1. What happens if I get injured or hurt on the job?
  2. What is considered injured “on the job”? (“within the course of employment”)
  3. Am I entitled to compensation for pain or injuries due to repetitive use?
  4. Am I entitled to compensation for pain or injuries due to repetitive use?
  5. What type of compensation am I entitled to under California’s workers’ compensation?
  6. If I get injured at work, how do I get medical treatment?
  7. If I cannot work due to my injury, am I entitled to get paid?
  8. What can I do if the insurance company does not pay temporary disability?
  9. What is permanent disability and how can I be eligible for permanent disability compensation?
  10. Can I be compensated for a psychiatric injury or mental stress due to work?
  11. Do I file a Workers’ Compensation claim or a Personal Injury claim?
  12. What if I am fired or threated to be fired for filing a workers’ compensation claim?
  13. How Do I retain an attorney?
  14. Who is eligible to file a claim?
  15. What if I do not like my doctor?
  16. Am I entitled to see different types of doctors or specialists?
  17. What is a PQME or QME?
  18. What is the difference between an accepted and denied case?

 

Q: What happens if I get injured or hurt on the job?

A: Report the injury to your employer or supervisor immediately. Your employer is required to provide you with a state approved Claim Form (DWC-1). You complete the top half of the Claim Form and your employer completes the bottom portion. You are to be given a copy of the fully completed Claim Form. If your employer fails to give you a Claim Form, within 24 hours of knowing you were injured, then you should call the workers’ compensation insurance company of your employer and immediately report your injury to them (You should, also, seek legal counsel whether through us or any other attorney). Failing to timely file a Claim Form can jeopardize your right to receive workers’ compensation benefits, including medical care for your injury. This information can often be found in your employee handbook if your employer has specific reporting instructions.

Once your injury is reported, your employer, or their workers’ compensation insurance, will tell you whether they have a “network” of physicians (called a Medical Provider Network (MPN)) that you must see for your injuries and provide you with a list of available doctors. If your employer does not have a network of physicians in place, the employer has the right to tell you where to get medical assistance for the first 30 days of the claim, after which you may choose your own doctor. We expect that most employers and insurance companies will have set up a network of physicians.

 

Q: What is considered “on the job”? (“within the course of employment”)

A: This question is often determined by “AOE/COE” i.e. arising out of and in the course of employment. This means that if the injury is sustained while you are on-the-clock or on the premises of your employer, it will be found to have arisen within the course of employment and therefore will be presumed compensable.

If an injury happens after clocking out or off the premises you may still be entitled to compensation (injured parties facing such issues should seek legal consult to fight on their behalf). The court has often found that employees who are injured walking to their car after work are still within the course of employment. Additionally, employees who sustain injuries while driving while running errands for work or where driving is part of their job duties are entitled to compensation.

 

Q: Am I entitled to compensation for pain or injuries due to repetitive use?

A: Yes, this is known as continuous trauma (CT). Injuries caused by repetitive motion or continuous  use are covered under the California Workers’ Compensation system.

Even though some injuries occur over time, as long as a repetitive motion injury is related to your job duty — in other words, the injury happened because of what you are required to do at work — it will likely be covered under workers’ compensation. This is very common for back pain and back injuries due to constant lifting.

 

Q: What type of compensation am I entitled to under California’s workers’ compensation system?

A: Generally there are three types of compensation an injured employee may receive: (1) temporary disability, (2) permanent disability, and (3) medical care.

  • Temporary Disability is compensation you receive for not being able to work due to your injury. This compensation is paid as your case goes along. However, if you did not receive temporary disability, this may be paid to you in one lump sum once your case is resolved.
  • Permanent Disability is any lasting disability that results in a reduced earning capacity. Compensation for permanent disability is determined by a percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity.
  • Medical Care and treatment is a form of compensation that you receive during the treatment stages of your case. However, at the conclusion of your case you are entitled to receive a lump sum payment by way of a ‘future medical care buyout’ that is based on what type of medical care you will need in the future.

 

Q: If I get injured at work, how do I get medical treatment?

A: California law requires the employer to authorize medical treatment for work injuries within one working day after an employee reports an injury.

Choosing which doctor to treat your injury is a crucial step in your workers’ compensation claim.  It is imperative the injured worker select a treating doctor who has the best interests of the injured worker as the doctor’s number one priority.

Unfortunately, many doctors put the interest of the employer’s insurance/adjusting company (the people paying the doctor) ahead of the interest of what is best for the injured worker. Our law firm is familiar with many of the doctors in the southern California area. Thus, we can help you in the selection of your treating doctor(s).

 

Q: If I cannot work due to my injury, am I entitled to get paid?

A: Temporary Disability (TD) benefits are payments you receive from the workers’ compensation insurance, if your doctor places you on Temporary Total Disability (TTD) status. You may, also, be eligible for TD benefits if the doctor imposes work restrictions on you but your employer is unable to accommodate your work restrictions, by offering you a modified or alternative job.

If the Temporary Disability benefits from the workers’ compensation insurance carrier cease or are denied, it may be possible to receive State Disability (SDI) benefits, from the Employment Development Department (EDD). Please contact our law firm for more information.

 

Q: What can I do if the insurance company does not pay temporary disability?

A: If for some reason (e.g. your claim is delayed or denied by the insurance/adjusting company of your employer) the insurance company will not pay temporary disability, it is often possible to receive disability payments from the Employment Development Department (EDD). These are called SDI (State Disability Insurance) benefits. Please note, an injured worker cannot receive benefits from both the workers’ compensation carrier and from the Employment Development Department simultaneously. Please contact us for more information.

 

Q: What is permanent disability and how can I be eligible for permanent disability compensation?

A: An injured worker may be entitled to receive a permanent disability award if the injury leaves him/her with any residual disability or permanent impairment. Permanent disability indemnity is not payable until the medical condition becomes “Permanent & Stationary”(P&S) (aka “maximum medical improvement”), which means the doctor has stated the medical condition has leveled off and will stay substantially the same in the future. “Permanent & Stationary” or “Maximum Medical Improvement (MMI)” does not necessarily mean that the person has recovered from their injury(ies). The information in the doctor’s final report will be put into a formula to determine your percentage of disability—this is called a Permanent Disability Rating. Permanent disability is expressed as a percentage, after the doctor’s report has been “rated.”

Again, often times the doctor your employer (or your employer’s insurance/adjusting company) sends you to will indicate a lower percentage of disability than a doctor you or your attorney choose. This is because a doctor selected by your employer, or your employer’s workers’ compensation insurance company, often times, has the employer or insurance companies’ interest at heart, as the employer/insurer is the entity that is referring them patients and business rather than the injured worker.

 

Q: Do I file a Workers’ Compensation claim or a Personal Injury claim?

A: When you are injured during while performing your job duties, you have the right to seek compensation through a workers’ compensation claim.

 

 

On the other hand, some worker injury cases involve the fault or partial fault of third party(ies) – a party other than your employer.

 

Depending on the details surrounding your accident and injury, workers’ compensation, personal injury or both may provide the best relief overall. We can help you to pursue an avenue that will be most effective in your case. We are one of the few injury law firms that handles both personal injury, and worker injury cases under the Workers Compensation laws. Thus, if it is determined that pursuing both avenues of recovery is best in your case, you will benefit from a firm that works in tandem with lawyers working both areas of laws in the same firm regarding the same client, and same accident. This avoids conflicting practices from different law firms that may harm either or both sides (Workers’ Compensation case or the Personal Injury case) of the cases.

 

Q: Can I be compensated for a psychiatric injury or mental stress due to work?

A: Yes, California workers’ compensation allows for recovery from mental stress, depression, and anxiety stemming from work. If something occurs at your job or a work environment leads to a psychiatric diagnosis and it can be shown that it was your work activities that led to that diagnosis, then you may have a claim.

Psychiatric injuries can be difficult to prove, since they do not often result in visible signs of an injury.  However, California law does recognize that employees may develop emotional, mental and psychiatric conditions as a result of either their working conditions, a work-related injury or a traumatic event that happens while they are at work.  If you have developed a psychiatric illness due to your work, (i.e – depression, anxiety, sleeplessness) you may be entitled to compensation.

 

Q: What if I am fired or threatened to be fired for filing a workers’ compensation claim?

A: To protect injured workers, California workers’ compensation laws prevent an employer from terminating or discriminating against an employee for filing a claim for a work injury. If an employer discharges, threatens to discharge or otherwise discriminates against an employee because that employee either filed, and/or made it public knowledge that they planned on filing a claim for compensation, then that employer is guilty of illegal employment discrimination retaliation. Even though California employees have a constitutional right to file a claim for a work injury and receive benefits, employers may not always be cooperative or understanding. A claim can disrupt business and increase workers’ compensation insurance premiums.

Firing is not the only act of discrimination an employer may take against an injured worker. The employer can take other actions that are considered retaliatory or discriminatory, including:

  • requiring the use of vacation time for medical appointments
  • a reduction in salary because of an injury
  • refusal to place the employee on an eligible to rehire list
  • a reduction in seniority

 

Q: How Do I retain an attorney?

 

A: First a consultation will need to be conducted. A consultation is needed to assess your case if you have already filed. If you have not filed or reported you claim the consultation is required to determine whether you have a valid claim.

 

Q: Who is Eligible to file a Claim?

A: All employees who have been injured on the job are eligible to file a claim. Immigration status DOES NOT PREVENT YOU from receiving benefits. Even as a travelling employee, if your injury stems from a work visit here in California, you are eligible.

Q: What if I do not like my doctor?

 

A: Generally, you are entitled to switch doctors at anytime. If you have an accepted liability case you may switch doctors so long as the doctor is also within the medical provider network. If your case is denied, you may switch to any doctor if the doctor so long as the doctor agrees to accept your case.

 

Q: Am I entitled to see different types of doctors or specialists?

 

A: If your injuries involve different body parts that require a specialist, then you may be entitled to see multiple doctors for your injury. Simply because your primary doctor does not specialize in medicine for another injured body part does not mean you don’t have the right to have that seen by another doctor.

 

Q: What is a PQME or QME?

  1. A PQME stands for Panel Qualified Medical Evaluator. The QME (Qualified Medical Evaluator) is an independent medical doctor certified by the Department of Workers’ Compensation Medical Unit to perform medical evaluations on injured workers.

 

Q: What is the difference between an accepted vs. denied case?

 

A: An accepted case means that your employer’s workers’ compensation insurance has decided to accept liability for your claim and injury. This means they will pay for medical treatment and any disability owed.

 

If a case is denied, this means that the insurance company is denying any and all liability for your all or part of your injury. This means you will need to be referred to a doctor on a lien basis and will have to fight to be paid permanent and temporary disability—which is even more reason to have an attorney represent you.

 

 

 

 

Q: Am I entitled to see different types of doctors or specialists?

A: If your injuries involve different body parts that require a specialist, then you may be entitled to see multiple doctors for your injury. Simply because your primary doctor does not specialize in medicine for another injured body part does not mean you don’t have the right to have that seen by another doctor.