Our office has a team of lawyers and claims handlers to help injured workers in San Diego County and throughout California. If you are a worker who has been injured on the job, you have an absolute right under California law to receive medical treatment and to receive temporary and permanent disability benefits for work you have lost or will lose in the future.

Workers' Compensation in California is a complex and convoluted area of the law. Competing interests have caused contradictory and unwieldy reform legislation to be passed every few years. Consequently, the law regarding work injuries is different depending upon the date of injury. To navigate your way through this maze, an attorney's services can often be indispensable.

A claim for Workers' Compensation benefits is not a lawsuit - rather, it is a request for benefits under an insurance policy for which a premium has been paid. It is extremely important to report all injuries at work to the employer as soon as possible, because an untimely or post-termination reporting of the injury can lead to a loss of entitlement to benefits.

Workers' Compensation benefits are normally available to employees who sustain an injury "arising out of, and in the course and scope of" employment. There are two types of injury recognized by California law:

Specific Injury: A specific incident, such as hitting your thumb with a hammer, lifting something that is too heavy, or being involved in a motor vehicle accident.

Continuous trauma: A gradual degradation of your physical condition due to repetitive work activities. Examples of this include carpal tunnel syndrome, degenerative arthritis in the spine, and asbestosis.

Benefits

There are many benefits available under the California Workers' Compensation system. The main ones are:

Medical Treatment: Medical care to cure or relieve from the results of the work injury.

Temporary Disability Indemnity: A weekly benefit which is paid during the period of time you cannot work at all because of the work injury.

Permanent Disability Indemnity: A weekly benefit based on your impairment to compete in the open labor market. It is expressed as a percentage, which is normally based on such factors as work restrictions, limitation of motion, disabling pain, or other considerations as set forth by a doctor.

Vocational Rehabiltation: Assistance in finding a new job when the disability from the injury precludes you from doing your regular job.

Medical Treatment

The most important aspect of Workers' Compensation is getting good quality medical care. You have the right to choose any doctor you want as long as you notify your employer before you have an injury. The law requires your employer to advise you of this right. It is always a good idea to predesignate a doctor for Workers' Compensation purposes, as then you do not have to worry about being subject to the uncertainties of being treated by the company doctor.

If you do not predesignate, the company can control which doctor or doctors you see for at least the first 30 days after your injury, and in certain circumstances for as long as a year.

After the first 30 days in most instances, you can designate a "free-choice" treating doctor. An attorney can help you make an appropriate choice.

Proceedings

Proceedings in Workers' Compensation matters are held before the Workers' Compensation Appeals Board, or WCAB. Despite the name, this is not an appelate court - rather, it is the trial court for Workers' Compensation. Jurisdiction is obtained by the filing of an Application for Adjudication of Claim in the local office. It is because of this document that the claimants are usually referred to as "Applicants." Each branch of the WCAB, as it is called, has an Information and Assistance officer who can provide some guidance for unrepresented claimants.

Normally, the first hearing at the Appeals Board is a Mandatory Settlement Conference, or MSC. At this conference, the parties attempt to settle the case. If this cannot be done, the matter is then continued to another date for an actual Trial. All discovery ends at the MSC. In real life, trial settings are often continued again, as the resources of the Board are limited, and several matters will be set for trial at the same time on the theory that most of these cases will eventually settle. This process can take many months, especially in a complicated case that will take more than two hours to be heard. Trials are held in front of a Workers' Compensation Judge - now called a Referee. There are no jury trials in the California Workers' Compensation system.

In limited situations, a hearing can be set within 30 days, but never when the injury itself is in dispute.

The end result of a trial favorable to the Applicant is called a Findings and Award. The Judge will also write a Decision supporting his or her conclusions. If there are no disputed issues, the parties can submit a Stipulated Findings & Award for approval by the Judge. It functions in exactly the same way: the award will set out the total percentage of permanent disability, the number of weeks it will be paid, and the amount per week to be paid. It will also state whether or not there is a need for medical care in the future.

The other method of resolving a case is by Compromise and Release. This document takes into account the value of the permanent disability as described by the doctor(s), the reasonable value of the future medical care, if any, and any disputed issues. It is paid as a lump sum, and relieves the Employer/Insurance carrier of any further responsibility for medical care or any other benefit with the exception of Vocational Rehabilitation. All settlements must be reviewed by a Judge for adequacy.

Attorneys

Attorneys can be a great help to injured workers, who are otherwise at the mercy of claims adjusters who are sophisticated in the ways of the Workers' Compensation system.

In some instances, legitimate workers' compensation claims may be denied by aggressive compensation carriers. An insurer can claim you haven't been injured, or that the injury you've suffered isn't serious enough to qualify for workers' compensation benefits. If this is the case, you may stand to lose critical benefits, such as medical care coverage, financial help and job retraining. If you feel your legitimate benefits have been denied and you live in San Diego County or anywhere in California, we'd like to talk to you to see if we can assist you through the appeals process.

Attorneys can help you choose a doctor who will provide appropriate treatment and give you a fair evaluation. If the claims adjuster is willing, the attorney can also agree to have you evaluated by a neutral doctor who both sides believe is one of the top doctors in the field. You cannot be seen by such an Agreed Medical Examiner without an attorney.

Once the evaluating doctor issues a report, an attorney has the expertise to rate the report, and negotiate a settlement for you based on experience as to the value of the rating and the other factors, such as future medical care.

Attorneys' fees are usually limited to 12-15% of the final award or settlement, and all fees must be reviewed and approved by a Judge.

WARNING: Under California law, "Making a false or fraudulent workers' compensation claim is a felony subject to up to 5 years in prison or a fine up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine."

Call us at 888-233-5020 or contact us online for a FREE consultation.