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.
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.
Workers’ Compensation Penalties For Delayed Payments (Labor Code 5814)
As an injured worker, understanding the various labor codes that govern your rights and protections in the workplace is essential. When claims administrators are late paying workers’ compensation benefits, California Labor Code 5814 can increase the benefit to the injured worker up to 25% up to certain maximums.
What is Labor Code 5814?
Labor Code 5814 is a section of the California Workers’ Compensation Law that outlines the penalties for employers who are overdue in paying medical and indemnity benefits owed to an injured worker.
Specifically, this section states that if a claims adjuster fails to timely provide workers’ compensation benefits in the form of payments for medical bills, or payments to an injured employee, they will be subject up to a 25% penalty on the amount of benefits that were not paid up to a certain maximum. This penalty is paid to the injured worker and IN ADDITION to any other penalties or fines that may be imposed by the state against the claims administrator.
Understanding the penalties for violating Labor Code 5814
The penalty is intended to deter claims administrators from delaying the payment of benefits to the injured workers that are owed. Some penalties are automatically owed if not paid promptly.
How to avoid violating Labor Code 5814
It’s simple: the best way for a claims administrator to avoid violating Labor Code 5814 is to ensure that they are fully compliant with workers’ compensation laws and pay the benefits owed to the injured worker and the physicians on time.
Steps to take if you believe your employer has violated Labor Code 5814
SAVE THE ENVELOPE!
The best way to prove that a payment to an injured worker was paid late is to save the envelope the late payment came in so it can be provided to the Workers Compensation Judge (WCJ) at the appropriate time.
SAVE LETTERS AND EMAILS
Any documentation you have related to the late payment should be saved as well.
KEEP ANY DEMANDS FROM DOCTORS
If you receive any notices of overdue bills from any of the doctors involved in your workers’ compensation claim, do not throw them away! Even if the workers’ compensation carrier may eventually pay the doctors, a penalty may still be owed to YOU.
DEMAND A BENEFIT PRINTOUT
You are entitled to see what payments the claims administrator has made and when. Keep a copy of any letter or email you send to the claims administrator demanding a printout of all payments made to you and medical providers.
Hiring a workers’ compensation attorney to help with Labor Code 5814 issues
If you believe that the claims administrator has delayed payments in your case, consider contacting an experienced workers’ compensation attorney. An attorney can help you understand your rights and options, gather evidence to support your claim and navigate the complex legal process involved in pursuing the penalties you may be owed. Contact Thomas F Martin PLC at 714-547-5025.
California Workers’ Compensation – Death Benefits
The California Workers’ Compensation system provides death benefits to the dependents of workers who die as a result of a work-related injury or illness. These benefits are intended to provide financial support to the surviving family members and dependents of the deceased worker.
The amount of death benefits that a dependent is entitled to receive depends on various factors, such as the worker’s earnings at the time of the injury and the number of dependents.
Generally, the death benefits include:
Burial expenses: Up to $10,000 for reasonable burial expenses.
In California, death benefits are usually paid as a flat sum to the beneficiaries, which could include:
$250,000 for one dependent or claimant.
$290,000 to be evenly split between two dependents or claimants.
$320,000 to be evenly split between three or more dependents or claimants.
Many deaths on the job may also involve misconduct of the employer, and if proven, the dependents may be entitled to a 50% increase in all benefits awarded.
If you’re a dependent of a worker who died as a result of a work-related injury or illness, consider consulting with an experienced workers’ compensation attorney to help you understand your rights and options. We can be reached 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.
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.
California Workers’ Comp Laws vs. Other States
In the US, workers’ compensation is regulated at the state level. This means states have widely differing workers’ compensation laws. In most states, with the exception of Texas, employers are required to carry workers’ compensation insurance.
Depending on the state, employers are required to make regular payments to a private insurance company or a state fund. These payments help cover the benefits paid out to injured employees. Benefits may include compensation for lost wages, medical bills, disability, and even death.
Typically, employers covered by workers’ compensation insurance must file a claim with the insurance company and forfeit their right to sue the employer in most cases. To avoid lawsuits, fines, and criminal charges, employers are required to know and understand local regulations governing employee rights.
How Workers’ Comp Laws Differ Across States
Generally, the differences between workers’ comp laws across the US can be broken down into the following questions:
- Is workers’ compensation coverage required or optional?
- Which employees must be covered by workers’ compensation?
For employees working in high-risk industries like farming and construction, workers’ compensation is generally required. Some states, like Wisconsin and Montana, distinguish between low-risk and high-risk industries to determine workers’ compensation requirements.
Other states, like Tennessee, Alabama, Missouri, and Mississippi, only require workers’ compensation for businesses that have at least five employees. In some cases, the five employees must be working full-time.
States like California, New York, and Connecticut allow employers to exclude high-level workers from workers’ compensation insurance as long as they provide the correct documentation. Corporate officers, directors, and LLC members may be excluded from workers’ compensation coverage.
States also treat general contractors and sole proprietors differently. In most states, sole proprietors aren’t required to carry workers’ compensation insurance.
California’s Approach to Workers’ Compensation Requirements
California has few exceptions for workers’ comp coverage, compared to other states. For example, every employer with at least one employee is required to carry workers’ comp coverage.
The state also doesn’t distinguish between high-risk and low-risk industries to determine coverage requirements. However, insurance companies will assign different rates to determine the insurance premium based on the risks in the workplace.
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.