin for a free and private consultation by calling 714-547-5025 or reaching out online. Learn more about workers’ compensation by clicking this link.
The High Costs of Delayed Medical Treatment in Workers’ Compensation Claims
When it comes to workers’ compensation in Orange County, CA, timely access to medical treatment plays a pivotal role in ensuring the well-being and recovery of injured workers. However, the consequences of delayed medical treatment in workers’ compensation cases can be far-reaching and have significant implications. As am experienced workers’ comp attorney at Thomas F. Martin, PLC, located in Santa Ana, CA, I can shed light on the high costs associated with delayed medical treatment in workers’ compensation claims.
- Prolonged Pain and Suffering:
When an on-the-job injury goes untreated or is not promptly addressed, the injured worker may endure prolonged pain and suffering. What might have been a manageable injury with timely medical intervention can escalate into a more severe condition, leading to increased physical discomfort and diminished quality of life. Delayed treatment prolongs the recovery process, prolonging the period of pain and suffering for the injured worker. A typical example is wieght gain due to a knee injury can cause or worsen high blood pressure, and complicate diabetes.
- Complicated Claims Process:
In workers’ compensation cases, delayed medical treatment can complicate the claims process. Insurance companies and employers may question the legitimacy of the injury and its relation to the workplace. Delays in seeking treatment give rise to doubts regarding the severity of the injury or whether it is work-related at all. This skepticism can result in the denial or reduction of benefits, leaving injured workers struggling to obtain the compensation they deserve.
- Weakened Evidence of Causation:
Timely medical treatment establishes a clear and compelling link between the workplace injury and the need for medical care. Conversely, delayed treatment provides an opportunity for the defense to challenge the causation between the injury and the workplace. They may argue that intervening factors or non-work-related activities contributed to the condition, making it difficult for injured workers to prove their claim’s validity.
- Financial Strain and Lost Wages:
Delayed medical treatment can impose a severe financial burden on injured workers and their loved ones. Without timely intervention, injuries may worsen, requiring more extensive and costly medical procedures. The accumulating medical expenses can strain an injured worker’s finances, exacerbating the stress caused by the injury. Additionally, prolonged time away from work can result in lost wages, further adding to the financial challenges faced by the injured worker and their family.
- Impact on Future Benefits:
The timing of medical treatment can significantly impact an injured worker’s entitlement to future benefits. Delayed treatment may allow the defense to argue that the injury or condition is unrelated to work or that it has been exacerbated by factors outside of the workplace. Consequently, injured workers may face difficulties in accessing benefits such as ongoing medical treatment, rehabilitation services, or disability benefits.
The costs of delayed medical treatment in workers’ compensation claims are extensive, affecting not only the physical well-being of injured workers but also their legal rights and financial stability. Prompt and appropriate medical care is essential for a successful workers’ comp claim. If you have experienced delays in receiving medical treatment after a workplace injury, it is crucial to consult an experienced workers’ comp attorney who can advocate for your rights and navigate the complex claims process.
Contact Thomas F. Martin, PLC in Santa Ana, CA, for expert legal guidance and dedicated representation to ensure you receive the full compensation and benefits you deserve.
Securing the Rights of Injured Workers in the City of Orange, CA: A Guide To Choosing a Workers’ Compensation Attorney
If you are looking for a Workers’ Compensation Attorney in the City of Orange, you have come to the right place. The City of Orange is home to many hard-working individuals who are injured on the job every day. A skilled Workers’ Compensation Attorney like Thomas F. Martin, PLC. can help you navigate the complex legal process of filing a claim and ensure that you receive the compensation you deserve. Whether you have suffered from a workplace injury or an occupational disease over a period of time, Thomas F. Martin, PLC can provide you with legal representation and help you get treatment and back to work earning a living for yourself and your loved ones. With over 30 years of experience, Thomas F Martin, PLC can help you obtain the benefits you are entitled to under the law.
Workplace injuries are unfortunately common, and employees in all sectors are vulnerable to different types of health hazards. The hazards workers face in the workplace vary depending on the type of work. For example, an office worker has the risk of suffering a carpal tunnel (wrist) injury due to prolonged data entry duties, and a warehouse worker may experience a back injury from lifting. Employers are required by law to take measures to protect their employees, but accidents still happen, resulting in employees requiring medical attention or even hospitalization. In such cases, injured workers should consider consulting with a workers’ compensation attorney to ensure they receive the compensation and benefits they deserve.
Muscle sprains and strains are the most common workplace injuries, with joints of the body being the primary sites of injury. Jobs that require the lifting of heavy objects or twisting of muscles are most likely to cause injuries to the joints of the body, muscles and connective tissues. Workers in the manufacturing, transportation, and warehousing sectors are most susceptible to such injuries. Joint injuries can cause difficulties with walking, sitting, bending, and other physical demands and work duties.
Employees may also sustain broken or fractured bones that require weeks or months to heal. The types of workers’ compensation benefits in Orange, California may require extensive medical care, temporary disability, permanent disability, and job displacement benefits. Medical treatment benefits cover workers’ care needed to recover from a work-related injury, while temporary disability benefits cover wages lost due to the injury. Permanent disability benefits cover the worker’s loss of future earning capacity due to the permanent effects of the injury, while job displacement benefits cover workers who may qualify for a $6,000 supplemental job displacement voucher.
Injured workers who want to pursue workers’ compensation claims may need the services of a workers’ compensation attorney like Thomas F. Martin, PLC. It is advisable to choose an attorney like Mr. Martin who specializes in workers’ compensation as they are more focused on serving the specific needs of injured workers.
Contact us today for your free case evaluation, or call 714-547-5025.
How Workers’ Comp Attorneys Are Paid: Exploring Fees and Costs Involved in a Work Injury Case
Attorneys who handle workers’ compensation cases work on a contingency basis, meaning they only receive payment after they have secured benefits for their clients. If there is no recovery there is no fee. The fee structure for California workers’ comp lawyers typically is 15% fee of the total permanent disability award (which is considerably lower than the 33% to 40% charged by personal injury lawyers in Superior Court cases). Once a workers’ compensation settlement is reached and awarded to the injured worker, the fee will also be awarded at that time.
During the initial consultation with an experienced work injury attorney in Orange County, clients will learn about the workers’ compensation system and the state-approved fee retainer is signed by the injured worker at that time. The consultation is free of charge. If the employer takes the client’s deposition, the employer’s claims administrator pays your lawyer for the preparation and deposition time, not you. Additionally, the claims administrator pays all medical expenses, including treatment, medical evaluations, diagnostic tests, reports, interpreter services, and other medically related services.
In addition to helping you secure benefits for your work injury, a skilled workers’ comp attorney can also provide valuable guidance and support throughout the entire process. For example, similar to a “tour guide”, they can help you understand your rights, answer any questions you may have, and provide legal representation along the way, including appearances at court. They can also work with medical professionals to gather the necessary evidence to support your claim and negotiate with insurance companies on your behalf. With an experienced and effective attorney by your side, you can feel confident that your interests are being protected and that you have the best chance of securing the benefits you deserve for your work injury.
It’s important to note that while the 15% fee structure is standard for most workers’ compensation cases, it can occasionally be more or less depending on the unique issues involved. That’s why it’s crucial to work with a knowledgeable work injury attorney who is familiar with the laws and regulations in your state and can explain the very rare exceptions to the usual 15% fee to you. For example, in a simple uncontested case, the fee may be less than 15%, whereas in a very complex case involving extensive litigation may be slightly more than 15%. All of this should be discussed ahead of time.
To ensure that clients receive all the benefits they are entitled to, it is crucial to choose a competent work injury lawyer in Orange County. Award-winning attorney Thomas F. Martin offers free and confidential consultations to discuss clients’ claims. To schedule a consultation, call 714-547-5025 or reach out online.
When Can Injured Workers Sue Their Employers?
Accidents and injuries can happen in any workplace, but what happens when an employee in California gets injured due to their employer’s actions or negligence? In such cases, injured workers may have grounds to sue their employer for damages. Below are four scenarios where an injured worker in California can pursue a lawsuit against their employer.
- Willful physical assault by the employer
If an employer intentionally physically assaults an employee, causing injury, the injured worker may have the right to sue their employer for the damages incurred. Willful physical assault is a serious offense, and victims deserve justice and compensation for their suffering.
- Fraudulent concealment aggravated the injury
In some cases, an employer may intentionally conceal information or mislead an employee, aggravating their injuries. For example, if an employer fails to disclose safety hazards or provides incorrect safety instructions, resulting in severe harm to the employee, the injured worker may have grounds to sue for damages based on fraudulent concealment.
- The injury was caused by a defective product manufactured by the employer
If an employee’s injury is caused by a defective product manufactured by their employer, they can file a product liability lawsuit. Employers have a responsibility to provide safe and properly functioning equipment and products to their employees. In cases where an employer’s defective product causes harm to an employee, they can seek compensation by pursuing a lawsuit against their employer.
- The employer doesn’t have workers’ compensation insurance
In California, employers are legally required to carry workers’ compensation insurance to provide benefits to injured workers. However, if an employer does not have workers’ compensation insurance or fails to provide the necessary coverage, the injured worker may have the right to sue their employer for damages. This allows them to seek compensation for medical expenses, lost wages, and other related costs.
Generally, in California, workers’ compensation is a no-fault system designed to provide benefits to injured workers regardless of who is at fault for the injury. Workers’ compensation benefits typically cover medical expenses, disability benefits, and vocational rehabilitation.
Even if an injured worker decides to sue their employer, they can still pursue workers’ compensation benefits alongside their lawsuit. However, it’s important to consult with an experienced Orange County workers’ compensation lawyer to navigate the legal process effectively and ensure the injured worker receives all the benefits they are entitled to. Contact Thomas F. Martin, PLC today to schedule a consultation.
Navigating the Workers’ Compensation System: When to Consult with a Workers’ Comp Attorney
If you have suffered a work-related injury or illness, it is important to know that you have important legal rights under the Workers’ Compensation system. A workers’ comp attorney can help ensure that you receive the medical treatment, wage replacement, and other benefits you are entitled to. Common work injuries include back and neck injuries, fractures, and head and brain injuries. Fatal injuries also occur on the job, with falls being the most common cause of construction worker deaths. In California, the maximum period of time a worker can be paid Temporary Total Disability is two years, with some exceptions.
Hiring a workers’ compensation attorney can be a game changer for an injured worker. These attorneys have the experience and knowledge to navigate the complicated process of filing a claim, negotiating with insurance adjusters, and representing their clients in court if necessary so you can focus on healing.
Workers’ compensation attorneys can also help employees who have pre-existing conditions aggravated by work-related activities. If you have a pre-existing condition that was made worse by your job duties, you may still be eligible for workers’ compensation benefits. An experienced attorney can help you navigate the claims process and ensure you receive the benefits you deserve. Additionally, if your employer disputes your claim or you have any concerns about the fairness of the process, a workers’ comp attorney can advocate for you and protect your rights.
When choosing a workers’ comp attorney, it’s important to look for someone with experience in the specific type of injury and industry in question. A skilled attorney will know how to assess the value of a claim, gather the necessary medical evidence, and negotiate with insurance companies to ensure their clients receive the maximum amount of benefits available under the law. Additionally, an attorney can help protect an injured worker’s rights if their employer retaliates against them for filing a claim or if they experience any other form of discrimination.
If you have been denied benefits or are experiencing retaliation from your employer for filing a workers’ comp claim, it is important to consult with an attorney. A competent workers’ comp lawyer, like award-winning attorney Thomas F. Martin, can help you receive all of the benefits you deserve. Call 714-547-5025 or visit our website to schedule a free consultation.