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.
Finding An Award Winning Orange County California Work Comp Lawyer
When searching for an award-winning Orange County, California Work Comp Lawyer, it’s not always easy to identify the lawyers that have been routinely recognized for their skill and ethics.
How to Find an Award-Winning Orange County California Work Comp Lawyer
If you do a Google search for “award-winning Orange County California Work Comp Lawyer”, you’ll likely see ads for top lawyers in the area. But well-worded ads, flashy commercials, and big promises don’t always mean the attorneys have the experience, depth of knowledge, attention to detail, and ethics you deserve to have.
Look For Awards That Really Matter
There are many awards an attorney can receive, but Martindale-Hubbell has been the premier rating service for attorneys for over a century.
“For more than 130 years, Martindale-Hubbell has been evaluating attorneys for their strong legal ability and high ethical standards through a Peer Review Rating system. Prior to the 1887 edition of Martindale’s American Law Directory, which was the first publication to provide such ratings to attorneys, there was no way of truly knowing if the lawyer you were considering to do business with was trustworthy, ethical, or skilled in the legal field.
Today – Martindale-Hubbell continues to provide verified ratings for attorneys based not only on their legal ability and ethical standards as judged by their peers, but also based on reviews from their clients. While the criteria and format of the Peer Review Rating system have evolved since the 1800’s – the goal of Martindale-Hubbell ratings remains the same: to help keep the public informed when making the decision to do business with an attorney or law firm.”
Martindale Hubbell explains its rating system this way:
“Historically the Martindale-Hubbell® Peer Review Ratings™ system utilized an “A – B – C” scale to estimate the legal ability and ethical standards of an attorney. To qualify for an “A” rating an attorney had to be reported as “Very High” in their legal ability and had been practicing for at least 10 years, a “B” rating meant an attorney was rated “High” and had to be practicing for at least 5 years, and a “C” rating meant that the attorney was rated “fair” with no limitations on how long they were practicing. A second rating was also given to go along with the “A – B – C” rating and that was a “V,” meaning that the attorney’s peers stated they had “Very High” ethical standards. Over the years this transitioned to “AV”, “BV”, and “CV” ratings – with an “AV” rating meaning that the attorney had reached the highest of professional excellence and is recognized for the highest levels of skill and integrity.
Today, Martindale-Hubbell conducts a thorough review of attorneys who wish to receive a Martindale-Hubbell® Peer Review Ratings™, through a secure online peer-review survey where a lawyer’s ethical standards and legal ability in a specific area of practice is assessed by their peers. Once the review process is completed an attorney may receive 1 of the following Martindale-Hubbell® Peer Review Ratings™:
AV Preeminent®: The highest peer rating standard. This is given to attorneys who are ranked at the highest level of professional excellence for their legal expertise, communication skills, and ethical standards by their peers.
Distinguished: An excellent rating for an attorney who has some experience and is widely respected by their peers for their professional achievement and ethical standards.
Notable: A rating is given to a lawyer who has been recognized by a large number of their peers for their strong ethical standards”
Of all the awards and recognitions he is privileged to receive, Thomas F Martin is proud to advise he has been once again given the AV Preeminent® rating from Martindale Hubble for 2022.
Thomas F. Martin, PLC has won other industry awards for his contributions to the workers’ comp system, and decades of recognition as a thought leader in the practice of workers compensation law as evidenced by his invitations to lecture to various attorney groups for decades.
Other recognitions include The Orange County Register, The Los Angeles Times, Los Angeles Magazine, Orange Coast Magazine, and many other professional organizations. He has been rated a top workers’ comp attorney by “Best Attorneys” and continues to be known for his relentless pursuit of appropriate benefits for the clients he has chosen to represent.
Thomas F. Martin has been a speaker at various industry events, lecturing to thousands of workers’ compensation attorneys and professionals about the latest changes and methods in the workers’ comp legal system.
He has also served as a Judge Pro Tem for the Workers’ Compensation Appeals Board.
If you have been seriously injured on the job, Thomas F. Martin is available to personally discuss your potential case.
How A Orange County, CA Workers’ Compensation Lawyer Can Help You
If you’ve never sustained a work injury before, the prospect of going through the legal process can seem daunting — especially if you’re receiving medical care and struggling to figure out how to manage other daily responsibilities. However, not all work injuries require an Orange County, CA Workers’ Compensation lawyer, so it’s important to know what to consider to decide whether to hire an attorney.
Should You Consider Hiring an Orange County, CA Workers’ Compensation Lawyer?
- Your employer or insurance carrier denies the accident is work-related.
Minor work injuries are often denied by the employer or insurance company. If an injury goes untreated, it could become more serious, and even provide an excuse for denying the injury. Injuries that occur over time, such as exposure to toxic chemicals or repetitive activities, such as typing or lifting need to be documented by a physician as soon as possible.
A workers’ comp attorney in Orange County, California could help a worker secure the proof necessary to obtain the compensation an injured worker deserves.
- Your employer isn’t taking your injury seriously.
It is the employee’s job to report the accident or injury to the employer as soon as possible. Once the employer is notified, it is their responsibility to follow California law and report the injury to its workers’ compensation carrier.
If your employer refuses to report your injury to its workers’ compensation carrier, or the carrier hasn’t contacted you within a week after you reported the injury to your employer, consider contacting a workers’ comp attorney to take appropriate actions on your behalf.
- You anticipate permanent disability.
If you anticipate permanent disability, you may not be able to return to the work you were performing at the time of the injury. Your future income may be reduced due to the injury and you may be entitled to permanent disability compensation to address your reduced earning capacity. Insurance companies are more likely to fight and deny claims with permanent disability because they tend to cost insurance companies more money.
- The insurance company refuses to pay for doctor-recommended treatment.
Insurance companies often deny much-needed medical treatment – even when their own doctors recommend it! An experienced Orange County, CA workers’ compensation lawyer can help you get the treatment you need so you can get back to work.
- The insurance company denies your legitimate claim.
When your legitimate claim is denied by an insurance company, a workers’ comp attorney can assist in gathering the information and documentation your will need to have a workers compensation judge decide the issue.
- The insurance carrier makes an inadequate settlement offer.
If the settlement offer made by the insurance company makes you a settlement offer that doesn’t come close to considering your financial losses and permanent injury, you may want to consider securing legal representation. Most permanent disability claims are valued based on the rating provided by an examining doctor. If the insurance company disagrees with a treating doctor’s rating of your permanent injuries, you have a right to an independent physician evaluation arranged by the State of California. A workers’ comp lawyer can assist you in documenting the permanent injury compensation you are entitled to.
- You have a preexisting condition.
Insurance companies try to blame your current Permanent Disability on “preexisting conditions” – even if you recovered from prior injuries and conditions. A workers’ compensation attorney can help you fight the insurance companies’ attempt to get a “discount” on the permanent disability compensation you deserve.
- You intend to file for Social Security Disability Insurance ( SSDI ) benefits.
There is a potential interaction between SSDI benefits and workers’ compensation benefits. A workers’ comp attorney can help you navigate these issues, and potentially reduce offsets.
- You experience employer retaliation due to your work injury.
If the employer fires or demotes you, cuts your hours, or pressures you to return to work too soon, you may have additional claims against the employer.
- Someone else is responsible for your work injury.
In addition to having a workers compensation claim, “third-parties” (a person or company other than your employer) may also be responsible to compensate you for the injuries you sustained. A workers compensation attorney can assist you in securing workers’ compensation benefits and also recover your damages in a personal injury case against the third party that caused your injuries while you were working.
Searching for the top Orange County, CA Workers’ Compensation lawyer? Contact the law offices of Thomas Martin, PLC for a free consultation.
California Injured Workers Are Just 0.4% Of Hospital Stays CWCI Finds
According to research from the California Workers’ Compensation Institute (CWCI), injured worker hospitalizations fell to 17.2% in 2020, down from 47.2% in 2010. Over the past decade, the number of inpatient discharges in California have declined steadily, except for Medi-Cal.
The report compiled data on nearly 39.2 million inpatient stays from 2010 through 2020. Since 2010, workers’ compensation hospitalizations have represented the smallest share of hospital stays, just 0.4%.
Factors contributing to the decline in workers’ comp hospitalizations include the adoption of cost-cutting programs requiring treatment of injured workers to meet certain criteria not found in other provider systems. Consequently, taxpayers end up paying for treatment that the workers’ compensation insurance companies refuse to cover.
Under Governor Newsom’s leadership, many injured workers were treated via telemedicine and didn’t experience significant delays in receiving treatment. Thankfully, the vast majority of COVID-19 claimants only needed limited treatment, contrary to the insurance industry’s original predictions that the losses would be catastrophic.
2020 wasn’t a banner year for PROFITS for workers’ compensation insurers and business owners. Insurers took in less premium but also paid fewer claims, according to the Insurance Journal.
The reductions in both the losses and premiums created an 86% combined ratio for workers’ comp calendar year 2020. This would be the third-lowest combined ratio in history and the seventh consecutive year of underwriting gains, according to National Council on Compensation Insurance (NCCI) director and actuary Vicky Mayen.
Meanwhile, as insurance company profits soar, many injured workers are struggling to get back to work due to delays in their medical treatment.
A very familiar story, unfortunately.
Three Charged In Workers’ Comp Insurance Fraud Costing More Than $5 Million
Three bay area men — Eric Andrew Oller, Brian Christopher Mitchell, and Yama Sekander — former owners of painting companies, were arraigned September 20th in an Oakland court on fraud charges filed by the Alameda County District Attorney’s Office and the California Department of Insurance (CDI).
Oller and Mitchell owned Walnut Creek-based Signature Painting and Construction Inc. and were each charged with one felony count of conspiracy to commit a crime, six counts each of felony insurance fraud, and two counts of workers’ compensation fraud.
The defendants used Valhalla Consulting and A-1 World Class Painting, businesses owned by Oller and Sekander, respectively, as a shell company to pay painting company employees from 2017-18. SPC misrepresented or omitted information about the company’s structure, misclassified employees, and underreported payroll costs to illegally reduce their workers’ compensation premium.
Alameda County District Attorney Nancy O’Malley said, “If a business creates an environment where they falsely pay a lower insurance premium, that company has an unfair competitive advantage over one that is law-abiding.”
Mitchell and Oliver are also charged with entering into agreements to move employees from one company to another to reduce workers’ compensation costs. Authorities have accused Mitchell of using Sekander’s A-1 company to obtain a workers’ compensation policy for SPC.
SPC owners paid some employees under the table and instructed injured employees to report they worked for a different company, which allowed SPC to avoid paying and reporting the full amount of taxes owed.
Their scheme defrauded insurance carriers of more than $5 million since 2015. State Compensation Insurance Fund (SCIF) lost premium payments totaling $3.1 million and AmTrust lost about $1.9 million.
SCIF submitted a fraud referral against SPC in 2019 and authorities began their investigation. Crimes date back to 2015, according to authorities.
Charges were filed in late August and all three men have pleaded not guilty to the charges. The next court date is November 18.
Healthcare Professionals 3x More Likely to Test Positive for COVID-19
A 42-year-old woman was discovered in her home, dead for at least 12 hours, alone except for her four-year-old daughter. She was a mammogram technician at a hospital and likely another victim of COVID-19. (more…)
3 Mistakes Employers Make When A Work Injury Happens
Workplace accidents and injuries have significantly decreased over the past few decades thanks to guidelines developed by OSHA. In 2017, private industry employers reported 2.8 million nonfatal workplace injuries and illnesses, compared to 3.4 million workers treated in Emergency Departments in 2004. (more…)
The Injured Workers Puzzle Picture – Part 1
If you are facing a criminal charge, no matter how minor, you should talk to a defense attorney to fully understand your case. A consultation with an experienced attorney will help you to understand the charges placed against you, the defenses available, what if any plea bargains may be offered to you, and what you should do if you are convicted.
Why YOU Should Care About Workers Compensation
If you are facing a criminal charge, no matter how minor, you should talk to a defense attorney to fully understand your case. A consultation with an experienced attorney will help you to understand the charges placed against you, the defenses available, what if any plea bargains may be offered to you, and what you should do if you are convicted.
Paying Your Bills After A Work Injury
If you are facing a criminal charge, no matter how minor, you should talk to a defense attorney to fully understand your case. A consultation with an experienced attorney will help you to understand the charges placed against you, the defenses available, what if any plea bargains may be offered to you, and what you should do if you are convicted.
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