Claims for permanent disability benefits and contested claims often require the assistance of a California workers compensation lawyer
The California workers compensation system is supposed to resolve work injury claims simply and efficiently. Unfortunately, that doesn’t always happen. In straightforward cases involving minor injuries that heal quickly, the system usually assures that benefits are paid promptly and accurately. When injuries are permanent or when claims administrators deny claims, it is usually a good time to hire a Santa Rosa workers’ compensation lawyer.
Simple Cases
The simplest cases are those in which the injured worker misses no work and simply needs short-term medical care. Employers must pay medical expenses for all work-related injuries. An injured worker who needs stitches for a laceration or treatment of a twisted ankle must usually go to a doctor or clinic designated by the employer, and the doctor will bill the employers insurance claims administrator. Under these circumstances there generally is no dispute about payment and no need to seek the services of a workers’ compensation lawyer.
Even when injured workers do miss work, the claim may resolve promptly. An injured worker who misses more than three days of work is entitled to temporary disability benefits until the condition becomes stable and/or he/she is able to return to work. Temporary disability benefits generally pay two-thirds of the injured worker’s gross wages, while he/she is unable to work.
When the facts are not disputed, temporary disability benefits are paid through a routine process. The claims administrator cuts a check every two weeks. The benefits end when the injured worker is able to return to work or when a doctor determines that the medical condition is stable and is no longer improving. This often means the injured worker will have some degree of permanent impairment.
A workers compensation lawyer can help even when temporary disability benefits are being paid. It is not uncommon for claims administrators to miscalculate the injured worker’s weekly disability rate. Likewise, it is not uncommon for claims administrators to stop, or fail to start paying temporary disability benefits when they should.
When calculating the injured worker’s weekly temporary disability rate, the claims administrator should take into account all of the injured worker’s earnings, not just those paid by the employer for whom the employee was working when the injury occurred. Income from second jobs should be included in the calculation, as should overtime, commissions, tips, and other forms of compensation, including meals. A workers’ compensation lawyer can help when a dispute arises about those issues.
Permanent Disability Benefit Claims
A workers’ compensation lawyer is most likely to be needed when a work injury causes a permanent disability. The calculation of permanent disability benefits can be more complex than the calculation of medical, or temporary disability benefits.
The permanent disability benefit calculation begins with a doctor’s report that the workers’ compensation system refers to as a Permanent & Stationary (P&S) report. If the report does not describe the injury or the injured worker’s limitations accurately, the permanent disability benefit could be less than it should be. A Santa Rosa workers’ compensation lawyer can help correct errors or problems in P&S reports, and can arrange for a second opinion when the treating physician disregards important information about the medical condition.
Claims for permanent disability benefits generally settle, but the claims administrator does have a financial incentive to settle for less than the claim’s true value. Unlike temporary disability benefits, the calculation of permanent disability benefits is not based entirely on objective factors. Benefits are based in large part on a disability rating, and that rating is inherently subjective. Claims administrators work for insurance companies, not for injured workers, and they typically want benefits to be based on the lowest disability rating that the P&S report can justify.
An experienced workers’ compensation lawyer understands the range of disability ratings that would be reasonable in each case. An injured worker’s attorney can negotiate with the claims administrator to arrive at a disability rating that is fair to the injured worker, not just to the insurance company. That negotiation can result in a higher value settlement than the injured worker might obtain without the benefit of a lawyer.
In addition, injured workers need to decide whether to settle the claim for a lump sum of money or to accept the payment of benefits over time. A lump sum puts money in the injured worker’s pocket right away, but he/she must give up the right to have the employer pay for future healthcare expenses. A workers’ compensation lawyer can often negotiate a better lump sum settlement in exchange for taking the insurance company off the hook for paying future medical bills. An injured worker can benefit from his or her attorney’s advice in deciding whether to accept a lump sum settlement.
Contested Claims
Most workers compensation claims settle, but sometimes disputes arise that need to be resolved in a court hearing before a workers’ compensation judge. Common disputes include:
- Whether the injury occurred at work
- Whether non-work activities contributed to the injury
- Whether the injury has completely healed
- Whether the injured worker waited too long before reporting an occupational disease or a condition (like a repetitive stress injury) that developed over time
- The appropriate disability rating
Contested claims are resolved at court hearings where certain rules of legal procedure and evidence apply. Representation by an experienced workers’ compensation lawyer who is familiar with those rules can maximize the injured worker’s opportunity to achieve a favorable outcome.
Santa Rosa Workers’ Compensation Lawyer
Not every workers’ compensation claim requires the assistance of a lawyer, but when a workers’ compensation lawyer is needed, it is important to hire one who is experienced and effective. To get advice in Santa Rosa about your workers’ compensation claim, call Kneisler & Schondel at (707) 542-5132. You can also ask us a question by submitting our online contact form.