Doctors and physicians often rely on magnetic resonance imaging (MRI) and computed tomography (CT) scans to identify the true source of a patient’s illness or injury and decide what to do next. The technology is fast and effective, and it has been heralded as one of the leading causes of increased average lifespans, decreased need for exploratory surgery, and an overall reduction of lengthy hospital stays.
So why do workers’ compensation insurance companies resist authorizing them? Because some ration care at the expense of an injured worker’s health.
Back in 2000, Medicare clearly recognized the legitimate uses of MRI, CT, and other similar advanced scanning technologies. From that year to 2006, it’s spending on such treatments more than doubled, from $3.6 billion a year to $7.6 billion. But the more they were using advanced scanning, the more they were costing themselves. So in response to the raised costs, they began to reimburse less and less for each incident of treatment, putting more of the cost onto individuals. They also created intense review processes that required patients to be examined thoroughly before permitting an MRI or CT scan, hoping to only use it when it was medically necessary. Of course, the risk was a condition that could remain undiagnosed for longer and potentially cause delay in the healing process.
Simply put, workers’ compensation administrators followed Medicare’s lead.
If the insurance adjuster is denying a request for an MRI or CT scan, consider calling us for a free consultation. We have been assisting people injured on the job for over 25 years.
The consultation is always free. 714-547-5025.
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.
In California, individuals who sustain injuries in a home, public place, or workplace may have the right to pursue legal action. How the injury occurred and the location of the accident will determine the type of claim: personal injury or workers’ compensation.
Personal injury cases are classified as either strict liability or intentional wrong.
- Strict Liability
Strict liability pertains to the consequences of the actions of a certain individual or party. For example, a car accident, faulty product, or an action that didn’t intend any harm or criminal intent could be categorized as strict liability.
Other types of strict liability include:
- Harm caused by owned animals
- Accidents due to negligence or carelessness
- Selling alcohol to minors
- Intentional Wrongs
Intentional wrongs can include obvious altercations between two parties; for example, a physical fight where the other party was liable. In such cases, it’s important to prove that one party intended to cause harm to the other.
Other types of intentional wrong include:
- Defamation or slander
- Assault and battery
- False imprisonment
Workers’ compensation claims refer to injuries or illnesses that are job-related. If an employee is unable to work as a result of a workplace injury, they can file a claim. Injured employees may be eligible for assistance with medical bills, lost wages, and psychological counseling.
An experienced work injury lawyer in Orange County could help injured workers determine the type(s) of compensation they are entitled to.
- Physical Injury Claims
Repetitive injuries, for example, are caused by doing repetitive activities such as bending or lifting, or as a result of improper workplace training. Common injuries caused by repetitive activities include carpal tunnel syndrome, neck and back strain, bulging discs, amputation, and nervous system damage.
- Mental Injury Claims
The workplace could also cause mental injuries such as anxiety, stress, and depression. These injuries may occur if the workplace is plagued by bullying, employee isolation, and threats of contract termination.
Injured workers should call the best Orange County workers’ compensation lawyer Thomas F. Martin, PLC to schedule a consultation and begin their journey to obtaining compensation.
Workers in a wide range of industries are at risk of sustaining specific injuries that could require extensive medical treatment.
Workers can also sustain injuries described as “wear and tear” or “cumulative trauma” injuries over time.
A specific injury occurs on a particular date and time, like falling off a ladder or lifting something that hurts your back.
“Wear and Tear” or Cumulative Trauma injuries / Occupational Disease
Physical injuries – Workers in occupations involving repetitive motions, like lifting, bending, or typing, may be at risk of developing “wear and tear” or cumulative trauma injuries. The symptoms can take weeks, months, or even years to develop. A physician should provide an opinion that supports a relationship between work duties and the condition.
Internal injuries – Other injuries and diseases can occur due to various exposures at the workplace. Exposure to periods of prolonged stress can contribute to high blood pressure, heart problems, or even aggravate diabetes, for example. Exposure to dust, chemicals, dust, or fumes at work can cause damage to the lungs. Unfortunately, workplace exposure can even contribute to certain cancers.
Hearing loss – A common injury for workers who work around loud noise, like airport workers, heavy equipment operators, farmers, ambulance drivers, manufacturers, and factory workers are all at risk. An explosion at work would be work-related as well.
Skin conditions – Rashes and thermal burns can be caused by exposure to harmful chemicals and lead to pain and scarring. Occupations at risk for these skin injuries include:
- Lab workers.
- Farmers who use pesticides.
- Working around radiation.
Brain injuries – Exposure to dangerous chemicals and even infections like West Nile Virus and viruses like Covid -19 can cause severe and lasting damage to the brain.
The above are only examples. If you suspect you have been exposed to harmful circumstances at the workplace, consider consulting with a work injury lawyer in Orange County to gather the evidence necessary to present to a workers’ compensation Judge.
How To File A Claim For Occupational Illness
Unfortunately, the California workers’ compensation system is complex, particularly when gathering evidence of serious injuries. To document a specific, cumulative trauma injury, or occupational illness, consider a free consultation with our Award-winning Orange County workers’ compensation lawyer, Thomas F. Martin, PLC.
For over 30 years, Tom has assisted injured workers to secure the financial and medical benefits they deserve.
While the workplace has become safer over the past few decades, and worker injury rates have decreased, obviously injuries still occur on a daily basis.
The workers’ compensation system is complex, and a work injury lawyer in Orange County can be of assistance in navigating the California workers’ compensation system. Almost like your “tour guide” through the system.
Here are some general answers to common questions:
1. What is workers’ compensation?
Workers’ compensation is a form of protection for employees that employers must have to pay for workers that are injured on the job. Wage replacement benefits are provided as well as medical treatment at not cost to the injured employee.
2. What should I do if I’m injured at work?
A Worker who gets injured at work or sustains a work-related illness should tell their supervisor as soon as possible and fill out a claim form. Prompt reporting will help the worker gets the medical care and benefits they deserve. The employer should investigate the accident and immediately file your claim with their insurance company. Once the employer receives the completed claim form from the employee, they are required to fill out their portion of the form. Workers who need medical treatment should get it immediately.
3. Do I need to fill out the DWC 1 claim form?
Workers generally must complete the DWC 1 claim form to start the process of obtaining benefits. Otherwise, the employer may later say they didn’t know about the injury or illness you reported.
4. What kinds of benefits am I eligible for?
After reporting a work injury, a worker may be eligible for the following immediate benefits:
· Up to $10,000 in treatment while the claims administrator investigates the claim.
· Wage replacement benefits if a physician determines that injury prevents working, or the employer refuses to honor your work restrictions.
If the claim is accepted, injured workers may qualify for the following benefits:
· Continuing medical treatment
· Temporary disability benefits
· Permanent disability benefits
· Future medical care
· Supplemental job displacement benefits
· Other benefits required by law
5. Do I need a workers’ comp lawyer?
Injured workers should consider obtaining a free consultation with an Orange County workers’ compensation lawyer if:
· The physician assigned to the case is not providing appropriate treatment
· Treatment is being denied by the insurance company
· The employer or insurance carrier denies the accident or injury is work-related
· The employer doesn’t file the necessary paperwork on time
· It appears there will be permanent disability
· The settlement doesn’t cover all lost wages and medical bills
· They have a preexisting condition the insurance company is using as an excuse not to pay benefits
· They plan to file for Social Security disability benefits
· The employer retaliates against the injured worker even though the injury or illness is work-related
· Another person or company may be responsible for the injury
Your rights can be lost if a claim is not pursued promptly. Delays in making a claim may result in the statute of limitations barring the claim forever. Act promptly.
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.
A group of injured workers has petitioned the Court of Appeal to determine whether the Workers Compensation Appeals Board (WCAB or Board) may legally grant itself indefinite extensions of time to issue final decisions regarding appeals from trial-level court rulings.
A party to a workers’ compensation case may appeal a trial-level ruling by filing a Petition for Reconsideration with the Board which is currently staffed by 6 Commissioners. The Labor Code requires that these appeals be decided by the WCAB within 60 days. However, in many cases the Board, following an unwritten, self-adopted policy and procedure, issues so-called “grant and study” orders which extend that time period indefinitely. In response to a recent public records act request, the WCAB provided data demonstrating that it has issued such “grant and study” orders in over 500 cases within a 3-year period alone, many of which remain undecided for years at time. While these cases remain in the WCAB’s “administrative limbo”, the injured workers involved in those cases are prevented from receiving the full range of workers’ compensation remedies and benefits to which they would otherwise be entitled. Employers and insurance companies are also prejudiced by the lack of finality.
On Friday, March 4, 2022, a petition for a writ of mandate was filed in the Court of Appeal, Second Appellate District. The petition requests that Court of Appeal find that the “grant and study” procedure is unconstitutional and unlawful, revoke all of the “grant and study” orders issued by the WCAB, and order the WCAB to provide a timetable within which it will render final decisions in all cases where such “grant and study” orders have been issued. This case is entitled Michele Earley, et al. v. The Workers’ Compensation Appeals Board of the State of California, et al., Case No. B318842, and has been assigned to Division of 8 of the Second District Court of Appeal.
Tom Martin, one of the co-signers of the petition in the Earley case said: “The California Constitution requires that the workers’ compensation system function in an “expeditious” manner, and the legislature passed laws to assure that. The system works best when injured workers and employers can get their disputes resolved as quickly as possible”.
Charles Rondeau, a co-signer of the petition explained: “As the data produced by the WCAB itself proves, the Board faces the daunting task of deciding a large number of petitions for reconsideration. Anecdotal information clearly suggests that the WCAB’s continued utilization of the “grant and study” procedure is that the Board lacks adequate resources to render final decisions regarding these petitions within the time limit established by law. While the workers’ compensation community can certainly empathize with the WCAB’s plight, the appropriate manner for the Board to address the situation is not to continue employing an ad hoc “workaround” which is impermissible under California statutes and which is inconsistent with the California Constitution that explicitly requires that the WCAB decide disputes “expeditiously, inexpensively and without incumbrance of any kind”. The “grant and study” procedure has been utilized by the Board for decades without a single decision by an appellate court directly addressing and definitively validating its constitutionality and lawfulness. The time has come for such a determination to be made and for the WCAB to seek sustainable, long-term solutions to the challenges which it is facing in rendering timely final decisions. This Petition provides an opportunity for the WCAB to explore and then implement such solutions.”
A copy of the petition filed in the Earley case can be found here:
For further information regarding the petition, please contact Mr. Martin or Mr. Rondeau.
Most injured workers take the time to carefully research the qualifications of a workers compensation attorney before they hire them. However, things can be hectic after a work injury, and sometimes the Orange County workers compensation lawyer that you hired may not the best fit for you.
Obviously, you don’t know how well the attorney you hired is going to perform until the case progresses. You may then realize that the attorney is not returning calls, not giving you regular status on your case, and does not have an adequate plan for your case.
In other words, injured workers sometimes choose the first workers’ comp lawyer they find through a Google search, and that can turn out to be a disappointment. If an Orange County workers’ compensation lawyer isn’t meeting your expectations, consider the following:
- Before You Hire Another Attorney, Try To Repair The Relationship
If you are calling your attorney and he or she is not returning your calls, that can be frustrating, but not necessarily a reason to fire your lawyer. It may be that the attorney IS working on your case, but not communicating the work is being done. In these situations, you may want to send the lawyer a letter requesting specific information regarding the status of your case.
In the event that the lawyer ignores your letter requesting status, or provides an unsatisfactory answer, then you may want to consider further options, as discussed below.
- Interview other lawyers BEFORE dismissing your current lawyer
While it is your right to represent yourself, the workers’ compensation system is complex, which is why you probably hired a lawyer in the first place. Consider interviewing qualified lawyers BEFORE you decide to dismiss your current attorney. You don’t want to end up navigating legal proceedings on your own while searching for a new lawyer.
- If You Find Another Lawyer To Represent You Let Them Handle The Paperwork
In the event that you find another lawyer to take over your case, they will know what paperwork to file so they can take over your case.
- If Your Decide To Represent Yourself, Consider Having A State Of California Specialist Assist You
The State of California provides free assistance to dismiss your attorney and answer your questions about processing your workers’ compensation claim. You can find help here:
It’s not easy to find a great work injury lawyer in Orange County. If you don’t have any friends or family members to ask for recommendations, then finding a good lawyer can be like looking for a needle in a haystack (also known as the internet).
Despite your best efforts to find a good lawyer, sometimes you end up with an attorney that isn’t working out for you, despite the fancy website, TV ads, or billboards.
Fortunately, you have the right to replace your current work injury lawyer in Orange County with one that can handle your case to your satisfaction.
- Does Your Lawyer Return Your Calls?
You deserve to know the status of your case and the major developments that occur.
If a lawyer isn’t returning your calls, and won’t even respond to your letters and emails, consider interviewing another lawyer to take over your case.
- Is Your Lawyer Familiar With Your Case?
Many lawyers use paralegals to manage your case. Some firms even have non-lawyers make appearances in court. Your lawyer may not even know who you are.
You are entitled to speak with the lawyer you hired.
If you have never even spoken to your attorney, and you are forced to deal with non-lawyer assistants, you may want to consider contacting a new work injury lawyer in Orange County. After all, you hired a lawyer to handle your case, not non-lawyer assistants.
- Does Your Lawyer Practice More Than One Area Of Law?
The Workers Compensation system in California is complex and the laws are changing constantly.
Would you hire an electrician that also claims they can tune up your car and prepare your taxes? No.
Yet many people hire a lawyer that claim they can handle many areas of law. If you have a lawyer that claim they are the “best” at workers’ compensation, but also handle auto accidents, trip and fall, personal injury, products liability and dog bite cases, ask some questions. Do they appear in court on your case? Are they recognized by other lawyers as competent to handle workers’ compensation cases? Are they rated by Martindale Hubbell as AV “Preeminent”?
If you are not satisfied that your current lawyer really knows workers’ compensation law, consider interviewing another work injury lawyer in Orange County.
4. Does Your Lawyer Engage In Unethical Behavior?
DANGER. An attorney should never pressure you to lie about your injuries, accident, or medical treatment. If an attorney asks you to twist the truth, or outright lie, you’ve got the wrong lawyer.
If you believe that your lawyer has issues in any of the above areas, consider reaching out to Thomas F. Martin, PLC for legal representation in your Orange County Workers Compensation case. Mr. Martin is rated by Martindale Hubbell as AV “Preeminent”, the highest rating given.
In November of 2021, over 400 sanitation workers employed by Republic Services at facilities in Anaheim and Huntington Beach voted to authorize a strike against the company. The workers’ contract expired in late September and was followed by multiple contract bargaining sessions.
Workers were concerned about excessive working hours and alleged persistent harassment in the workplace. Members of Teamsters Local 396 called attention to the large pay gap between the CEO and the company’s worker. In 2020, the CEO’s total compensation was over $12 million and 154 times the pay of an average worker. That same year, Republic Services grossed over $10 billion with $1.2 billion in net profit. In addition, the company spent more than $736 million buying back its stock.
Republic Services is the second-largest trash collection, disposal, and landfill company in America, with facilities in over 40 states. More than 7,000 Republic workers nationwide are represented by the International Brotherhood of Teamsters.
Ron Herrera, Secretary-Treasurer of Teamsters Local 396, said, “Teamsters working at Republic Services across Orange County are sending a strong message that they are ready to do whatever it takes to secure a fair contract. Republic Services needs to take negotiations seriously to ensure that these essential heroes who work hard to keep our cities clean and protect our environment get a fair contract.”
The Orange County strike had five members traveling to Republic’s hauling yard in New Orleans and putting up a picket there, while other workers extended the picket line to Republic’s recycling facility in Anaheim.
In December of 2021, more than 450 sanitation workers at Republic Services’ waste hauling yards in Anaheim and Huntington Beach ratified new collective bargaining agreements after a seven-day strike protesting the company’s unilateral changes without bargaining and threatening to retaliate against employees participating in union activity.
According to a press release, the new contracts include significant wage increases and other improvements.
Soon after the new contracts were ratified, more than 250 workers at Republic Services in San Diego went on strike demanding a fair contract.
Chuck Stiles, Director of the Teamsters Solid Waste & Recycling Division, said, “The strike in Los Angeles may be over, but Teamster members across America are fed up and will continue to take action until the company stops breaking the law and is willing to bargain fair contracts for these essential workers.”
In these increasingly frequent situations, I am reminded of the Warren Gunnels quote:
“You’re not a failure in life if you work for starvation wages with no benefits. You’re a failure in life if you are a business owner who depends on the exploitation of a poverty-wage workforce, no matter how many yachts and mansions you own. It’s time to redefine success in America”.