What is Workers’ Compensation?
Workers’ compensation is a means for workers to receive a set amount of compensation for any injuries that they receive on the job. Workers’ compensation replaces the traditional method of pursuing personal injury claims in court against employers by injured employees. Instead, employers pay for workers’ compensation insurance in order to avoid the risk of paying large settlements and litigation expenses. This system also reduces the burden on the state courts and provides employees with medical and wage coverage when they are injured on the job regardless of fault. On the other hand, workers’ compensation waives an employee’s right to sue their employee in court.
I’ve Been Injured at Work, What Should I do?
- If the situation is an emergency, seek medical help as soon as possible. It is important to remember that your personal well-being takes priority in an emergency. If you can, inform the emergency medical technicians, nurses, and doctors that provide you with emergency medical treatment that you were injured while at work. After your situation has become stable, proceed to step two (step two is where you should start if your injury does not cause an emergency).
- Inform your employer of your injury as soon as possible. Informing your employer of your injury is the first step in the claims process. Your notice to your employer should be in writing and include your name, what happened leading up to your injury, and the date you sustained your injury. If your injury developed over time, you need to inform your employer as soon as you discover that your injury may have been caused by your work. After you inform your employer, the company will send you a Workers’ Compensation Claim Form (DWC1 Form) within one day after your injury. You will need to fill out the “employee” section of this form and send it back to your employer within one day so that your employer may fill out the “employer” section. The form will then be given to your employer’s insurer who will accept or deny your claim.
- If your claim is accepted, you will be notified by mail (in most cases). However, the insurance company may take some time to decide whether or not to accept your claim. It is usually presumed that your claim is accepted if the insurance company does not reply within 90 days, although you should not rely on this presumption if that is the case. You should call your employer’s insurance company if they have not sent you a notice of claim approval or denial after 14 days, as this is when you should start to receive income benefits if your claim was approved.
May I Chose My Own Doctor to Treat My Work-Related Injury?
Whether or not you can choose your own doctor for treatment of your work-related injury depends on a few different factors.
If your employer is a part of a healthcare organization, your options will be limited to a list of approved doctors. Generally, employers will have you chose the doctor you want to treat your injury in case of an incident shortly after they hire you. If you fail or choose not to pick a doctor every year, then your employer will likely assign you to a doctor on your behalf.
If your employer’s workers’ compensation plan does not include a specific healthcare organization, you will be able to pick your own treating physician by predesignating him/her. To predesignate a physician, you must give your employer a notice of doctor predesignation in writing. You may tell your employer that you would like to file a predesignation, to which he may give you a “Predesignation of Personal Physician” Form, or you can simply create your own.
Your notice of predesignation must contain:
- Your name
- Your employer’s name
- A statement saying that in the case of a work-related injury that you would want (blank) physician to treat you for said injuries
- Your physician’s phone number
- The address of your physician’s clinic or hospital
- The insurance company who is providing you with medical coverage (more on that later)
- Your signature
- The signature of the physician who you are predesignating
There are two requirements when you predesignate a physician. You must have the physician’s consent if you choose to predesignate him/her (which is why you will need their signature). You must also have medical coverage if you wish to predesignate a physician in the case of an incident.
What Benefits does California Workers’ Compensation Law Provide?
There are many different forms of compensation that you may receive under California state law for workers’ compensation. You will receive payment for any relevant medical expenses and vocational rehabilitation, as well as reimbursement for traveling expenses. Although, workers’ compensation is primarily used as a source of income benefits for workers who have a reduced wage because of their injury. The available income benefits are:
- Temporary Total Disability (TTD) Benefits
If your injury stops you completely from returning to work, or if your employer cannot accommodate your new work restrictions because of your injury, then you may qualify for Temporary Total Disability (TTD) benefits. TTD benefits are equal to two-thirds of your average weekly wage from before you were injured. However, these payments, like any other form of income benefits, are limited to the maximums and minimums set by California’s average weekly wage. You may receive TTD benefits until you are able to earn a wage equal to or greater than your pre-injury wage, or until you injury is determined to be “permanent and stationary.” Your TTD benefits may also be limited depending on the date of your injury; for example, if your injury occurred in 2008, then your TTD benefits might be limited to 104 weeks of payments.
- Temporary Partial Disability (TPD) Benefits
If your injury only partially limits the amount or type of work that you can do, but you still suffer a smaller wage because of your injury, you may qualify for Temporary Partial Disability (TPD) benefits. TPD benefits are equal to two-thirds of the difference of your wages before and after your injury. Like TTD benefits, you TPD benefits could last until your wage is equal to or greater than your wage from before you were injured, or until your injury is deemed permanent and stable.
- Permanent Disability (PD) Benefits
Some injuries never completely heal. In such cases, your treating physician will file a “permanent and stationary injury” report that will list the total impact that your injury has as a percentage. There are many factors used to determine the amount you may receive per week for permanent disabilities, and for how long. As of 2016, the maximum amount that can be paid each week for permanent disabilities is $290. Additionally, the impairment rating that you receive will also determine how long you may receive permanent disability payments, which is between three and 99 weeks. The following injuries are generally presumed to be total and permanent under California State Law:
- Loss of sight in both eyes
- Loss of both hands or their use
- Total (practical) paralysis
- A brain injury that results in incurable imbecility or insanity
What Are My Options if My Claim is Denied?
It is not common for claims to be denied. When claims are denied, it is usually because a claims was misfiled or because of a lack of evidence that the injury was work related. In most cases, a claim denial can be fixed with a simple phone call to the insurer. However, if your employer’s insurer still challenges your claim after that point, you should retain a workers’ compensation attorney.
To appeal a workers’ compensation claim, you and your attorney will need to file an appeal at the local California Division of Workers’ Compensation office. There, you will attend a hearing the will be presided over by a judge, who will determine the verdict instead of a jury. Having a strong legal representation is key at this point. An experienced workers’ compensation attorney should be willing and able to take your case to a hearing, and provide a strong legal argument in your favor. Remember, you will be arguing for your right to compensation because of your injury caused at work, so make sure that you are prepared as much as possible when you arrive for trial. Your employer’s insurer will have an attorney to represent them. Thus, the best way to protect your rights is to have your own attorney who has an in depth knowledge of the complicated details of workers’ compensation law.