California Workers’ Comp Frequently Asked Questions
Many people who get injured at work are unfamiliar with the workers’ compensation claim process, especially those who are dealing with their first work injury. Fortunately, there are some basic guidelines that California employees can easily learn in order to ensure they get the workers’ compensation benefits that they deserve after an injury in the workplace.
California Workers’ Compensation Lawyer
At The Law Office of Kneisler & Schondel, our goal is to help injured workers pursue their claims for workers’ compensation benefits and obtain successful outcomes. Attorney Matthew A. Schondel has decades of experience litigating workers’ compensation claims on behalf of California employees.
Our legal team understands that the aftermath of a work injury can be challenging in many ways. We are committed to making the litigation process easier for our clients and helping them navigate the complexities of a workers’ compensation claim. If you have recently been injured at work and are considering your options for filing a workers’ compensation claim, contact us today.
Who Is Entitled to Receive Workers’ Compensation Benefits?
One of the first concerns brought up by someone injured at work is often whether or not they are entitled to receive workers’ compensation benefits in the first place. In California, to be eligible for these benefits, there are certain conditions that must be met. First, to be eligible for these benefits in California, your work injury must arise out of and occur in the course of your employment with your employer.
Additionally, you must be an employee to be eligible for benefits and not an independent contractor. Occasionally, workers may be misclassified as independent contractors when they meet the requirements of what is considered an employee under the law.
Many different factors are weighed when determining whether or not someone is considered an employee. Generally, if the company or person paying you does some or all of the following, you may actually be an employee, not an independent contractor:
- Supplies your materials or tools;
- Controls the manner or details of your work;
- Requires you to work on specific days or adhere to a specific schedule;
- Pays you salary or an hourly wage;
- Has the right to terminate you; or
- Makes deductions from your payment for social security or unemployment.
For this reason, it is always a good idea to consult an experienced lawyer after a work injury if there is a chance you should be eligible for benefits as an employee.
What Should I Do If I Suffer an Injury at Work?
Another common question people have regarding workers’ compensation claims is what they should do after getting injured at work. First and foremost, after an injury, you need to focus on obtaining medical treatment as soon as possible. If your injury is severe, you should go to the nearest emergency room right away. Once any immediate medical needs are taken care of, the next step you should take is to notify your employer of your injury.
To report your work injury, inform your supervisor about it right away. By quickly notifying your employer, you can help prevent delays in receiving your benefits. Providing notice to your employer is a critical step in this process. If your employer does not find out about your injury within 30 days, you could potentially lose your right to workers’ compensation benefits.
It may not be immediately apparent that your injury or illness is work-related, or it may be an injury that develops over time. In these cases, you should report it to your employer as soon as you learn or have reason to believe by your job caused the injury or illness.
The next step you should take is to fill out a claim form and give a copy of it to your employer. The form is called DWC-1, and it can be found on the California Department of Industrial Relations website. Giving the completed form to your employer should initiate your workers’ compensation claim.
What Benefits Are Available Under California’s Workers’ Compensation Act?
Multiple benefits for injured workers are available under California’s workers’ compensation laws. One of the most important benefits is the payment of the injured worker’s reasonable and related medical bills. Injured workers may also be entitled to additional benefits, such as temporary disability payments, supplemental job displacement benefits, and permanent disability benefits.
When injured workers must take time off work because of their injury, they are typically entitled to temporary total disability benefits. These benefits are paid out to the worker at a rate of two-thirds of their average weekly wage and are subject to maximum and minimum amounts set by the state. Generally, the treating physician must support this time off work.
Injured workers can also be eligible for temporary total disability payments in cases in which their treating physician has recommended light duty work restrictions that prohibit them from returning to their former job. If their employer cannot accommodate these restrictions, an injured employee may be entitled to temporary disability benefits for the time period in which they are off work due to their employer’s inability to accommodate the restrictions.
Supplemental job displacement benefits may be available to workers in some circumstances in which they cannot return to their former job. In addition, injured employees may be entitled to permanent disability benefits for any disability that lasts and results in a reduced earning capacity following a determination of maximum medical improvement.
Are There Limits to the Medical Treatment I Can Receive for My Injury?
Following a work injury, an injured worker can obtain medical care for as long as it is deemed medically necessary. However, there are certain limits under the law regarding some types of treatment. All treatment covered under workers’ compensation must be evidence-based, reasonable, and related to the work injury.
The State of California bases medical guidelines for treatment for work injuries using a Medical Treatment Utilization Schedule (MTUS) that the state has adopted. The MTUS includes guidelines that have been adopted from the American College of Occupational and Environmental Medicine’s Practice Guidelines.
In addition, the MTUS uses established guidelines for chronic pain and therapy after surgery. It also specifies treatments that are scientifically proven to relieve or cure work-related injuries and illnesses and helps establish how often and for how long treatment is necessary. If your doctor recommends treatment that goes beyond the MTUS recommendations, they must prove that the proposed treatment plan is necessary and will be effective with additional evidence.
Finally, you should be aware that your employer has the ability to use a third party hired by the claims administrator to review your doctor’s treatment plan. This process is called utilization review (UR). The claims administrator will use the UR program to determine whether or not treatment recommended by your doctor should be approved.
What Happens If My Workers’ Compensation Claim is Disputed?
The reality is that not all workers’ compensation claims in California are accepted. Some claims for benefits will be denied for a variety of different reasons. For example, your claim may be denied because your employer disagrees that the injury occurred in the course of your employment.
Claims can also be denied or disputed due to a failure to provide notice of the injury to the employer, or because there is a disagreement regarding whether the injury arose out of the injured worker’s employment with their employer. One example of an injury not arising out of employment would be an injury such as a heart attack. While the heart attack may have occurred while the employee was working, that does not necessarily mean it actually arose out of their employment.
Do I Need to Hire an Attorney for My California Workers’ Compensation Claim?
Although you can pursue a claim for workers’ compensation benefits in California on your own, it is often a better idea to hire a workers’ compensation lawyer to represent you. If you are considering hiring a lawyer, typically, the earlier you do—the better. It can be challenging to get a case turned around late in the process after it has been disputed or denied. When you have an attorney from the start of your case, they may be able to help you avoid these disputes or at least act promptly to address any that arise.
If you do choose to hire a workers’ compensation attorney, it is always wise to research before making any decisions. There are many different factors to consider when choosing a lawyer.
Some of these factors include the attorney’s experience level, how specialized the attorney’s practice is in the area of workers’ compensation, the potential fees and costs involved, and whether you feel that the attorney will zealously advocate for your rights and take your case to trial, if necessary. If you are ready to move forward with your workers’ compensation claim, please reach out to us today to learn more about what The Law Office of Kneisler & Schondel can do to help you obtain benefits.