10 Reasons You Need a Workers’ Comp Lawyer in California

Updated March 2024

Navigating the complex landscape of workers’ compensation in California can be a daunting task for injured workers. The Division of Workers’ Compensation (DWC) serves as a foundational pillar, offering essential resources and information on workers’ compensation policies. Despite the availability of these resources, the intricacies of filing a workers’ compensation claim often necessitate professional guidance. A workers’ comp attorney is not just a legal advisor; they are an advocate for your rights and an indispensable asset in ensuring you receive the benefits to which you are entitled.

The importance of seeking the expertise of a workers’ compensation lawyer cannot be overstated, as they significantly enhance the likelihood of a successful claim by adeptly navigating the claims process and protecting your rights. Armed with a deep understanding of workers’ compensation law, a compensation lawyer becomes a crucial ally in securing your rightful benefits, highlighting the undeniable value of seeking professional legal assistance from a reputable workers’ compensation law firm.

Table of Contents:
1. Your Employer Is Refusing to Pay Anything
2. Your Employer Will Not Report the Injury
3. You Have Not Received Disability Benefits
4. You Were Fired After Your Workplace Injury
5. You Are Unsure If You Are Getting All of the Benefits You Are Entitled to Receive
6. You Are Having Trouble Communicating with the Employer’s Doctor
7. Your Employer Will Not offer You Alternative Work After Being Released Back to Work
8. The Employer’s Doctor Says You Are Ready to Go Back to Work When You Are Not Comfortable Doing That
9. You Have Been Offered a Lump Sum Settlement for Your Workers’ Comp Claim
10. Your Employer is Dragging Its Feet on Paying Benefits

1. Your Employer Is Refusing to Pay Anything.

When an employer in California refuses to acknowledge a workplace injury by not providing workers’ compensation benefits, it’s crucial for the employee to understand their rights and the steps they can take. Employers in the state are mandated to either provide workers’ compensation insurance or become self-insured. Here are the essential actions an employee should take:

  • Immediate Reporting: Report job injuries to your employer as soon as possible.
  • Documentation: Fill out a workers’ compensation claim form provided by your employer.
  • Know Your Benefits: Employers must give you a workers’ compensation pamphlet, post a notice to employees, and provide immediate medical care and temporary disability benefits.

 

free workers compensation claims checklist

Key Benefits and Rights

Workers’ compensation benefits in California include:

  • Medical Care: Necessary treatment paid for by your employer to help you recover.
  • Temporary Disability Benefits: Two-thirds of your gross wages lost while you are recovering, up to a maximum weekly amount set by law.
  • Permanent Disability Benefits: If you don’t fully recover.
  • Supplemental Job Displacement Benefits: Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and can’t return to work.
  • Death Benefits: Payments to your spouse, children, or other dependents if you die from a job injury or illness.

Actions Against Uninsured Employers

If your employer is uninsured, you have additional options:

  • Civil Action: You can file a civil lawsuit against your employer in addition to a workers’ compensation claim.
  • Uninsured Employers’ Benefit Trust Fund (UEBTF): May pay benefits if your employer is illegally uninsured.
  • Report to Division of Labor Standards Enforcement: Employees can report uninsured employers to ensure they are held accountable.

Medical Treatment and Disputes

Understanding your rights regarding medical treatment is critical:

  • Pre-designate Your Physician: Before an injury, you can choose your personal physician for treatment in case of a work-related injury.
  • Utilization Review (UR) and Independent Medical Review (IMR): These processes are used to approve or resolve disputes over medical treatment recommended by your doctor.

    In situations where employers refuse to comply with their legal obligations, consulting with a workers comp attorney becomes indispensable. A skilled workers compensation lawyer can guide you through the complexities of filing a workers compensation claim, ensuring that you are well-informed about the pros and cons of hiring a workers’ comp attorney. Whether it’s negotiating with insurance companies, representing you in disputes over medical treatment, or helping you understand the intricate details of workers compensation law, a reputable workers compensation law firm or an injury at work lawyer can provide the support and advocacy needed to secure your rightful benefits.

2. Your Employer Will Not Report the Injury.

Workers’ Compensation Appeals Board explained by santa rosa workers compensation lawyer

In the event your employer refuses to report a workplace injury, it is imperative to take immediate and decisive action to safeguard your rights and benefits under California’s workers’ compensation law. Here are the steps you should consider:

Internal Reporting:

  • Inform Your Supervisor or HR Department: Directly report the injury to your immediate supervisor or the human resources department if your employer initially refuses to report the injury.
  • Document Your Report: Keep a written record of your report, including date, time, and the person you reported the injury to. This documentation can be crucial in your workers’ compensation claim.

Seek Medical Attention:

  • Immediate Care: Regardless of your employer’s action, seek medical attention for your injury. This not only ensures your health but also provides medical documentation of your injury.
  • Notify Health Insurance: If necessary, inform your health insurance provider about the incident, especially if you’re receiving treatment before the workers’ comp claim is acknowledged.

Legal Steps:

  • File a Workers’ Compensation Claim Independently: With the guidance of a seasoned workers comp attorney, you can file a claim directly with the state’s workers’ compensation board.
  • Understand Your Rights: A workers compensation lawyer can explain your rights, including protection against termination for filing a claim, and the potential for additional benefits and penalties against your employer.
  • Options for Uninsured Employers: If your employer lacks workers’ compensation insurance, your attorney can advise on receiving benefits directly from the company or pursuing a civil lawsuit.

Key Considerations:

  • Medical Provider Network (MPN): Typically, injured workers are treated by doctors within their employer’s MPN. However, exceptions exist, and your workers comp attorney can help navigate these options.
  • Settlement Options: Understanding the available settlement options is crucial, and a workers’ compensation attorney can provide invaluable advice on negotiating a fair settlement.

    Employers in California are legally obligated to report workplace injuries, and failure to do so not only jeopardizes the well-being of their employees but also exposes them to legal consequences. By taking the steps outlined above and enlisting the support of a skilled workers compensation lawyer, employees can ensure their rights are protected, and they receive the compensation they deserve. Engaging with a reputable workers compensation law firm early in the process can provide the guidance and advocacy necessary to navigate the complexities of workers comp claims effectively.

Has your employer failed to report your injury? Contact us now to discuss at (707) 542-5132.

3. You Have Not Received Disability Benefits.

Navigating the complexities of disability benefits in California can be challenging, especially when you have not received the benefits you are entitled to. Understanding the eligibility criteria and the steps to apply is crucial in ensuring you receive the support you need. A skilled workers comp attorney can guide you through this process, ensuring that your rights are protected and that you receive the maximum benefits possible.

Eligibility and Application Process:

  • Eligibility Criteria: To qualify for disability benefits in California, an individual must have a disability that prevents them from performing their usual work for more than one week. Care must be overseen by a licensed health care provider or authorized religious practitioner.
  • Application Timeline: Applications for disability benefits should be submitted within 49 days from the date the disability prevented the worker from performing their usual job duties.
  • Benefit Calculation: The State Disability Insurance (SDI) benefits are calculated based on the worker’s earnings in the highest-earning quarter of their base period, providing about 60-70% of their regular earnings, with the maximum SDI benefit in 2018 being $1,216 per week.

    Understanding the Benefits and Coverage:
  • Temporary vs. Permanent: Workers’ compensation covers both temporary and permanent disabilities due to work-related injuries, ensuring medical bills and necessary benefits are provided.
  • SDI and Workers’ Compensation: Initially, workers should qualify for temporary income replacement through Workers’ Compensation. If these benefits are less than SDI benefits, a claim for SDI can be filed.
  • Coverage for Self-Employed and Undocumented Workers: Self-employed individuals must enroll in “Disability Insurance Elective Coverage” with EDD and pay premiums to be covered. Importantly, undocumented workers cannot be denied SDI benefits if they meet all other eligibility requirements.

    Navigating Disputes and Seeking Legal Assistance:
  • Dispute Resolution: If there is a disagreement with a workers’ compensation claim decision, contacting the Department of Industrial Relations, Division of Workers’ Compensation is a critical step. They provide information about the appeal process.
  • Legal Representation: A workers compensation lawyer can be invaluable in navigating disputes, especially if workers’ compensation benefits are denied or delayed. They can assist in filing a Disability Insurance (DI) claim for non-work-related injuries, illnesses, or pregnancy. Furthermore, if SDI issues benefits while a workers’ compensation case is pending, a workers comp attorney can address the complexities of a lien filed to recover those benefits once the case is settled.


Engaging a workers comp attorney early in the process can ensure that you are well-informed about the pros and cons of hiring a workers’ comp attorney and receive the necessary guidance and advocacy. Whether it’s understanding the intricate details of workers compensation law, negotiating with insurance companies, or representing you in disputes, a reputable workers compensation law firm or an injury at work lawyer can provide the support needed to secure your rightful benefits.

Contact a California workers’ compensation attorney as soon as you can or connect with us right now to discuss at (707) 542-5132.

 

related resources: calculating permanent disability benefits

 

4. You Were Fired After Your Workplace Injury.

fired after experiencing a workplace injury

Being terminated from a job due to a work-related injury can be a distressing and confusing experience. In California, however, the law is on the side of the injured worker. Labor Code Section 132(a) explicitly prohibits employers from firing employees for filing workers’ compensation claims, ensuring that the rights of workers are protected.

Understanding Wrongful Termination and Workers’ Compensation Claims:

  • Legal Protections: It’s illegal for employers to retaliate against employees for filing workers’ compensation claims.
  • Wrongful Termination Lawsuit: If an employee is wrongfully terminated, they may be eligible to file a lawsuit to recover back wages and potentially be reinstated.


Navigating the Legal Landscape:

  • At-will Employment: While at-will employees can be terminated for legitimate reasons, they cannot be fired for exercising their right to file a workers’ comp claim.
  • Retaliation is a Misdemeanor: Employers who violate Section 132a by terminating an employee for claiming workers’ comp can be charged with a misdemeanor.
  • Filing a 132a Claim: Employees must file a claim within one year from the date of termination to seek remedies under this provision.

    Steps to Take if Wrongfully Terminated

File a Retaliation Claim:

  • Timing: Submit a 132a claim within the one-year deadline.
  • Legal Representation: Consult with a workers comp attorney to ensure proper filing and representation.

Demonstrate the Connection:

  • Evidence: Work with your workers compensation lawyer to show a clear link between the claim and the termination.
  • Documentation: Keep detailed records of all communications related to your workers’ compensation claim and subsequent termination.

Understand Potential Outcomes:

  • Reinstatement: You may be entitled to reinstatement to your former position.
  • Compensation: Seek compensation for lost wages during the period of unemployment.
  • Additional Penalties for Employers: Employers may face additional sums up to $10,000 and civil suits for wrongful termination.

To ensure that your rights are fully protected, it is advisable to engage with a workers compensation law firm. A workers comp attorney can provide comprehensive guidance on the pros and cons of hiring a workers’ comp attorney, helping you navigate through the complexities of workers compensation claims. With their expertise, they can assist in building a strong case for your retaliation claim, aiming for a resolution that upholds your rights and interests.

5. You Are Unsure If You Are Getting All of the Benefits You Are Entitled to Receive.

Determining whether you are receiving all the benefits you are entitled to can be complex and overwhelming. A workers comp attorney can help clarify your entitlements and ensure you are not missing out on critical benefits. Here’s what you need to know:


Types of Benefits Available:

  • Medical Treatment: Coverage for all necessary medical care directly related to your workplace injury or illness.
  • Wage Loss/Temporary Disability Benefits: Compensation for lost wages if you’re unable to work due to injury, typically up to two-thirds of your pre-tax gross wage.
  • Permanent Loss of Function/Permanent Disability Benefits: If your injury or illness results in permanent impairment.
  • Retraining or Job Displacement Benefits: Vouchers for education-related retraining or skill enhancement if you’re unable to return to your previous job due to your injury.



Understanding the Calculation of Benefits:

  • Temporary Disability: For injuries after January 1, 2021, the maximum weekly benefit was $1,356.31.
  • Permanent Disability: Calculated based on the extent of your impairment, age, occupation, and wage at the time of injury.

Navigating Disability Insurance (DI) Claims:

  • Filing for DI: If a work-related injury or illness occurs, or an existing condition worsens, file a DI claim.
  • Denial or Delays in Workers’ Compensation: If you face denials or delays, DI benefits may be available.
  • Receiving the Difference: You may be eligible for the difference if your workers’ compensation weekly benefit amount is less than your DI weekly benefit amount.
  • Concurrent Benefits: Typically, you cannot receive both workers’ compensation and DI benefits simultaneously.
  • Pending Cases and Liens: If SDI benefits are issued while a workers’ compensation case is pending, a lien will be filed to recover those benefits after the case is settled.

When to Consult a Workers Compensation Lawyer:

  • Medical Condition Assessment: If unsure whether your condition is work-related, a physician/practitioner can determine the cause.
  • Reporting to Employer: Immediately report a work-related disability to your employer.
  • Medical Report Submission: A physician/practitioner must submit a medical report to your employer’s insurance company.
  • Disagreements and Appeals: If disputes arise with your claim, contact the Department of Industrial Relations, Division of Workers’ Compensation, and consider seeking legal advice.
  • Right to Appeal: You have the right to appeal any decision regarding DI or Paid Family Leave benefits within 30 days of the notice.

A workers compensation attorney can provide valuable guidance, ensuring you understand the intricacies of your claim and advocating on your behalf. They can assist with filing claims, handling disputes, and navigating the appeal process, all while keeping your best interests at the forefront. Consulting a workers compensation law firm can be a significant step towards receiving the full range of benefits you deserve.

6. You Are Having Trouble Communicating with the Employer’s Doctor.

having trouble communicating with workers compensation doctor

Communicating effectively with the employer’s doctor is essential for managing your workers’ compensation claim. However, if you’re encountering difficulties, it’s important to know your rights and the steps you can take to address these issues:

Confidentiality and Medical Information:

  • Protection of Medical Information: California mandates employers to have procedures that safeguard the confidentiality of your medical information.
  • Authorization Requirements: Any authorization to disclose medical details must be clear and comply with specific criteria, such as being in 14-point type or handwritten, signed and dated by you or your representative, and must outline the scope and limitations of the information shared.

Rights and Complaints:

  • Non-Discrimination: You have the right not to be discriminated against for refusing to sign any authorization concerning the disclosure of your medical information.
  • Filing Complaints: If you believe there are workplace safety concerns or health hazards, you can file a complaint with Cal/OSHA. For issues related to coverage or care, members can file a grievance with Blue Shield of California.

HIPAA and Reasonable Accommodations:

  • HIPAA Privacy Rule: This rule restricts how protected health information is shared and stipulates that an employer can request a doctor’s note or relevant health information for specific purposes like sick leave or wellness programs.
  • Disability Leave: If you need leave due to a disability, employers are expected to consider providing unpaid leave as a reasonable accommodation, barring any undue hardship.

    When addressing communication issues with the employer’s doctor, it may be beneficial to consult with a workers comp attorney to ensure your rights are upheld and to navigate any potential disputes. A workers compensation lawyer can assist with understanding the pros and cons of hiring a workers’ comp attorney, and a reputable workers compensation law firm can offer the necessary support to resolve these issues effectively. Engaging an injury at work lawyer early in the process can be crucial to maintaining clear communication channels and protecting your interests in a workers compensation claim.

7. Your Employer Will Not offer You Alternative Work After Being Released Back to Work.

Upon being medically cleared to return to work following a workplace injury, California employees may encounter a situation where their employer is not providing suitable modified or alternative work. Understanding your rights in this scenario is imperative:

Rights to Modified or Alternative Work:

  • Modified Work: This is your original job, adjusted to accommodate medical restrictions. For example, if you were a warehouse worker who can no longer lift heavy objects, modified work might involve lighter tasks within the same role.
  • Alternative Work: If you cannot perform any aspect of your original job, even with modifications, your employer may need to offer you a different role that suits your physical capabilities.

Criteria for Work Offerings:

  • Physical Limitations: Any work provided must align with the medical restrictions outlined by your healthcare provider.
  • Commuting Distance: The modified or alternative position should be within a reasonable commuting distance from your residence.
  • Duration of Employment: The position should be guaranteed to last for at least 12 months, providing job security as you continue your recovery.

If Suitable Work Is Not Offered:

  • Temporary Disability Payments: You may be entitled to continue receiving temporary disability payments if your employer fails to offer appropriate modified or alternative work.
  • Reasonable Accommodations: Request adjustments or changes to the workplace that will enable you to perform job duties without exacerbating your injury.
  • Ongoing Medical Treatment: You have the right to continue receiving necessary medical care related to your workplace injury, even after resuming work.

Legal Protections and Support:

  • Protection from Discrimination: It is unlawful for employers to discriminate, retaliate, or terminate employees due to a disability, job-related injury, or for filing a workers’ compensation claim.
  • Seeking Representation: A qualified workers’ compensation attorney can provide reliable representation to ensure you are not mistreated or retaliated against upon your return to work.

Should you find yourself in a situation where your return to work is met with resistance or lack of accommodation, it is beneficial to consult a workers comp attorney. They can help you understand the pros and cons of hiring a workers’ compensation attorney and advocate for your rights, ensuring that your employer adheres to the obligations set forth by workers’ compensation law. Employers must recognize the importance of facilitating a supportive environment for recovering employees, and a workers compensation lawyer can be instrumental in achieving this goal.

8. The Employer’s Doctor Says You Are Ready to Go Back to Work When You Are Not Comfortable Doing That.

injured worker not ready to return to work

If you find yourself in disagreement with your employer’s doctor regarding your work readiness after a workplace injury in California, it is important to know that you have the right to seek a second opinion. Here’s how you can proceed:

Requesting a Reevaluation:

  • Qualified Medical Examiner (QME): You can request an evaluation by a QME, an independent physician certified by the Division of Workers’ Compensation to examine injured workers and resolve disputes.
  • Agreed Medical Examiner (AME): If you have a workers’ compensation attorney, you and your employer may mutually agree upon an AME to conduct a reevaluation.

Appealing the Decision:

  • Filing an Appeal: Should your workers’ compensation claim be denied based on the employer’s doctor’s assessment, you have the option to file an appeal with the WCAB.
  • Petition for Reconsideration: This is a formal request to have the WCAB review the decision made regarding your claim.

Understanding Your Rights Under California Labor Code:

  • Labor Code Section 4062: Outlines the dispute process over medical determinations, including time limits for objections and qualified medical evaluator selection procedures.
  • Labor Code Sections 4062.1 and 4062.2: Specify the procedures for unrepresented and represented employees, respectively, in selecting a qualified medical evaluator.
  • Labor Code Section 4067: Details the procedures for a formal medical evaluation in cases where the effects of an injury have changed.

Legal Protections and Employer Liabilities:

  • Attorney’s Fees: If your employer contests the formal medical evaluation from an AME, they may be liable for your attorney’s fees as per Section 4066.

By understanding these rights and procedures, you can take informed steps to ensure your health and readiness to return to work are accurately evaluated. A workers comp attorney can guide you through this process, helping you understand the pros and cons of hiring a workers’ comp attorney and ensuring that your workers compensation claim is fairly assessed.

9. You Have Been Offered a Lump Sum Settlement for Your Workers’ Comp Claim.

In the realm of workers’ compensation in California, a lump sum settlement is a critical juncture in the claims process. It’s a one-time payment offered in lieu of ongoing weekly or biweekly payments for temporary or permanent disability benefits. If you’re faced with this option, it’s vital to weigh the pros and cons carefully.

Advantages of a Lump Sum Settlement:

  • Immediate Funds: A lump sum provides instant access to money, which can be pivotal in addressing current financial obligations.
  • Closure: Accepting a lump sum settlement brings an end to the workers’ compensation process, freeing you from the stress of continued legal proceedings.
  • No Further Medical Examinations: Once settled, you won’t be required to attend additional medical check-ins or evaluations related to the claim.

Disadvantages of a Lump Sum Settlement:

  • Potential for Underestimation: There’s a risk that the lump sum may not fully cover future medical expenses or complications that arise after the settlement.
  • One-Time Offer: After accepting a lump sum, you typically cannot request additional funds or reopen the claim, even if your condition worsens.

Before making a decision, it’s advisable to consult with a workers comp attorney. They can critically assess the insurer’s initial offer and negotiate for a fair settlement that considers both current and potential future needs.



Settlement Options and Processes:

Stipulated Findings and Award:

  • Quick Resolution: This option involves less complexity and can be settled without a hearing, saving you time.
  • Future Benefits: If your condition deteriorates, you may apply for additional compensation within five years of the injury date.

Compromise and Release:

  • Higher Settlement Potential: Often results in a higher payout compared to Stipulated Findings and Award, as it includes giving up future rights.
  • One-Time Payment: The settlement is received as a single payment, which can be beneficial for immediate financial needs.

Ensuring Fairness in Settlements:

  • Rating Disputes: If you or your workers compensation lawyer disagree with the disability rating provided by the Division of Workers’ Compensation, you can request a review within 30 days.
  • Legal Representation: A workers compensation attorney can guide you through the intricacies of the settlement, including understanding the disability rating and its impact on your settlement.

Remember, a workers comp attorney is not just a legal representative; they’re your advocate, ensuring that your workers compensation claim results in a settlement that aligns with your financial needs and compensates for the hardships endured.

10. Your Employer is Dragging Its Feet on Paying Benefits.

In California, the law mandates a prompt response to workers’ compensation claims, ensuring that injured employees are not left in financial distress due to delayed benefits. If you find yourself in a situation where your employer or their insurance provider is dragging their feet on paying benefits, it’s essential to understand your rights and the steps you can take:

Understanding Time Limits and Rights:

  • Mandatory Insurance: Employers must have workers’ compensation insurance for employees, which is designed to provide timely aid.
  • Strict Time Limits: Insurers must resolve claims within 90 days; failure to do so can lead to the presumption of liability.
  • Filing Deadline: A workers’ compensation claim must be filed within one year of the injury, or the cessation of temporary disability or emergency medical treatment benefits.

Potential Penalties for Delays:

  • Late Disability Payments: Insurers face a 10% penalty for late disability payments.
  • Unreasonable Delays: Up to a 25% penalty may be applied for delays deemed unreasonable, which can include those that are excessive, non-accidental, part of a pattern, or negatively affect the injured worker.

Common Delay Tactics and Presumptions:

  • Investigation as a Pretext: While further investigation by employers or claims adjusters can be legitimate, it may also be a tactic to protect their financial interests.
  • Presumption of Liability: If a claim isn’t approved or denied within the 90-day window, the law presumes the employer and insurer admit liability.
  • Reasons for Delays or Denials: These can include inaccurate diagnosis, pre-existing conditions, or insufficient evidence, among others.

As a worker facing delays in receiving your compensation, it’s advisable to consult with a workers comp attorney who can guide you through the complexities of your workers compensation claim. A skilled workers compensation lawyer can help you understand the pros and cons of hiring a workers’ comp attorney and advocate on your behalf to expedite the process. Engaging a reputable workers compensation law firm can be a significant step towards ensuring that your rights are protected and that you receive the benefits you deserve without unnecessary delay.

Contact Kneisler & Schondel for Help with Your California Workers’ Compensation Claim

When faced with the complexities of a workers compensation claim in California, having expert legal assistance can be pivotal in ensuring a fair and timely resolution. Kneisler & Schondel stands ready to provide that expertise, with a focus on Workers’ Compensation and Social Security Disability benefits.

By choosing Kneisler & Schondel for your workers compensation claim, you align yourself with a workers compensation law firm that prioritizes your needs, offering straightforward solutions to complex problems. With their guidance, you can confidently navigate the intricacies of workers’ compensation law, ensuring that your claim is handled with the expertise and attention it requires.

 

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