As a form of insurance, workers’ compensation provides employees with medical benefits and wage replacement if they are injured on the job. In return, the employee agrees not to file a lawsuit against his or her employer. Workers’ compensation laws protect not only employees but help their families when the worker dies due to a work-related accident. Federal employees, seamen such as the Merchant Marine and railroad workers have their own version of workers’ compensation protection.
Los Angeles Workers’ Compensation Lawyer David Azizi
Workers’ compensation can become a challenge for a worker already struggling to feel better after an injury. Paperwork, including appeals if the initial application is not accepted, can take time and effort, something that might be in short supply. Documentation is required to prove that the injury was the result of work activity or conditions in the workplace and not a pre-existing condition. Toxic exposure to both chemicals and mold are also covered under workers’ compensation insurance. To assure you receive what you deserve, an attorney experienced in workers’ comp is essential.
David Azizi has been protecting workers’ rights for over 25 years. He makes sure all documentation is filed appropriately. Most of all, he knows that timeliness is essential for workers to receive the medical care they need and be able to support themselves and their family after an injury. Moreover, David can help if a third party was involved in your accident. In such instances, a civil tort claim for negligence may be possible. Turn to David immediately after a work-related accident as soon as you have sought a medical evaluation and treatment by calling 800-991-5292 or contact him online.
What Is Workers’ Compensation in California?
Workers’ compensation is state regulated. California requires that every employer have workers’ comp insurance. This is covered in Section 3700 of the California Labor Code. Even if a business has only one employee, that employee must be covered under workers’ comp. The insurance must come from an insurance company that is state licensed or from the State Fund. Employers can also choose to self-insure. The latter requires that the business meet certain parameters such as net worth and must have approval by the state.
Employer Posting Requirements
An employer must post details about their workers’ compensation insurance for employees to read. It must be posted in an area where it can be easily seen. If an employer fails to do this, they can be charged with a misdemeanor offense and fined up to $7,000. All new employees must be given a manual describing what they have the right to expect from workers’ comp and their obligations.
Employer and Employee Responsibilities When a Worker is Injured
When an employee is sickened by work-related issues or is injured, he or she has 30 days to report the injury to the employer. It is best to do this as soon as possible within this framework and to do it verbally and in a written format. The employer then has 24 hours to provide the worker with a claim form for workers’ compensation. Once the employer completes his or her portion of the form, a copy of the form must be sent to the employee. The form then is sent by the employer to the insurance carrier for review. The employer has a turnaround time to complete their portion of the form and send a copy to the employee of 24 hours.
Insurance Company Response
Once the insurance company has the form, they can either approve it or deny the request for workers’ compensation benefits. If they deny the claim, an appeal can be filed. Some reasons a workers’ compensation claim is denied include:
- The employer said the injury was not work-related.
- The information on the claim form was not accurate.
- The employee was using drugs in the workplace.
- Filing deadlines were not met.
- The seriousness of the injury is in doubt.
- The injury is thought to be due to a previous condition.
The Appeals Process
The appeal is a complex process that must be executed with great care. Hearings related to the appeal are heard by an administrative court judge. The outcome of the appeal itself may be appealed. The appeal must be filed within a specific time period after the initial denial. The bottom line is that the evidence supplied from the beginning about the work injury and its effect on the employee must be accurate and complete from the start. In addition, all deadlines must be met. In the event that a claim is not denied within three months of receipt, an employee is considered to be deserving of all benefits.
If you are a stranger to the complexities of workers’ comp, the process might seem daunting. It is important to have an experienced legal advocate by your side every step of the way during the workers’ compensation process. Your family’s welfare and your ability to be treated are dependant on it.
Once the claim is officially filed and before a decision is made, the employer must release $10,000 in insurance funds for necessary medical treatment within 24 hours. If the claim is accepted, a worker’s medical benefits are fully covered without a deductible. This includes:
- Doctor bills
- Hospital bills
- Medical prescriptions
- Chiropractic treatments (limited to 24 visits)
- Medical equipment
- Medical supplies
- Physical therapy
- Occupational therapy
Medical Treatment Network
If your employer has established a medical treatment network, the employee may be required to see a doctor within that network. If the worker has asked that their own physician be set as their treating doctor before the accident happened, they can see their primary instead. The emergency room the employee visits has no limitations. Preauthorization may be necessary before an employee can be treated other than emergency care. However, this rule is relaxed in the first month after injury.
Wage Replacement Under Workers’ Compensation
A worker who is deemed unable to work, either in full or part, may collect disability benefits. Procurement of benefits usually has a three-day lag time. There are two types of benefits:
Temporary Disability Benefits: Fully disabled workers receive 66 ⅔ percent of their wages while they are unable to work. This consists of the employee’s gross wages, bonuses, overtime payments and wages from any jobs. In 2018, the maximum is $1,215.27 each week with a minimum of $182.29. The maximum amount changes each year. However, for the first 24 months after the worker begins to collect, it will remain the same. After this time, it will reflect any increases that have been made. If part-time work is allowed by the physician, the employee will still receive benefits less the amount they are earning. The total number of temporary disability wages is limited to 104 weeks. They may stop and start, but the total limit is still 104 weeks within five years.
Permanent Disability Benefits: If a physician determines that an employee will not improve for at least one year, they are eligible for permanent benefits. The amount is calculated based on the worker’s age and type of work.
If a worker dies due to a work-related injury, his or her survivors are entitled to receive death benefits. The date of the injury and the number of survivors determine the amount of the benefits.
When an Employer Does Not Have Workers’ Comp Insurance
If an employer does not have workers’ comp, he or she can be charged criminally (misdemeanor) and fined at least $10,000 and possibly imprisoned. The employer is then responsible for all medical bills the employee incurs. In the event an employer lacks workers’ comp insurance, their inability to be sued for the injury personally is nonexistent. This means that an employee can not only collect workers’ comp benefits but is able to file a personal injury lawsuit against the employer. The Uninsured Employers Benefit Trust Fund pays the workers’ comp benefits in this situation. The UEBTF seeks to have the payments repaid by legal actions against the employer.
Taxes on Workers’ Comp Benefits
For the most part, workers’ compensation benefits are not taxable, according to the IRS. However, if the injured worker receives both workers’ comp and Supplemental Security Income (SSI) or Social Security disability insurance (SSDI), the workers’ comp benefits can be taxed.
Difference Between Workers’ Compensation and a Personal Injury Lawsuit
One difference between a workers’ comp claim and a personal injury lawsuit is that in the former a worker cannot collect for pain and suffering. Also, a workers’ comp case is not based on fault or negligence while personal injury cases are. Negligence by an employer, a coworker or the injured employee has no part in a workers’ comp case.
Can an Employee Sue Their Employer or a Third Party?
There are three instances when a worker can sue their employer or third party. These are:
- The injury was caused by an intentional act by the employer or third party.
- If the employer does not have workers’ comp insurance, the employee can file a lawsuit.
- If a third party was the cause of the injury, a lawsuit can be pursued. This includes injuries due to defective tools, a negligent driver that caused a motor vehicle accident when the employee was driving for a work activity or the owner of a building where the employee worked who failed to maintain the building properly. In addition, if a company was making repairs in the building and due to irresponsibility caused conditions that led to an accident, the owner of that company can be sued.
- In the event the worker was hurt by a toxic substance, he or she might be able to file a toxic tort lawsuit against the company that made the substance.
- If a worker has an accident due to a slip and fall when building maintenance failed to clean up a spill or remove obstacles leading to a trip and fall accident at work, the worker can file a lawsuit.
Filing a Personal Injury Claim Against a Third Party or an Employer
While workers’ comp benefits are helpful to most workers, they are incomplete in some ways. For instance, if a worker has been disabled due to an intentional act by an employer, or if the employer failed to have workers’ comp insurance or a third party was responsible for the person’s injuries, by choosing to file a personal injury lawsuit, the worker will be able to recover damages:
- Loss of permanent ability to advance their career and the wages the individual might have earned can be recovered.
- Payment for pain and suffering can be recovered. This includes the continuing physical pain the person might have and the mental and emotional trauma the injury caused.
- Loss of companionship and enjoyment of life is recoverable.
- Punitive damages for egregious negligence can be applied. This is done to punish the person who was responsible, and prevent similar acts of negligence in the future to other workers.
A Proven Los Angeles Workers’ Compensation Law Firm
Workers’ compensation is a complex area of the law. Workers are often unaware of their rights and responsibilities. Beyond that, they are also unaware of their ability to go outside workers’ comp under certain circumstances and be compensated for the totality of their loss. David Azizi stands ready to help you in any phase of an injury or toxic exposure due to work. David has the compassion you want coupled with the expertise you need during this difficult period. Call him anytime at 800-991-5292 to set up a free consultation. You have nothing to lose and everything to gain.