Workers’ compensation lawyers in California help injured employees obtain benefits for work-related injuries. By offering advice, gathering facts, negotiating with claims administrators, and presenting evidence to workers’ compensation judges, workers’ compensation lawyers help injured employees maximize the benefits that are available under California’s workers’ compensation scheme.

What Is Workers’ Compensation?

Every state has workers’ compensation laws. The federal government also has a laws that provide workers’ compensation benefits to federal workers who are injured at work.

Workers’ compensation is a form of employer-provided insurance that guarantees benefits to employees who are injured at work. California’s workers’ compensation scheme is designed to help injured workers avoid financial problems (such as losing their homes) if they are unable to work because of an injury. Workers’ compensation benefits provide partial income replacement while the injured worker is recovering from an injury, as well as financial compensation for disabilities that will permanently impair an injured worker’s health or future earning capacity.

California’s workers’ compensation scheme does not require injured workers to prove that anyone was at fault in causing the injury. Unlike personal injury cases, which require proof that the negligence of another caused them injury, workers’ compensation benefits are available regardless of fault. With rare exceptions (such as an injury caused by a fight that the injured worker started), benefits are available even if the injured worker’s own carelessness contributed to a work injury.

In exchange for the making workers’ compensation benefits available regardless of fault, the benefits are usually more limited than a personal injury victim might receive. However, workers’ compensation cases tend to resolve more quickly than personal injury cases, because benefits are determined by an administrative process that is designed to resolve claims soon after the full extent of an injury is understood.

What Are Workers’ Compensation Benefits?

The California’s workers’ compensation system provides benefits to employees who suffer a work-related injury. Employers must carry insurance that provides those benefits or must satisfy the state that they are lawfully self-insured.

Employers must provide medical treatment for work-related injuries that require more medical attention than first aide. Employers must also provide temporary disability benefits which replace some of an employee’s income while he cannot work full time and is recovering from a work injury.

Injured workers who suffer permanent impairment that is caused by a work injury are entitled to permanent disability benefits. Since workers’ compensation claims administrators often resist paying the full benefit that the law allows, injured workers often seek help from a California workers’ compensation lawyer when their injury is unlikely to heal fully.

Injured workers who are unable to resume their employment may also be eligible for a benefit that will pay for job retraining and certain other expenses (such as tools or a computer purchase) that may help the worker reenter the work force.

Finally, certain dependents are entitled to death benefits if an employee dies because of a work-related injury or health condition. The amount of the death benefit a dependent will receive depends on several factors, including the dependent’s age and relationship to the deceased worker, the total number of dependents, and the extent to which the dependent relied upon the deceased worker for support.

What Is a Workers’ Compensation Lawyer?

A workers’ compensation lawyer is a licensed attorney who handles workers’ compensation cases. Since workers’ compensation is a very complex field of law, many workers’ compensation lawyers limit their practice to workers’ compensation cases and to closely related areas of law, such as social security disability claims.

California’s workers’ compensation system is described in the California Constitution and in California statutes. Many of the details, however, are found in administrative regulations and in publications of the California Department of Industrial Relations that workers’ compensation judges consult when they decide cases.

Since workers’ compensation law depends so heavily on statutes and administrative rules, a workers’ compensation attorney must analyze the law in great detail in order to represent clients effectively. A lawyer who dabbles in workers’ compensation cases might not understand the nuances of the law that help injured workers maximize their recovery.

What Do Workers’ Compensation Lawyers Do?

Workers’ compensation lawyers advise clients who have suffered a work-related injury about their rights. They ask questions to determine how an injury was caused. When the facts surrounding a work injury are disputed, the lawyer’s team may conduct an investigation by interviewing witnesses and collecting important evidence.

Workers’ compensation attorneys also review medical evidence to determine the extent of an injured worker’s disability. They review reports written by physicians to assure their accuracy and may help injured workers correct any facts that the physician may have gotten wrong. When patients dispute a treating physician’s assessment of an impairment, lawyers advise patients about procedures they can follow to obtain a second or third opinion.

When a claims administrator has taken an unreasonable position, workers’ compensation lawyers fight to maximize the benefits that injured workers receive. In most cases, a workers’ compensation attorney will negotiate a settlement. When a claims administrator continues to take an unreasonable position, however, the lawyer will represent the injured worker at a hearing before a workers’ compensation judge. In some cases, it may also become necessary to represent the injured worker in an appeal to a California appellate court.

Do I Need a Workers’ Compensation Lawyer?

When a work injury requires treatment that the employer willingly provides and the injured worker misses no more than a day or two of work, he probably will not need a workers’ compensation lawyer. As long as there is no dispute about medical treatment and no need for temporary disability benefits, there is usually no need to hire a lawyer.

When an injured worker misses more than three days of work, he is usually entitled to temporary disability benefits while recovering from the injury. As long as the claims administrator pays those benefits and calculates them correctly, there is probably no need at that stage to get help from a workers’ compensation lawyer. If the injured worker returns to work and has no permanent disability, he will probably receive all the benefits that the law provides without seeking help from a lawyer.

In other circumstances, an injured worker may need a workers’ compensation lawyer. Examples of those circumstances include:

  • The claims administrator disputes that the injury is work-related
  • The claims administrator disputes that a health condition was caused by work
  • The claims administrator will not agree to pay for medical treatment that the injured worker requires
  • The claims administrator has not considered all wages that the injured worker earns from all jobs when computing the temporary disability benefit
  • The claims administrator disputes that the injured worker has a permanent disability
  • The claims administrator and the injured worker disagree about the extent of the permanent disability
  • The claims administrator and the injured worker disagree about how much of the injury was caused by work and how much was caused by other activities
  • The claims administrator and the injured worker disagree whether the he can return to work
  • The employer refuses to respect work restrictions imposed by the treating physician

While California workers’ compensation lawyers can be hired to resolve any dispute, they most often become involved in cases involving permanent disability. Most permanent disability claims are based on expert medical opinion about functional impairment. Since judgments may differ, some claims administrators try to take advantage of uncertainty by offering less than the injured worker may be entitled to receive.

When Do Claims Administrators Dispute Claims?

Some disputes revolve around how workers’ compensation laws should be interpreted, but most disputes involve facts. When there are no witnesses to a work injury for instance, or when a claims administrator learns that an injury may have been caused by an accident that was unrelated to work, claims administrators are more likely to dispute that the injured worker is entitled to benefits.

Some injuries might have more than one cause. An accident outside of work might weaken a muscle, while a later accident at work might cause the same muscle to tear. In that situation, benefits must be adjusted by determining the percentage of the permanent disability caused by the non-work related event and percentage caused by the work injury. A claims administrator will often dispute an allocation that does not favor the insurance company.

Claims administrators might not approve recommended treatment if they think the treatment is unnecessary. Often that means they think the treatment is too expensive. While California has adopted guidelines (known as “review utilization schedules”) to minimize those disputes, physicians who advise the injured worker and physicians who advise the employer do not always interpret those guidelines in the same way. A workers’ compensation lawyer may be able to get recommended treatment approved, even if it is not included in the review utilization schedule.

Claims administrators tend to be very suspicious of mental health injuries. Workers’ compensation covers psychiatric injuries under limited circumstances. Injured workers must prove that work was the predominant cause of their psychiatric injury. Since mental health injuries are often caused by multiple factors, claims administrators often feel they have little to lose by challenging a claim for psychiatric injuries.

Claims administrators are also more inclined to dispute claims that involve health conditions rather than physical injuries caused by an accident. A lung disease caused by exposure to toxic chemicals is an example of an occupational health condition that a claims administrator might argue was caused by environmental exposures outside of work.

How Do Workers’ Compensation Lawyers Settle Claims?

Most workers’ compensation cases settle. A settlement is usually advantageous for both the insurance company and the injured worker. A settlement gives parties control over the outcome. Leaving the fate of a claim to a workers’ compensation judge carries a risk that both parties usually want to avoid.

To maximize a settlement, a workers’ compensation lawyer will complete an investigation of all disputed issues. The more evidence the lawyer has, the better the settlement is likely to be. Claims administrators offer better settlement terms when they worry that they will lose at a hearing. Preparing the case for trial is often the best way to persuade a claims administrator to settle the case on favorable terms.

There are two kinds of workers’ compensation settlements:

  • Stipulated Findings and Award — the injured worker and the claims adjuster agree about all the facts, and a workers’ compensation judge enters an appropriate award of benefits that are generally paid over a period of time. In addition, the injured worker retains her right to ongoing medical care at the expense of the insurance company.
  • Compromise and Release — the injured worker and the claims adjuster agree upon a lump sum payment that will release the insurance company from making any additional payments for permanent disability or medical care in the future.

Which settlement is best depends upon the injured worker’s circumstances. If the injured worker is likely to need continued medical care, a Stipulated Findings and Award might be used to assure that the employer continues providing medical treatment.

If the injured worker will not need future medical care or will not need the employer to pay for any additional treatment, a Compromise and Release puts a lump sum of money in the injured worker’s pocket immediately. A workers’ compensation lawyer can usually negotiate a more favorable settlement in exchange for a Compromise and Release, because claims administrators want to be relieved of the obligation to continue providing medical treatment.

How Do Workers’ Compensation Lawyers Handle Hearings?

Disputed issues that cannot be resolved informally by the parties are decided by a workers’ compensation judge. While workers’ compensation hearings are less formal than civil or criminal court hearings, they too are governed by rules of evidence and procedure. Workers’ compensation lawyers learn those rules so that they can present evidence effectively and efficiently at workers’ compensation hearings.

Presenting a case begins with a full investigation. After gathering all necessary evidence, the workers’ compensation lawyer will prepare witnesses to testify. The injured worker is usually one of the most important witnesses, so his lawyer will spend as much time as it takes to make sure he is prepared to testify.

How Do Workers’ Compensation Lawyers Get Paid?

Workers’ compensation lawyers receive a fee which is calculated at 15% of the settlement amount or recovery obtained. Whether the case settles or is resolved after a contested hearing, the fee must be approved by a workers’ compensation judge. The potential fee must also be disclosed to the injured worker before the employee hires the lawyer.

How Do I Choose a Workers’ Compensation Lawyer?

It is important to find a lawyer who has the right qualifications to handle a workers’ compensation case. A lawyer whose practice is devoted to workers’ compensation and related cases has the opportunity to develop the knowledge and experience that is needed to achieve favorable results for clients.

Since you will be working closely with your workers’ compensation lawyer, you want to choose a lawyer with whom you feel comfortable. You should assure yourself that you are working with someone who is compassionate, honest, diligent, and thoroughly professional.

With 25 years of experience representing injured workers, Attorney Matthew A. Schondel has earned a reputation as one of Northern California’s most respected workers’ compensation attorneys. Attorney Schondel is certified as a Workers’ Compensation specialist by the State Bar of California Board of Legal Specialization. The peer-reviewed lawyer rating service Super Lawyers identifies Attorney Schondel as a “Top Rated Workers’ Compensation Attorney in Santa Rosa, CA.”

To learn how our workers’ comp attorney can help you with your workplace injury claim, call Kneisler & Schondel at (707) 542-5132. You can also ask us a question by submitting our online contact form.

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