Workers’ compensation is designed so that you can get medical care and replacement income for at least a portion of your wages if you are injured at work. It is supposed to be an easy-to-use system that automatically gives you these benefits if you qualify. Unfortunately, the system does not always operate as well as it should, and that is largely because insurance companies and employers do not want to pay workers’ compensation benefits unless they absolutely must. In those situations, you may need the help of a worker’s compensation attorney in California to get the benefits that you are entitled to receive as an injured worker in California. So, how can you tell when you are getting everything you are entitled to receive or if you need some extra help?
Below are ten reasons that you may need to call a California workers’ compensation lawyer:
1. Your Employer Is Refusing to Pay Anything.
If you are injured at work or while doing any activity that benefits your employer, and you are considered an employee under California law, then you should be getting workers’ compensation benefits. Payments under workers’ compensation laws in California include:
- Medical care
- Payment of lost wages while you are unable to work (temporary disability)
- Reimbursement for the permanent loss of function caused by your work injury (permanent disability)
- Job retraining benefits if you are unable to return to your previous job
- Mileage reimbursement for attending medical care treatments
You are entitled to these benefits under California law if you are hurt on the job. It does not matter whose fault the injury is or why it happened. If you were hurt—you should receive benefits. It is supposed to be that straightforward.
There are a variety of reasons that an employer or their insurance company will outright refuse to pay you these benefits, however. The most common reason is that they have denied your claim for benefits entirely. This could happen because they do not think you were actually hurt at work or that your injury was not caused by something work-related.
Whatever the reason, if you think you should be getting workers’ compensation benefits, and you are not, then you need to talk to a workers’ comp attorney as soon as possible.
2. Your Employer Will Not Report the Injury.
Although workers’ compensation benefits are provided by your employer, they are usually paid by their insurance company. The worker’s compensation system in California has specific requirements that California employers and insurance companies must comply with when providing benefits to injured workers.
Your employer is required to report your injury to its workers’ compensation insurance company.
Your employer can often report the injury to their insurance carrier via phone call or email. They may need to fill out some additional paperwork for their insurance company as well.
The employer must also give you a Workers’ Compensation Claim Form (DWC 1) to complete. There is a section for the employer to complete, too. This form is used to initiate the claim.
If your employer refuses to report your injury, that is a huge red flag. They may be worried about safety violations, not having the right insurance or a variety of other potential issues. You need to contact a California workers’ compensation attorney as soon as you realize that your employer has not reported your injury so you can take quick action.
3. You Have Not Received Disability Benefits.
In some situations, an employer or its insurance company will provide you with medical care as required but refuses to pay you disability benefits to cover your lost wages. You are entitled to a portion of your wages if you are unable to work as a result of the injury. If your injury makes you unable to work as many hours as you previously worked while you recover (sometimes referred to as limited or light duty work), you should also get benefits for those lost wages as well.
You are entitled to both of these types of disability benefits if you cannot work after a work injury or illness—it is not one or the other. If your employer or their insurance company tells you that you are not entitled to these benefits, then you have a problem. Contact a California workers’ compensation attorney as soon as you can.
4. You Were Fired After Your Workplace Injury.
You should never be terminated by your employer just because you were injured on the job or because you have requested workers’ compensation benefits. Getting fired for this reason is against California law. An injured worker who is fired for filing a claim does have legal recourse for this unlawful termination.
Ending your employment is a form of retaliation that is not permitted under California law. In fact, you also cannot be treated unfairly at work because of your injury either.
If you do any of the following and your employer terminates you or treats you unfavorably, it is critical that you call your local workers compensation attorney:
- Announce an intent to file a workers’ compensation claim
- File an application for adjudication of claim in order to resolve a dispute with the Division of Workers’ Compensation
- Submit a work comp claim to your employer
- Win your workers’ compensation case
- Get a disability rating from a doctor
- Settle your workers’ compensation claim with your employer
If an employer retaliates against their employee following a workplace injury, they may be subject to additional penalties, including fines and money that should be paid directly to you.
5. You Are Unsure If You Are Getting All of the Benefits You Are Entitled to Receive.
The average injured worker does not understand the workers’ compensation system. That means that you might not know how much money you are supposed to get after a work injury. Some people may not realize that they are supposed to get benefits at all.
Use the following general outline to measure your benefits.
- All of your medical treatment that relates to your injury should be paid for, including doctor’s appointments, physical therapy, surgery, and any other follow up procedures
- Your disability payments should generally equal two-thirds of your average weekly pay
- Your permanent disability benefits are based on the severity of your injury—the more serious and limiting the damage, the more benefits you are entitled to receive
Many workers put a lot of trust in their employer or its insurance company and count on them to tell the worker what they should and should not do and how much money they should get. This trust is often misplaced, however. Your employer and its insurance company want to pay you as little as possible—even though you may be entitled to more benefits. That also means that they might be giving you bad advice or bad information about what your rights are after a work injury.
In some situations, your employer may pay you some money or may cover some of your medical costs, but not everything. If you think you are supposed to be getting more or if something about what your employer is telling you seems strange or inaccurate, then you need to talk to a workers’ compensation lawyer.
6. You Are Having Trouble Communicating with the Employer’s Doctor.
If you suffer a work injury, your choices are limited on which doctors you can treat with. If your employer or its workers’ compensation insurance company has a medical provider network (MPN), then you must choose a doctor from a list that they provide.
It is possible that you do not get along with an MPN doctor or the doctor does not seem to care about your well-being as much as your family physician might. You have options to change your doctor under those circumstances. However, if there is an MPN, you still are limited to switching to a medical provider who is within that network. If there is no MPN, you will be allowed to choose your doctor. However, finding a doctor outside of a work comp MPN who is willing to treat you is extremely difficult.
If you want to make a change in your medical care, a California workers’ compensation lawyer can be a great asset. He or she can provide helpful information about who would be the best person to use for your unique health situation and type of injury.
7. Your Employer Will Not offer You Alternative Work After Being Released Back to Work.
When your treating doctor tells you that you can no longer work in your previous job, you need some way to get back to work so you can earn a living. After all, you still have to be able to support yourself and your family even after a work injury. If you have been released to work, but you can only do modified or alternative work, and your employer does not provide you a position that meets your restrictions, you may be entitled to additional benefits to help you get back to work.
These benefits are generally called “supplemental job displacement benefits.” They are designed to help you get some training so you can go into a different line of work. Before you qualify for these benefits, you must be able to prove two things:
- Your doctor has told you that you have a permanent work restriction that were caused by your work injury or illness and
- Your employer has not or cannot offer you work modified or alternative work that fits the restrictions provided by the doctor
Your doctor will give you “work restrictions,” that set out what you can no longer do safely. Restrictions on the following tasks are fairly common.
- Lifting limited amounts of weight
- Overhead lifting
- Pushing, pulling
- Sitting, standing, or walking for extended periods of time
- Environments where it is no longer safe for you to work
- Repetitive movements
- Bending and twisting
In some cases, you may be restricted to doing sedentary work, such as sitting at a desk.
If your employer cannot permanently accommodate your new restrictions, then you may be entitled to receive a retraining voucher. This a voucher which allows you to go a vocational or trade school to learn a new line of work. The voucher provides a total of $6,000 toward your retraining.
If your employers work comp insurance company is refusing to provide you this voucher or has provided work that does not meet your restrictions or seems unreasonable, it is time to call in a workers’ comp lawyer.
8. The Employer’s Doctor Says You Are Ready to Go Back to Work When You Are Not Comfortable Doing That.
The claims adjuster for the workers’ comp insurance company and the treating doctor have a unique relationship. In some cases, the doctor will do things that the claims adjsuter wants because that doctor wants to continue seeing injured workers and maintaining membership in the MPN. While this type of thinking can lead to unethical situations, what it more often triggers are doctors who are more willing to release an employee back to work when she is not ready to go back.
Generally, you must go back to work if the treating doctor says that you are capable of doing so. However, if you know that you are not ready to go back because you are not quite healed, you need to get a second opinion from another doctor. The last thing you want is to make your condition worse by hurting yourself even further going back to work.
You must go through a specific process to get a second opinion in a way that will force the employer to not only listen to what your doctor has to say, but also ensure that you get the treatment that you really need to heal properly. A workers’ comp lawyer can help you with that process.
9. You Have Been Offered a Lump Sum Settlement for Your Workers’ Comp Claim.
If you have permanent disability because of your work injury, your employer or their insurance company may offer to settle your claim. There is a good chance that if you are being offered a workers’ compensation settlement, it is not for the full value of your disability. You need to have the settlement offer reviewed by an experienced workers’ compensation lawyer who knows what you are entitled to receive based on California law. He or she will be able to tell you about what the average workers’ compensation settlement might be for a case like yours.
Insurance companies are notorious for short-changing injured workers when they offer settlements. You often cut off your rights to medical care and additional benefits when you agree to a settlement. Not having those medical benefits or wage loss benefits can not only be a huge hit to your budget, but it can also hurt your ability to recover properly after a work injury.
10. Your Employer is Dragging Its Feet on Paying Benefits.
If your employer keeps telling you that benefits are coming, but you have not seen any progress on your claim, then you need to talk to an attorney to get things moving. Your workers’ compensation lawyer will be able to push things along on your behalf. You can only survive so long being unable to work without your benefits, and you should not have to wait.
Thankfully, California workers’ compensation law has a mechanism to penalize employers and insurance companies who do not take quick action to get you the benefits you need. You can get penalties if your employer refuses to pay your benefits promptly. This benefit amount can be up to 25% of the total amount of benefits that are due to you that you have not received.
Contact Kneisler & Schondel for Help with Your California Workers’ Compensation Claim
Although workers’ comp in California was designed so that you do not need a workers’ compensation attorney, getting help from an experienced professional is sometimes necessary to ensure that you receive all of the benefits you are entitled to receive under California law.
Contact the team at Kneisler & Schondel for more information or to set up an appointment to go over your claim. We offer a free consultation – so you have nothing to lose.