When an employee gets injured at work or becomes sick due to work conditions, they may be entitled to workers’ compensation benefits. However, receiving these benefits requires meeting a specific legal standard of proof. In this blog, we’ll explore what the legal standard to prove a workers’ compensation case entails, helping you understand the key aspects in simpler terms.
What is the Legal Standard of Proof?
The legal standard of proof is like a rule that helps determine if someone’s claim meets the requirements of the law. In a workers’ compensation case, the injured employee needs to provide evidence that proves it is more likely that not their injury or illness is work-related. It’s not enough to just say an injury or condition was caused by work, they must prove it to the standard of the law in order to receive the workers compensation benefits they are entitled to.
Types of Legal Standards:
In workers’ compensation cases, the legal standard the court uses is known as “preponderance of the evidence.” This standard requires the employee to show that their injury or illness is more likely to have happened because of work, rather than some other reason. It doesn’t have to be 100% certain, but the evidence should show that it is more probable than not – over a 50% chance.
To meet the preponderance of the evidence standard, the injured employee and their attorney may need to collect various types of evidence, such as:
- Medical Records: Medical reports and records from doctors that explain the injury or illness and connect it to work activities.
- Witness Statements: Statements from co-workers, supervisors, or others who saw the incident or can verify the work-related conditions.
- Work History: Information about the employee’s job duties and how the injury relates to their work tasks.
- Expert Opinions: Sometimes, experts in specific fields may be needed to provide opinions on the work-relatedness of the injury or illness.
One essential element in workers’ compensation cases is “causation.” This means that the injury or illness was caused OR INFLUENCED by work-related activities and not by something unrelated to work. The evidence presented should clearly establish this connection.
The Burden of Proof:
In workers’ compensation cases, the burden of proof lies with the injured employee. It means they have the responsibility to gather and present the evidence needed to show that their injury or illness is work-related.
Proving a workers’ compensation case involves meeting the legal standard of “preponderance of the evidence.” This requires providing convincing proof that the injury or illness is more likely to have happened because of work activities. To achieve this, gathering and presenting relevant evidence, like medical records and witness statements, is essential. By understanding the legal standard and working with a qualified attorney, injured employees can increase their chances of receiving the benefits they rightfully deserve.
If you need help with a work injury claim in Orange County, choosing a skilled attorney like Thomas F. Martin is crucial to ensure you receive all the benefits you deserve. Call 714-547-5025 or contact us online to schedule a free and private consultation.
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.
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.
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.
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.
An injury that occurs at work can require weeks and even months for an employee to fully recover. Some workers may not fully recover and require medical treatment for years to come. In these cases, injured employees want to be assured their medical bills and lost wages are fully reimbursed. Regardless of the details of the accident or illness, the value of a workers’ comp settlement takes time to determine — using the following factors.
- Severity and duration of injury
The severity of the injury or illness is the primary factor affecting the value of a workers’ comp claim. The extent of a worker’s injuries will direcly impact how much time they will be out of work, if they’ll ever be able to return to work, and whether or not they’re entitled to job retraining or occupational therapy benefits. Some workers may need permanent disability benefits, driving up the value of the settlement.
- Future medical needs
Injured workers who need years of treatment will need to be reimbursed for medical costs they’ll incur long after the claim has been settled. In these instances, workers will need an experienced work injury lawyer in Orange County to determine the appropriate compensation for future medical expenses. The insurance company will do their best to undervalue a claim if they suspect a worker has significant future healthcare costs.
- Employee wages
While a worker is receiving treatment, they’re eligible for lost wages reimbursement. The amount of money a worker is entitled to can be calculated through four ways:
- Their regular, full-time earnings
- The workers’ average earnings in a week for both jobs (if they’re working two jobs)
- The average weekly earnings from the previous year (for part-time or seasonal workers with an inconsistent wage)
- Any combination of the above methods to determine a fair amount
- Involvement of a workers’ comp lawyer
An experienced Orange County workers’ compensation lawyer will fight on behalf of injured workers to get the settlement they deserve. Thomas F. Martin PLC has helped many injured workers overcome the legal hurdles and obstacles in the workers’ compensation process and secured a fair settlement. Without the help of a lawyer, workers may not get the full benefits they deserve.
Reach out to Thomas F. Martin today to schedule a consultation!
Understanding Workers’ Compensation: Who Qualifies, How to File a Claim, and When to Consult a Workers’ Comp Attorney
Workers’ compensation is a vital protection for employees who have suffered injuries or illnesses while on the job. This system ensures that workers receive necessary medical care and wage replacement by filing a claim with the Workers Compensation Appeals Board (WCAB). Claims are handled by the Workers’ Compensation Appeals Board (WCAB) and overseen by judges. Employers in California with at least one employee are required to provide workers’ comp protection, and employees who meet the eligibility requirements can file a claim to receive benefits.
While many claims can be processed by the employee, some many require the assistance of a workers’ comp attorney because the system is complex. Employees may want to seek legal representation if their employer denies the claim, denied wage replacement benefits, fails to provide treatment or retaliates against them for filing a claim. A workers’ compensation attorney can also help if the injury or illness prevents the employee from returning to their previous job, limits their working capabilities, or keeps them from working entirely. Additionally, if the injury or illness occurred because of a third party’s actions or employer gross negligence, employees may need additional special legal assistance.
It’s important to note that workers’ comp attorneys can also assist employees in understanding how workers’ compensation benefits coordinate with other benefits, such as State Disability Insurance (SDI), Long or Short Term Disability, Social Security, Medicare, and other benefits. These can be complex and confusing areas of law, and a skilled attorney can help employees navigate the various options available to them. Additionally, an attorney can ensure that employees meet all reporting and filing deadlines and provide the necessary documentation to support their claim, giving them the best chance of receiving the benefits they deserve. With the help of a workers’ comp attorney, injured employees can focus on their recovery while their legal representation handles the details of their claim.
If you are unsure whether you need a workers’ comp attorney, it is best to obtain a free consultation with one to ensure you understand the potential benefits to which you may be entitled. Thomas F. Martin, an award-winning workers’ comp attorney who has been practicing for over 30 years, and he can help you understand your options and guide you through the claims process. Call 714-547-5025 today, or visit his website to schedule a free and confidential consultation. Don’t wait to get the help you need to protect your rights and obtain the compensation you deserve.
With every workers’ comp lawyer promising to help you win your case, how do you know which one to hire? What sets a workers’ comp lawyer apart from the rest? Here are a few characteristics injured workers should look for in a workers’ comp lawyer before making their selection.
Specialization in workers’ comp
The best workers’ comp lawyers specialize in the field and can confidently call themselves experts in workers comp. Thomas F. Martin, PLC has over 20 years of experience representing injured workers in workers’ comp cases and has deliberately chosen to limit his practice to this one field. This specialization allows him to stay up to date on the latest developments and changes in workers’ comp law. As a result, clients can rest assured Thomas F. Martin has the specialized knowledge and expertise they need to win.
Honesty and integrity
Honest and trustworthy workers’ comp attorneys are committed to collecting evidence that is credible, accurate, and relevant. In addition, an honest attorney has built a reputation among colleagues, judges, and the local legal community, bringing another level of credibility to every case he or she presents. For injured workers, a workers’ comp attorney’s reputation is one characteristic that should be considered.
Awards and recognition
Thomas F. Martin, PLC has received numerous awards and accolades throughout his career. He has been included in “Best Attorneys” listings by The Orange County Register, The Los Angeles Times, Los Angeles Magazine, Orange Coast Magazine, and numerous professional organizations. Martin also frequently lectures about the latest laws and trends in the workers’ compensation system. Thomas F. Martin, PLC is a well-recognized name that insurance companies can’t dismiss or ignore.
Experience judging workers’ comp cases
An attorney that has judged workers’ compensation cases for the California Workers’ Compensation Appeals Board (WCAB) has an insider view of how the system works and knows what it takes to analyze and prove a case to the WCAB. Thomas F. Martin has served as a Judge Pro Tem for the WCAB and had the authority to conduct a trial, and make and file a finding, opinion, order, decision, and award.
Before a case goes to court, a workers’ compensation attorney must lead multiple rounds of negotiations. It helps to know the tricks and tactics used by insurance companies to reduce the settlement. But when you’re being represented by Thomas F. Martin, PLC, rest assured he’s prepared for every move the opposite side will make.
Reach out to Thomas F. Martin PLC today to schedule a consultation and begin building your case.
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.
Workers’ compensation is a state-regulated system that provides benefits to employees who are injured or become ill as a result of their job. The system is designed to cover medical expenses, replace a portion of lost wages, and other costs associated with the injury or illness. However, the claims process can be complex and time-consuming, especially when it comes to utilization review (UR).
Introduction to workers’ compensation utilization review delays
UR is a process that is used to review medical treatment requests of treating physicians to confirm they are medically necessary and appropriate. In California, the Division of Workers’ Compensation (DWC) requires all medical treatment requests undergo UR. UR is intended to control costs and ensure that injured workers receive appropriate medical care. However, UR delays can have significant impacts on both employers and employees.
The impact of UR delays on employers
UR delays can have significant impacts on employers. Delayed medical treatment can result in longer recovery times and increased workers’ compensation costs. When employees are unable to return to work, employers may have to hire temporary replacements or adjust work schedules to accommodate the injured worker’s absence. This can result in lost productivity and increased labor costs.
UR delays can also lead to increased litigation costs. When employees legitimate treatment is being delayed unnecessarily, they are often forced to hire an attorney to assure prompt treatment is provided. These unnecessary frictional costs are passed on to the employers, and can result in increased workers’ compensation premiums.
The impact of UR delays on employees
UR delays can have significant impacts on employees as well. Delayed medical treatment can result in longer recovery times, increased pain and suffering, and decreased quality of life. In some cases, delayed medical treatment can result increased permanent disability.
UR delays can also lead to financial hardships for injured workers. When employees are unable to work due to their injuries, they may not receive a regular paycheck. This can result in financial stress and difficulty paying bills.
The cost of UR delays on taxpayers
When treatment is unnecessarily delayed by UR, this usually results in increased administrative costs for the workers compensation system because administrative resources are required to resolve the issues. Some injured workers are forced to obtain the benefits from Medicare or State medical programs like Healthy Families.
Strategies for dealing with UR delays
There are several strategies that employers and employees can use to deal with UR delays. One strategy is to work with an experienced workers’ compensation attorney. An attorney can help navigate the complex UR process and ensure that injured workers receive the medical treatment they need.
Employers can also take steps to prevent UR delays. This includes working with their workers’ compensation carrier to ensure that all medical treatment requests are submitted correctly and promptly so that the injured worker receives the treatment they need so they can get back to work.
Legal options for employers and employees
If UR delays result in financial or other hardships for employers or employees, there may be legal options available. Employers and employees can file complaints with the DWC or file lawsuits against workers’ compensation carriers or employers for bad faith handling of their employee’s claim.
An experienced workers’ compensation attorney can provide guidance on the best legal options for the injured worker so they can finally get the care they deserve.
Don’t wait any longer
If you need help navigating the workers’ compensation system and are facing UR delays, contact Tom Martin at 714-547-5025. He has been securing the benefits his clients deserve for over 30 years.