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Workers’ Comp

Workers’ Comp Lawyer in Los Angeles

Workplace injuries happen on a daily basis, and (unfortunately) in California there are many high-risk professions. Roofers, fishermen, and pilots are just a few of the career fields most likely to experience a workplace injury or death, but the truth is a workplace injury can happen anywhere in any industry:

  • A high-rise construction worker can slip and fall, seriously injuring his or her back or potentially even dying;
  • A worker at a chemical plant can be exposed to toxic fumes and become violently ill, requiring hospitalization; and
  • A secretary or administrative worker can develop carpal tunnel syndrome after typing years, causing her significant pain and requiring surgical intervention to correct.

When a worker has been injured or has become ill while on the job in California, in most instances the worker can apply for workers’ compensation benefits. These benefits are designed to compensate the worker for his or her medical expenses and, if the worker must miss a significant period of time from work, his or her lost wages as well.

What is Workers’ Compensation and What Is Its Purpose?

Workers’ compensation laws have been adopted by California to provide protections and benefits to workers who are injured while on the job. A qualifying worker or employee who is injured on the job in California can apply for and receive compensation for his or her medical treatment as well as a portion of his or her lost wages. Benefits are available to most workers in California.

These laws are meant to stand in the place of personal injury laws that could otherwise result in the injured worker or employee not receiving any compensation for a workplace injury. Without the workers’ compensation laws, the injured worker would have to prove that his or her employer acted negligently in causing the worker’s injury. This scheme would put many workers at a disadvantage in that (1) their employers would likely have greater resources to litigate a workplace injury case; and (2) this would create an antagonistic workplace environment for the worker, who still would likely need to return to employment with the employer once the injury or illness healed.

Injuries and Illnesses Covered by Workers’ Compensation

Any type of illness or injury that occurs while the worker is engaged in the performance of his or her work duties is covered by California’s workers’ compensation statute. Under California’s

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workers’ compensation law, it does not matter if the employee him- or herself was careless in causing his or her own injuries, whether a fellow employee contributed to the injuries, or whether the injury incident was truly an accident.

Legal disputes arise in situations where it is not clear that the worker was “engaged in the performance of his or her duties” when the injury or illness occurred. For example, a worker traveling home from work at the end of the day who is struck and injured in a car accident may not be “engaged in the performance of his or her duties” and therefore may not be covered by the workers’ compensation laws. On the other hand, a worker who has to travel from one jobsite to another would likely be covered under the workers’ compensation laws if he or she is involved in an accident while traveling from one site to the other.

Who Is Eligible to Receive Workers’ Compensation Benefits After a Workplace Accident?

In most cases, employees of businesses in California are covered by the state’s workers’ compensation program. There are very few exceptions to the rather broad definition of “employee.” Employees do not need to pay anything into the workers’ compensation program in order to receive benefits: the employer, on the other hand, is required by law to maintain adequate workers’ compensation insurance coverage or similar coverage or else face penalties. Even if the worker’s employer does not have workers’ compensation coverage, benefits are still available through the State of California.

One group of workers that are not covered by California’s workers’ compensation law are termed “independent contractors.” The distinction between an employee and an independent contractor can sometimes be confusing: in general, though, an independent contractor has a greater deal of independence over his or her work and how it is completed than an employee. An independent contractor may be paid per job completed (as opposed to an hourly wage or salary) and may be required to supply his or her own tools in order to complete the job.

Any questions about whether or not someone is an “employee” for purposes of the workers’ compensation statute ought to refer those questions to a qualified and competent workers’ compensation attorney. An attorney can examine your situation and your unique circumstances to determine whether the person would qualify for coverage under the workers’ compensation laws. (Note: The employer’s terminology – how the employer refers to the worker – is given very little, if any, weight in determining whether someone is an employee or not.)

What Benefits are Available to Injured Workers Through Workers’ Compensation?

Workers’ compensation benefits are designed to enable the injured worker to receive adequate medical treatment so that his or her condition may improve as much as possible. The main benefit available to workers under the workers’ compensation statute is the payment of medical bills, treatment costs, and related expenses. These benefits can last until either the injured worker has made a full and complete recovery or until such time that doctors determine that injured worker has received the maximum benefit from treatment and he or she is not likely to improve with further treatment.

Wage benefits are available to injured workers who are unable to return to work for a period of time. The amount of wage benefits the injured worker would receive is tied to his or her wages just before the accident. However, the worker will not receive a wage benefit that equals his or her full wages: instead, the worker will receive a wage benefit calculated at a percentage of the worker’s wages.

In addition, an injured worker who is either temporarily or permanently disabled may receive corresponding benefits. These benefits are meant to compensate the injured worker in some way for being unable to return to work either on a temporary basis or on a permanent basis and the related loss of income that comes with this. The amount of benefits the injured worker would receive is based upon the worker’s average weekly wage immediately preceding the injury accident.

Beyond these benefits, the workers’ compensation statute gives the surviving family members of a deceased worker who was killed while in the performance of his or her job duties a death benefit. Unlike the benefits for temporary or permanent disability, death benefits are determined based on (1) when the fatal injury occurred; and (2) the number of dependents the deceased worker had. Included in the death benefit is a $10,000 burial expense allowance (for fatal injuries occurring after January 1, 2013).

Finally, California’s workers’ compensation statute allows injured workers to be compensated for the reasonable costs of traveling to receive treatment. This includes not only amounts to compensate the worker for mileage traveled but would also include any tolls and parking fees that the injured worker had to pay. (Of course, this benefit is not unlimited: the treatment facility to which the worker is traveling must be one that is reasonable under the circumstances. In other words, the injured worker is not going to receive reimbursement for mileage and traveling expenses to travel to a facility across the country if there is a comparable facility closer to the worker.)

One of the chief issues that injured workers have with the workers’ compensation system is not understanding how benefits are calculated and what benefits they are entitled to. Although California places information about the workers’ compensation program on its site, it can be difficult to understand. An experienced workers’ compensation attorney can help an injured worker understand the various types of benefits, how they are calculated, and under what circumstances they are paid.

What if My Workers’ Compensation Benefits are Not Enough?

The “trade-off” of the workers’ compensation statute is that injured workers are not able to seek additional compensation from their employers, even if the workers’ compensation benefits do not fully compensate the employee. Suppose a worker is injured when a coworker accidentally hits him or her with heavy machinery. Outside the workers’ compensation sphere, the worker would be able to file a lawsuit against both the negligent employee as well as the employer and seek compensation. But because of California’s workers’ compensation scheme, this avenue of compensation is effectively closed for the injured worker. He or she must make do with the workers’ compensation benefits.

There is one small and rare exception to this general rule, however. If the employer acted willfully or intentionally in causing harm to the employee, then the injured employee can bring a lawsuit against the employer directly. As part of this lawsuit, though, the employee would need to provide sufficient evidence to show that the employer was acting with the requisite intent to support a lawsuit; otherwise, the employer will be able to successfully argue that the injured employee is not permitted to bring the lawsuit and the case will be dismissed.

Finally, the workers’ compensation laws do not prohibit an injured employee from bringing a personal injury suit against a negligent third party who caused or contributed to his or her injuries. The third party must be unrelated to the injured worker’s employer. So for example another contractor, a private citizen, and/or a manufacturer of an industrial part who was negligent and who contributed to the worker’s injury could all be sued in a personal injury lawsuit without violating the workers’ compensation law.

Time Limitations Applicable to Workers’ Compensation Cases

Injured workers must comply with strict timelines in order to receive workers’ compensation benefits and/or appeal a denial of benefits. Much like the statutes of limitations in other types of lawsuits, failure to follow these timelines in a workers’ compensation case will typically mean that the worker is unable to recover any compensation for his or her injuries through the program. The following is a general overview of the deadlines applicable in a typical California workers’ compensation case:

  • The worker must submit a DWC-1 form to his or her employer within 30 days of the workplace injury or incident. This form alerts the employer that a workers’ compensation case needs to be filed soon. If you fail to file this form timely, you may be responsible for your medical costs and lost wages.
  • The employer has five days from the date it receives the form to file a workers’ compensation claim with its workers’ compensation insurer.
  • The worker is typically notified about the status of his or her claim within 14 days of the date the employer submits the claim.

The worker will generally have one year from the date of his or her workplace injury to file a claim or appeal:

  • From the expiration of workers’ compensation benefits;
  • Alleging discrimination under California’s Labor Code;
  • Alleging serious and willful misconduct on the part of the employer;
  • Seeking increased benefits under the Labor Code;
  • Seeking death benefits; and
  • Alleging third party negligence.

Many injured workers find it difficult to remember the various deadlines that must be met while getting treatment for their workplace injuries. The assistance of a workers’ compensation attorney can be extremely valuable in this regard as the injured worker will now have someone with experience and knowledge to remind the worker of important deadlines that must be met and tasks that must be completed.

Where Can I Go If I Need Additional Assistance?

Workers’ compensation laws in California are supposed to be worker-friendly so that injured or ill workers can navigate the workers’ compensation process quickly and without assistance. Unfortunately, this does not always happen and many workers have situations or circumstances that make applying the workers’ compensation statutes cumbersome for them. A workers’ compensation attorney is one of the best resources available to have your questions answered and to help you navigate the workers’ compensation system.

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