A Santa Rosa workers’ compensation lawyer explains how injured workers become entitled to benefits

California law allows injured employees to receive benefits for a work-related injury. While that seems like a simple concept, Santa Rosa workers’ compensation lawyers know that eligibility for workers’ compensation benefits can sometimes be difficult to understand. Here are some basic concepts to keep in mind.

workers compensation lawyer explains who is eligible for workers compensationWork-Related Injuries

The workers’ compensation system covers work-related or on-the-job injuries. It does not usually cover injuries that occur while an employee is traveling between home and work, either before the work day has begun or after it ends. There are some situations, however, when travel outside of work hours is considered “work related,” so it makes sense to get advice from a Santa Rosa workers’ compensation attorney to determine whether an injury is covered.

Unreported Injuries

Employees should report a work injury to a supervisor as soon as possible. A delay of more than 30 days may prevent the injured worker from receiving workers’ compensation benefits.

Disputes about workers’ compensation coverage often arise when injured workers delay reporting the injury, even if the delay is brief. A failure to report the injury may encourage the employer or its insurance company to question whether the injury actually occurred at work.

Medical Expenses

When a work injury results in a need for medical care, injured workers are entitled to have their employers’ workers’ compensation insurance company pay the medical bills. Those payments may be delayed or denied however, if the injured worker fails to follow the procedures required by California law.

In addition to following rules about reporting the injury, injured workers are required to obtain medical care from the physician or clinic designated by their employer. An injured worker who is not treated by the designated physician may be responsible for payment of his or her own medical expenses.

When visiting the designated physician for treatment, it is important to make clear that the injury is work-related. The physician must bill the employer, not the injured worker, for medical care related to work injuries. When a workers’ compensation insurance company fails to pay medical expenses, a workers’ compensation lawyer in Santa Rosa can help injured workers resolve the problem.

The Three-Day Rule

Injured workers qualify for disability benefits when they miss three days of work or more, or when they are hospitalized overnight. An injured worker who is injured but does not miss work and is not hospitalized qualifies for medical care at the expense of the workers’ compensation insurance company, but they will not qualify for disability benefits.

The disability benefits the injured worker receives after missing three days of work or more are intended as income replacement. The injured worker receives temporary disability payments that equal two-thirds of their gross average weekly wages. Temporary disability benefits are however, subject to minimum and maximum weekly payments. Since temporary disability payments are not taxed, the benefits may sometimes come close to equaling the injured employee’s take-home pay.

Temporary disability benefits end after 104 weeks. Injured workers who cannot return to work within that time, however, generally qualify for permanent disability benefits. A Santa Rosa workers’ compensation lawyer can help injured workers determine the amount of any permanent disability benefits to which they are entitled.

The Employment Rule

Workers’ compensation benefits are generally available only to employees. Volunteers (usually working for a nonprofit organization) are not generally eligible for benefits, although some nonprofits elect to cover volunteers with their workers’ compensation insurance.

Independent contractors are not covered by workers’ compensation insurance. However, some employers intentionally misclassify employees as independent contractors in order to avoid paying for workers’ compensation insurance, overtime, and other benefits. In those cases, an injured worker may be eligible for workers’ compensation benefits even though an employer claims the worker is an independent contractor.

The distinction between an employee and an independent contractor is not always obvious. In general, an independent contractor:

  • is self-employed;
  • works for more than one client;
  • sets his or her own hours;
  • is given a task and then decides how to do it;
  • furnishes his or her own tools; and
  • is subject to minimal supervision while working.

When a company hires someone and controls how that worker does the job and provides close supervision of the work, it is likely that the worker should have been classified as an employee rather than an independent contractor. In that case, a worker who has been injured while working might be eligible for workers’ compensation benefits. A workers’ compensation lawyer in Santa Rosa can help injured workers receive benefits if they have been misclassified as independent contractors.

Questions Answered

Workers often have questions about workers’ compensation coverage and benefits. A workers’ compensation lawyer at Santa Rosa’s Kneisler & Schondel can help employees understand their right to receive California’s workers’ compensation benefits. If you have a question, call us at (707) 542-5132 or submit our online contact form.