Frequently asked Questions about Work Injury.

A work related injury or illness enabling the employee to possibly obtain the following benefits:

• Medical treatment to help the injured worker recover and return to work
• Temporary Disability Benefits if the injury has them off of work fully or partially
• Permanent disability benefits if a doctor indicates they have an injury with permanent impairment 
• Supplemental Job Displacement Voucher to retrain an injured worker back into the work force
• Death Benefits to family members/dependents in the event the work injury causes death

An attorney will have a better understanding of the system, terminology, and process.  Insurance companies look for any reason possible to try to delay or deny your claim and keep you from getting the benefits you may be entitled to. If you disagree with a doctor's opinion, an attorney will be better able to assist as well. Adjusters and insurance companies will try to minimize exposure and the potential value of your case. Thus, having an attorney is crucial. 

Top reasons to hire an attorney:

1. Find the proper physician who will adequately and reasonably treat your injury
2. Have a better understanding of the workers' compensation process so that you do not miss any crucial steps
3. Negotiate fairly and aggressive to maximize settlements
4. Go to Trial if necessary 

Employees are covered under CA workers' compensation laws, independent contractors are not. Some employers misclassify employees as an independent contractor to avoid workers' compensation benefits. You are probably an employee if your employer:

• Directs and control the details or manner of your work
• Has the right to terminate you
• Pays you an hourly wage or salary
• Makes deductions for unemployment or social security
• Supplies materials or tools
• Requires you to work specific days or hours.

• Specific injury
  • occurs at a specific date, time, location
  • Ex: A teacher falls in her classroom on 9/1/2020.  The specific injury occurred on 9/1/2020.
• Continuous Trauma injuries 
  • Injuries that occur over the course and scope of employment  due to repetitive job duties 
  • Ex: A construction worker has been working for 10 years and gradually develops pain in his back over the years.  There is no specific date, but an injury gradually appeared due to requisite job duties.

• Report the injury to your supervisor
• Fill out a claim form and give to your employer
• You typically have 1 year from the date of injury to file the Application 
• Try to contact an attorney ASAP

• Primary Treating Physician (PTP)
  • Every injured worker is entitled to a PTP for evaluation and treatment
• Panel Qualified Medical Evaluator (PQME)
  • If there is a dispute over a legal or medical issue whether causation, nature & extent, need for future treatment, or permanent disability, you may be evaluated by a PQME
• Agreed Medical Evaluator (AME)
  • a doctor agreed upon by your attorney and the defense attorney to resolve a medical or legal dispute

After you are evaluated by a doctor, the doctor will assign an impairment percentage to each part of body injured. That is then adjusted for occupation and age and a permanent disability percentage is obtained. Settlement is based on the permanent disability.

Under the Labor Code, your percentage of impairment or disability can be offset or reduced if you have had prior injuries or prior settlements to the same body parts currently alleged. An attorney will help you better understand and minimize apportionment.

If you have work restrictions and your employer is able to accommodate them, you can continue to work. The regular, modified, or alternative work offer must be within the restrictions in the doctor's report.

If your employer is not able to provide you with work, you may be entitled to a Supplemental Job Displacement Voucher (SJDB) to help pay for educational retraining or skill enhancement

If your employer has fired you, reduced your hours or wages or discriminated you because you filed a workers' compensation claim, LC Section 132a benefits may apply and you may be entitled to increased benefits.

Stipulations with Request for Award

• a settlement based on the permanent disability of your claim for each body part found industrial, with future medical care remaining open

Compromise & Release

• a lump sum settlement of usually all issues including a buyout of future medical care

A Medicare Set Aside (MSA) may be necessary before you can settle. An MSA is money that is set aside from the settlement to pay for future medical benefits. The money goes toward any treatment for the work-related injury that would have been paid by Medicare. An attorney will help you with issues of an MSA.