How To Build a Successful California Workers’ Compensation Case
If you’ve been injured on the job, taking the right steps is key to building a successful workers’ compensation case. An experienced workers comp attorney will guide you through the process and ensure you receive the benefits you deserve.
- Understand the basics of workers’ compensation.
In California, a workers’ compensation case primarily addresses physical injuries. Workers may receive benefits for mental and emotional injuries, but these cases (referred to as stress claims) are more difficult to prove and must meet stringent requirements. To receive benefits for a psychiatric injury, workers must:
- Have a mental disorder that has been diagnosed under acceptable procedures
- Have required medical treatment or experienced disability
- Have worked for the employer for at least six months
- Prove that actual events of employment were the predominant cause of psychiatric injury
- Obtain prompt medical treatment.
Workers with physical injuries must seek medical care right away. Neglecting early treatment may give insurance companies a reason to deny or fight a claim. Once workers have reported the injury to their employer, they may receive $10,000 worth of medical care regardless of whether their claim is approved or denied.
- Don’t skip medical appointments.
Claimants must show their commitment to receiving medical treatment and attend every medical appointment. Gaps in treatment will give the insurance company a reason to doubt the validity of your claim and the extent of your injuries. A consistent record of medical appointments will help build a solid workers’ compensation case.
- Set realistic expectations for case value.
An experienced workers’ compensation attorney will determine the value of your case and help you set realistic expectations. It’s important to understand that the California Workers’ Compensation system doesn’t give workers the full range of benefits available in the civil court system. Injured workers won’t receive compensation for pain and suffering or compensation for punitive damages.
- Choose the right attorney.
An attorney specializing in workers’ compensation will know the ins and outs of the legal system and help you secure the compensation you deserve. Before hiring an attorney, read customer reviews, schedule a consultation, and find out who will be handling your case. If you have any questions about your workers’ comp case, don’t hesitate to reach out to Thomas F. Martin, PLC.
The Top 7 Causes of Workplace Fall Injuries
An experienced work injury attorney has worked on many cases involving falls. Though there are numerous causes of workplace falls, the injuries workers sustain from a fall inevitably require medical attention and time off from work.
Recognizing the risk factors for falls in the workplace can help prevent these accidents and keep workers safe. Here are the top seven causes of falls in the workplace.
- Uneven floors
Uneven floors may be slightly angled, without any warning signs posted. In other cases, the sidewalk outside of a building may have sunk into the ground or risen up, creating cracks that could lead to an accident. Cracked tile floors with missing pieces could also lead to a fall.
- Loose cords
Loose cords from equipment and machinery pose a trip hazard that could lead to serious injuries affecting the back, hip, pelvis, spinal cord, and bones. Workers may suffer concussions, fractures, and even brain damage from just a few loose cords.
- Wet floors
Floors that were recently cleaned should have a caution sign posted, warning workers to watch their step. On the other hand, oil or other liquid spilled onto the floor should be cleaned as soon as possible to prevent falls.
- Insufficient lighting
Poor lighting makes it difficult to see steps, uneven flooring, and obstacles on the floor, increasing the risk of a fall. Employers need to make sure lighting is working properly in all work areas and install additional lighting where necessary.
- Obstructions
One common cause of falls is obstruction. Work injury attorneys often handle cases in which workers tripped over boxes, tools, and various containers.
- Rugs
Old, small rugs aren’t very sturdy and likely to become bunched up and create a tripping hazard. Workers can fall in bathrooms, storage closets, and hallways, and sustain injuries that require medical treatment.
- Improper footwear
Restaurants, stores, and manufacturing buildings are likely to have wet floors that increase the risk of a fall. Employers should ensure every worker is wearing slip-resistant footwear in these environments.
Choosing a Work Injury Attorney
Not every fall is preventable and in some cases workers can sustain serious injuries. Hiring the right work injury attorney is key to receiving the necessary benefits and compensation. Call Thomas F. Martin today for a legal consultation.
What to Expect From a Psychiatric Workers’ Comp Claim in CA
When we think of workers’ comp injuries, we generally think of physical injuries like broken bones, tissue damage, burns, and lacerations. But workers’ compensation also includes psychiatric injury, which is a mental disorder determined to be at least 50% caused by the workplace.
How to claim a psychiatric injury.
To obtain compensation for a psychiatric injury, an employee must:
- Show employment for six months or longer
- Prove that work activities or the work environment were greater than 50% of the cause of psychiatric injury
- Prove the injury was not a consequence of physical injury
If the psychiatric injury was caused by a violent act, then the employee must show that 35-40% was caused by work. In addition, the six-month requirement doesn’t apply to injuries caused by a sudden and extraordinary event.
Can physical and psychological injuries be combined in a claim?
A psychological injury cannot be caused by a physical work injury. An injured employee can only add a psychological claim to the original injury if it was due to a violent crime or a catastrophic injury such as paralysis, severe burn, amputation, or severe head injury.
What is the difference between an injury and a permanent disability?
If the worker has not sustained a psychiatric work injury, then they will not receive any medical treatment, temporary disability, or permanent disability. If a physician does identify a psychiatric injury in a worker, then the extent of disability and evaluation of non-work-related factors will be determined on a separate basis.
How a psychiatric claim is rated in CA workers’ comp.
In California, a psychiatric work injury is rated using the Global Assessment of Function (GAF) scale, which is then converted to a percentage and adjusted up or down using the Permanent Disability Rating Scale (PDRS). A GAF rating below 70 is considered a permanent disability.
What to expect during a psychiatric injury claims process.
To determine a worker’s eligibility for compensation, the insurance company will ask questions about the workers’ relationship with friends and family, medical conditions, sex life, past abuse, and trauma. An injured worker should decide if filing a psychiatric claim is worth answering questions on such personal matters.
Why CA Workers’ Comp Investigation Timeline May Change
The length of time it takes to investigate a workers’ compensation claim varies depending on the type of injury reported, the circumstances surrounding the accident, witness availability, the extent of the medical conditions, the availability of documentation, and the cooperation and availability of all parties involved.
California bill SB 1127 would reduce the investigation period for claims in which workers have a presumption of compensability to 75 days from the employer notification of the injury. In other claims, the investigation period would remain at 90 days.
Challenges With Workers’ Comp Investigations
The California Workers’ Compensation Institute (CWCI) conducted a study that found potential problems associated with reducing claim investigation time frames; these include:
- Litigated and denied claims require significantly more time to gather reports and documentation from outside sources. Only 49.2% of litigated claims that are eventually denied have a compensability decision at 75 days.
- Employers are currently liable for up to $10,000 of medical treatment for a claimed injury during the investigation period, regardless of the insurance company’s final decision. Reducing the time frame would reduce the amount of time workers whose claims are eventually denied have to receive $10,000 worth of medical care.
How Workers’ Comp Investigations Proceed
A workers’ comp investigation looks at video surveillance, online social media channels, interviews, and medical reports to determine whether the claim should be approved or denied. The insurance company’s claims team is checking to see if the injury is fake or exaggerated if the injury is job-related, and if the employee is still working.
Investigators will watch employees coming and going from home and doctor’s offices. In addition, they will review the injured employee’s online posts, tagged photos, status updates, and other online activities. Investigators will also interview employees over the phone or in person to see if the injury is valid and work-related. Workers’ comp claims teams may also interview the injured employee’s relatives, close friends, coworkers, and neighbors to learn more about the employee and identify potential fraud.
Legitimately injured workers don’t need to worry about the claims investigations process. Hiring an experienced work injury lawyer in Orange County, CA will help ensure they have a solid case and receive the compensation they deserve. Call Thomas F. Martin, PLC today to schedule a consultation.
Hospitality Workers Are At Higher Risk For Work Injuries
Competition for customers in the hotel and restaurant industries, particularly as we emerge from the COVID-19 pandemic, is intense, and the pressure on workers to get work done puts workers at great risk for injury and repetitive motion conditions.
Working in a restaurant and/or hotel is incredibly physical. Prolonged weight bearing, pushing and pulling carts, making beds, cleaning rooms and bathrooms, lifting and carrying heavy items, high risk of slip and falls, vacuuming, and burns are unfortunately common activities that can cause injuries. Repetitive motion injuries – also known as cumulative trauma injuries – are also common. Injurious conditions can include:
– Back and neck damage
– Wrist and hand conditions ( such as carpal tunnel syndrome)
– Chemical exposure/lung injury
– Knee injuries
– Shoulder and elbow injuries
Thomas F. Martin, PLC has helped many hospitality workers obtain workers’ compensation benefits for their injuries.
Your free and confidential consultation is available by calling 714-547-5025.
Undocumented Workers Have A Right to Workers’ Compensation Benefits
The simple truth is that in California, undocumented workers qualify for workers’ compensation benefits because all workers are considered employees under California law regardless of immigration status or whether or not the employer is uninsured. However, certain job retraining benefits may be unavailable.
If an employer is unable to offer modified or permanent work based on an injured worker’s medical status, the worker may receive benefits. But if the employer is unable to offer work due to the employee’s immigration status, then the benefits may be unavailable.
This typically occurs after an injured worker is found to be undocumented. Under federal law, businesses are prohibited from hiring individuals who don’t have a legal right to work in the United States.
Once a business owner finds out that a worker is undocumented, they will no doubt take the position that they are required to terminate the employee. Under federal law, violation of laws governing work eligibility can be punishable by fines and criminal prosecution. The use of false employment documents by workers may also lead to fines and criminal prosecution for the worker.
However, California workers’ compensation laws are not in conflict with federal immigration laws because these laws don’t address workers’ comp benefits. Thus, an undocumented worker may be eligible for:
– Temporary disability
– Medical treatment
– Permanent disability
– Future medical treatment
– Other workers’ compensation benefits
California is a “no-fault” state. This means that as long as the injury or condition happened while working, that injured worker is entitled to workers’ compensation benefits. Immigration status is irrelevant.
In some cases, an employer or insurer may (falsely) claim that immigration status is an “excuse” not to provide workers’ compensation benefits. An experienced work injury lawyer in Orange County can help undocumented workers injured on the job navigate the complex workers’ comp system and obtain the benefits they deserve. Don’t let them get away it.
Call Thomas F. Martin, PLC at 714-547-5025 to schedule a free consultation and learn more about your rights.
What Type Of Death Benefits Are Included In Workers’ Compensation?
Losing a loved one is difficult for everyone. Especially when it happens suddenly on account of an unforeseen accident, it is more painful to know that the person could have had a great life ahead. Such accidents are avoided by many but sometimes the worst happens. Workers in construction, factories and shop floors are the most vulnerable to such accidents. Whenever a worker dies, it is the duty and moral obligation of the company to provide his or her dependents with workers’ compensation death benefits. Here is some more information on death benefits included in workers’ compensation.
Why does one receive death benefits?
When a person dies at work, ANYONE who was dependent on them for financial support may be entitled to workers’ compensation death benefits.
Who is eligible for the death benefits?
People who were partially or totally dependent on the deceased may be entitled to death benefits. By law, some relatives are automatically considered to be totally dependents and these are:
· A child under the age of 18
· A child of any age who is physically or mentally challenged to be able to work or earn a living
· A spouse who earned less than $30,000 in the 12 months before the deceased’s death.
· Other individuals qualify for being total dependents or partial dependents but in general, they must be a part of the household, a relative by blood, marriage, or adoption. And if a person relied on the worker in full or partial, they become a dependent entitled to benefits.
What amounts are included in death benefits?
· Burial Expenses: The Workers’ compensation insurance company has to provide expenses incurred by the family for the funeral. Burial expenses up to $10,000 is provided as compensation.
· Death Benefits: Generally (there are exceptions) the benefits are: One total dependent, $250,000; two total dependents, $290,000; for three or more, $320,000 is paid by the insurance company. This amount is released in installments but not less than $224 per week, and under certain circumstances awarded in a lump sum.
· A partial dependent may receive four times the amount they received from the deceased as financial aid.
Thomas F. Martin is an experienced attorney working for workers injured on the job and has worked in the field for over 25 years. If you need any help or information on workers’ compensation, call us for a free case evaluation today.
Junk Apportionment: Work Itself Can Accelerate Aging
Anti-employee interests are always thinking about ways to “reform” California’s worker’s compensation laws in their favor.
Take, for example, the last few reforms, which assured increased profits for insurance companies and increased benefits for injured employees. Not surprisingly, the employees ended up on the losing side of the so-called “reforms”.
Recent reforms included changes to “apportionment,” which is a fancy word for discount.
When an employee suffers permanent injuries from work activities, like lifting heavy boxes or inhaling dangerous chemicals, the employee is entitled to money to replace the lost ability to work in the future. “Apportionment” simply means a discount on the money the employer owes for the permanent disability. So let’s call it what it is – a discount.
Now, one of the ways the employer tries to get a discount is to blame the injured employee’s age for the disability. If the employer can convince a doctor in the case that “age” is responsible for part of the permanent disability – even if the employee was able to do the work – then the employer gets a discount of by whatever percentage the doctor blames age.
So, for example, if the doctor says 90% of the reason an employee has back problems was due to “age,” then the permanently disabled employee will only get 10% of what they are owed – even if they were doing the job without any problems before the injury.
Where am I going with this? Simple. Science proves that the aging process can be accelerated by the type of work you do.
For example, a new study found an association between the time spent sitting at work and increased disability. The chance of suffering permanent disability increased by 57% for each sedentary hour at work. And, the increased risk isn’t just to your joints – prolonged sitting also increases your risk across the board – arthritis, cardiovascular disease, diabetes, hypertension, lung disease, and risk of stroke. Think about that when you are spending countless hours working from home.
So next time a doctor blames “age” for some (or most) of your permanent disability, force the doctor and employer to justify the “junk apportionment.” Science-based medical studies have plenty to say about work-forced activities accelerating the aging process. Don’t let them get away with an unjustified discount on what you are owed in lost wages.
With more workers’ compensation “reforms” on the horizon, be on the lookout for even more efforts to limit or eliminate employees’ right to be awarded disability money for the cumulative effects of work activities such as sitting for hundreds of hours for work each month.
4 Signs It’s Time to Hire an Orange County Workers’ Compensation Lawyer
An injured worker often needs to take time off work to attend doctor’s appointments, obtain treatment, and fully recover. During this time, they deserve medical benefits and wage replacement. But to obtain the compensation they deserve, they must file a claim with their employer’s insurance company. Unfortunately, many insurance companies deny most initial insurance claims, making it difficult for employees to pay medical bills and daily living expenses.
A work injury lawyer in Orange County is qualified to handle the legal aspect of workers’ compensation, as well as helping the worker access the medical services they need to recover. Here are a few signs an injured worker needs to hire an Orange County workers’ compensation lawyer.
1. The injured worker needs surgery.
Most insurance companies have a cap on how much they’re willing to pay for medical expenses. Most of the time, surgery expenses are not covered and a worker’s claim may be denied. In this case, the injured worker will need the help of an experienced workers’ comp attorney to have their claims paid in full.
2. The worker has sustained a permanent injury.
Employees who sustain a permanent injury, such as paralysis, brain trauma, severe burns, amputation, disfigurement, and neck and spine issues are entitled to greater compensation than temporary injuries.
An experienced work injury lawyer in Orange County will file the necessary paperwork and gather the evidence necessary to ensure the worker receives long-term benefits.
3. The worker has received incorrect benefits.
It’s possible that an insurance company will provide the worker with some benefits, but not the right compensation. In these cases, the injured worker needs the help of a work injury lawyer to determine what kind of compensation they deserve and negotiate with the insurance company.
4. The worker has a pre-existing disability or condition.
Workers with a pre-existing disability or condition will need to prove the accident wasn’t caused by their disability. A work injury lawyer will help the worker build a strong case and gather the evidence necessary to back up their claim and receive the compensation they deserve.
Thomas F. Martin, PLC is an experienced work injury lawyer in Orange County, helping workers obtain the benefits they deserve. Give him a call today to discuss your case!
What Should You Do If Your Workers’ Compensation Claim Has Been Denied?
After a workplace injury, workers’ compensation benefits may be the only medical treatment and wage replacement resource available to you. If your claim is denied by the insurance company, you will not receive these benefits until the claim is resolved by a Workers’ Compensation Judge.
WHY WAS YOUR CLAIM DENIED?
Some reasons why a workers’ compensation claim is denied:
· Late or incomplete paperwork: Even when an injured worker completed the required paperwork, sometimes the employer does not. Following up on the claim status is usually a good idea.
· The severity of injury: Even if the injured worker reports an injury, the employer may not consider it “important” enough to tell their insurance carrier. Again, follow up!
· The “employer level investigation”: If you have received a letter from the insurance company that says “based on an employer level investigation” the claim is denied ( or some other excuse) even though you know it happened, it’s time to consider getting help.
If you have questions about your denied workers’ compensation claim, give us a call at 714-547-5025 for a free consultation.
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