Workers compensation lawyer - work injury attorneys
Workers compensation lawyer - work injury attorneys
Workers Compensation is controlled by the Labor Code. The most common question we get is about denial of treatment or delays in obtaining treatment. The process is frustrating, but by filing a Declaration of Readiness to Proceed and going to court, a worker can force the insurance company to provide benefits.
Labor Code Section 5401 - Employer must provide injured worker a claim form
Your employer must provide you a workers compensation claim form within one day. Once you are injured, you must give written notice to your employer as soon as possible. The claim form is a legal document, and has legal implications. California Labor Code Section 3600a10 says you may get nothing if you were terminated from your job before filing a workers compensation claim.
A Workers Comp Lawyer will help you fill out all claim forms, attend all hearings and conferences, and answer all your questions about the workers compensation insurance system. Many times an employer does not act in compliance with the law and the insurance companies will take any advantage they can. Here are some important laws they must follow.
Labor Code 5402 - Employer has 90 days to accept or deny your claim.
Your employer has 90 days from the time you submit your claim form to decide whether to deny or accept your claim. Denial of your workers compensation claim would get you no benefits, and you would need to decide to file an appeal. Many employers deny a claim, and hope the injured worker will not try to appeal the denial. However, if they do not timely deny the claim it will be presumed to be accepted by the courts.
Labor Code 3600 - Employee gets benefits even if totally at fault.
Workers are entitled to most benefits even if the worker was totally at fault for the injury. Your employer may try to say you can't get care if you made a mistake, or they did not do anything to cause the injury. Other times an employer might say you are not an employee, but an independent contractor not entitled to any benefits. We see this all the time and have successfully shown injured workers called contractors are really employees, and should get workers compensation benefits even if there was no employer negligence involved.
Labor Code 4610 - Utilization Review of Workers Comp Treatment
Utilization Review is the process by which the insurance companies deny medical treatment. When your doctor wants to provide some form of treatment he will send a Request for Authorization to the insurance company. The insurance company is supposed to be on a strict time limit to respond and will send the RFA over to a Utilization Review Company. This is a company hired by the insurance company to review the request under Medical Guidelines to determine whether the requested treatment is reasonable under the circumstances. If you received a letter in the mail denying some form of treatment this came through UR. There are then time limits for appealing the UR decision to the Independent Medical Review. We work to make sure these deadlines are not missed and will drag insurance companies to get the judge to Order the insurance company to comply with the law and provide requested treatment.
Labor Code 4656 - Temporary disability benefits.
An injured worker may receive temporary disability benefits of 2/3 regular salary for up to 2 years. However, in order to receive these payments a Primary Treating Physician must state that you are unable to work, or that you have restrictions that your employer cannot provide. That is why it is important to treat with a physician that is sympathetic to injured workers and not looking to make friends with insurance companies. There are many exceptions where the injured worker is denied this benefit, or where the insurance company underpays the injured worker. Temporary Disability benefits stop when a doctor states that you are Permanent and Stationary. This is a turning point in the life of a case. However, many times a doctor will state that someone is Permanent and Stationary even though more treatment, even surgery, is required. You may need to get second opinions from a Panel Qualified Medical Evaluator and even ask for supplemental reports to use as evidence in Court.
Labor Code 4656 - Permanent disability benefits.
Permanent Disability benefits begin when the treating physician states that the employee is Permanent and Stationary. This stops the TD payments and begins PD payments. Unfortunately, the Permanent Disability payments will be deducted from any final settlement amount where the TD payments typically are not. As such, it is important to keep receiving TD rather than PD. Insurance companies want to switch you over as quickly as possible.
Permanent Disability is usually paid in a lump sum payment upon settlement of the case, and is calculated using a complex system used to rate each injured body part. This is done by have a doctor provide a percentage of impairment for each injured body part.
The work comp lawyer has enormous input into this calculation. It is a complicated process that should not be left to anyone that has not undergone specific training and knows how to rate the AMA Guides doctors use to prescribe impairment. It is also necessary to make sure that each body part is addressed, which is difficult to do because the insurance company will try to limit the body parts that are allowed in the claim.
Our staff will fight to get treatment for all body parts, so you can get the treatment you need and be able to increase the permanent disability rating. Our work comp attorney has years of training and experience to ensure the doctors utilize the AMA Guides correctly and will ask the tough follow up questions to keep the doctors on point.
Labor Code 4659 - Life Pension.
If the impairment from the injuries is combined together to reach as high as 70% Permanent Disability, then 1.5 percent of the average weekly earnings for each 1 percent of disability in excess of 60 percent is to be paid during the remainder of the injured worker's life, after payment for the maximum number of weeks specified in Labor Code Section 4658 has been made. Average weekly wages shall not be take at more than $515.38.
Labor Code 4600 - Medical care and procedures for injured worker.
The workers' compensation insurance must provide for all medical treatment, medications, procedures and therapy necessary to the injured worker. You have the right to select a doctor, and we will help you select the correct doctor.
There are many more laws in the Labor Code that are important. Feel free to call and ask a friendly attorney what laws can be used to help you.
Workers Comp Lawyer is a professional corporation, all rights reserved to Workers Comp Lawyer, PC, the information provided is not legal advice. Please consult an attorney to determine what laws apply to your case.