Workers’ Compensation: A Complete Guide

Being injured on the job can abruptly throw your life into turmoil. In mere seconds, an injury can occur while you’re going about your workday. Suddenly, you’re concerned about your finances, providing for your family and if the injury is serious enough, being able to return to your job at all.

The workers’ compensation system is designed to be there for you and your family during this difficult time. But it’s easy to encounter multiple roadblocks along the way. And if a loved one has been tragically killed on the job, filing a workers’ compensation claim may be too much to bear during this difficult time.

California Workers’ Compensation Act allows you to file a claim to cover your medical bills and related costs if you’re injured on the job. A portion of your income will also be replaced if you temporarily or permanently can’t return to your job. If a family member is killed on the job, the next of kin can recover compensation. This is meant to pay for reasonable funeral and burial costs as well as to replace a percentage of lost income.

While this all sounds very good, the workers’ compensation system can also be very difficult to navigate. That coupled with obstacles put up by employers and their insurance companies often make the recovery process difficult. That’s why having an experienced workers’ compensation attorney by your side every step of the way can make all the difference. Plus, you can concentrate on your recovery while your attorney handles every detail of your claim.

Below, you’ll find some of the most commonly asked questions that those injured on the job and their families ask. This guide is meant to give you a complete overview of the workers’ compensation system. That way, you’ll have a better idea of how the process works and what to expect.

What is Workers’ Compensation and How Does it Work?

If you’re injured or become ill while on the job, your employer must pay you workers’ compensation benefits. In California, employers with even just one employee are legally required to carry workers’ compensation insurance. In exchange for having the right to file a workers’ compensation claim, you give up your right to pursue negligence claims against your employer if you’re injured while on the job.

Workers’ compensation is a no-fault system. This means that you don’t have to prove that your employer negligently caused your injury or illness. Most workplace injuries and illnesses will be covered under this no-fault system. This is intended to speed up the process: receive benefits without having to bring a lawsuit against your employer while at the same time, your employer is not forced to admit any guilt.

When you suffer an injury at work or become ill due to your job, you must report it to your employer within a specific time frame. Your employer must then report it to their workers’ compensation insurance carrier. Once your claim is submitted, your employer and their carrier will have a set time limit to accept your claim or deny it.

If an employee dies due to a work injury or work-related illness, death benefits are available to their dependents. The definition of who is a dependent can include non-family members, such as a boyfriend or girlfriend, as long as they share the same household. Before any death benefits are paid, the employer’s insurance carrier will most likely conduct a thorough investigation which will include anyone claiming to be a dependent.

You can find the actual law that governs workers’ compensation in California by referring to 4 Cal. Labor Code §§ 3200 to 6002. Keep in mind, if your employer and their insurance company disputes or denies your claim, you have the right to appeal that decision.

What Types of Benefits Are Available to Me?

In California, five types of workers’ compensation benefits may be available to you:

• Healthcare– These benefits cover payments for all of the medical expenses that you
  incur related to your injury or illness. These include doctor’s appointments,
  the cost of any prescription medications, rehabilitation costs, and other
  related medical costs.

Your healthcare benefits should be available to you throughout your workers’ compensation case and in some cases, beyond the end of your case. You also won’t have any copays or deductibles and you won’t have to use your own insurance.

• Temporary Total
  Disability – If your work-related injury or illness causes you to be
  temporarily disabled and unable to work at all, you may be entitled to up to
  two-thirds of your weekly income, subject to minimums and maximums as set by
  law. These benefits may be available to you for up to two years or 104 weeks.

• Permanent Disability
  – If your workplace injury or illness causes you to become permanently
  disabled, you may be entitled to these benefits. A doctor will need to
  determine the percentage of disability that keeps you from performing your specific
  job duties to determine if you qualify. You can receive up to two-thirds of
  your salary, also subject to the minimums and maximums set by law.

• Supplemental Job
  Benefits – Pays for new training or education so that you can
  transition into a job where you will be able to perform your duties. These
  benefits are earmarked for employees who can’t return to their former roles due
  to their injuries or illnesses. This can mean training for a new job at a
  different company or a move into a new position with your current employer.

• Death Benefits
  – Are available to a spouse, minor child or other dependents of an employee who
  has died due to a workplace accident or illness which was caused by the nature
  of their job. Several factors go into the formula used to calculate the
  benefits payable to qualifying beneficiaries.

What Should I Do if I’m Injured at Work?

Your health and safety should always be your top priority. If you have been injured on the job, seek or request medical attention right away. Delaying treatment can cause harm both to you and your potential workers’ compensation case.

Read on to see what steps you should take after a work-related accident:

• Seek immediate
  medical attention – In the case of a serious injury, ask to be taken
  to an emergency room—or go yourself if you are injured performing job duties outside
  your place of work. For less serious injuries, do not try to shake it off or
  continue working. Ask your employer which doctor you should see. Many employers
  in California have specific doctors they can refer their employees to under
  their workers’ compensation plans. And keep in mind: if you disagree with a
  doctor’s diagnosis, you can request a second opinion.

• Report your injury
  to your employer immediately – Waiting can hurt your case or may
  even prevent you from recovering any workers’ compensation benefits. That’s
  because, under California law, you must report your injury to your employer
  within 30 days of when you were injured. If you became ill due to the
  nature of your job, you must notify your employer within 30 days of the date
  when you learned that your illness was related to your job or from the time you
  should have reasonably known about the connection between your job and the illness.
  Ideally, notify a supervisor right away.

If a loved one has suffered a work-related death, the same rule applies; contact their employer immediately.

• File a formal
  workers’ compensation claim – Your employer should provide you with Form
  DWC-1. If your employer fails to give you this claim form, you can download it
  from the Department of
  Industrial Relations. Once you’ve completed it, your employer files this
  form with their workers’ compensation insurance company for you. To make sure
  the claim was filed, you can request a copy of the filed DWC-1 form.

• Keep records of all
  communication with your employer regarding your injury or illness –
  Make copies of all documents, including your written injury report and your
  formal claim. Write down notes regarding any conversations you might have had
  as well as dates, times and the names of any witnesses to your accident.

• Seek the help of an
  experienced workers’ compensation attorney – Workers’ compensation
  cases are complex. Plus, employers and their insurance companies are known to
  try to reduce or worse, completely deny your claim. An experienced workers’
  compensation attorney can help you gather the documentation necessary to
  support your claim. They can also handle the negotiations with your employer’s
  insurance company on your behalf. If the insurance company does deny your
  claim, an experienced workers’ compensation lawyer can be crucial in helping
  you appeal the denial before the Workers’ Compensation Board.

What’s the Process Once My Employer Files My Work Accident Claim?

Technically, you have 1 year from the date of your injury to file your DWC-1 claim form with your employer, thus beginning the process. However, do not wait that long; submit your DWC-1 claim form to your employer as soon as possible.

Once your employer completes their section of the claim form, they must forward it to their insurance company. The time frame of the next steps are as follows:

• One day after you submit your claim form
  to your employer, they’re legally obligated to authorize medical treatment for
  your injury or illness. While you wait for a decision regarding your workers’
  compensation claim, you are entitled to receive up to $10,000 in medical
  treatment.

• Within 14 days of your employer
  submitting your claim, their insurance company will send you their decision
  regarding your claim. There are 3 possible outcomes:

• Your
  claim is accepted – You immediately receive the benefits and services to
  which you are entitled.

• Your
  claim is delayed – Your employer’s insurance company wants to investigate
  your claim. They have 90 days to do so. During this time, the only
  benefit available to you is for medical treatment. If there’s no communication
  from the insurance company after 90 days, your claim will be considered to have
  been accepted.

• Your
  claim is denied – This doesn’t necessarily leave you with no further
  options. Read on to find out more.

No matter the outcome, a skilled workers’ compensation attorney is a must. Taking on your employer and their workers’ compensation insurance company on your own is as intimidating and difficult as it sounds. Plus, it may be financially damaging to you and your family as they attempt to close your workers’ compensation claim for the least amount possible.

What Happens if My Claim is Denied?

There are three main reasons why a claim is denied:

• Your employer and/or their insurance carrier do
  not believe that your injury or illness was caused by your job.

• You filled out your paperwork incorrectly.

• You missed the deadline for filing your claim.

No matter why your claim was denied, it’s always a good idea to seek the help of an experienced workers’ compensation attorney. This is especially true if your claim was denied because your employer and/or their insurance carrier don’t believe your injury or illness are work-related.

Under California law, you can appeal the denial of your claim. All denial appeals are made before the Workers’ Compensation Appeals Board (WCAB) by requesting a hearing via an Application for Adjudication of Claim form. This application will provide you with your workers’ compensation case number. Then, you and your attorney will file a Declaration of Readiness to Proceed form. This will allow the (WCAB) to provide you with a hearing date.

If your claim was denied because the insurance company didn’t believe that your injury or illness was caused by your job, then your attorney or you need to check the AOE/COE (Arising Out of Employment/Course of Employment) box on the Declaration of Readiness to Proceed form along with the priority conference box. That’s because these types of denials are given expedited hearings by the WCAB. You should then be given priority for your conference by the judge.

Also, if the insurance company denied your claim because of medical reasons, you will need to have your illness evaluated by a doctor. If you don’t agree with the evaluation you receive, you can request a second opinion from a different doctor. On the flip side, if the insurance company doesn’t like the evaluation you receive, they too can ask for a second evaluation from a different doctor. If you have an attorney, they can work with the insurance company to come to an agreement on the doctor that will complete your evaluation.

If the denial wasn’t based on AOE/COE reasons, the WCAB may schedule a pretrial conference for you and your attorney to submit a Readiness to Proceed form. The WCAB will send you a notice telling you the time and date of your hearing. At the pretrial hearing, the WCAB judge will try to help resolve the dispute as to whether your claim should be accepted or not. If the judge feels they need more information, they may order discovery to help uncover evidence that might resolve the dispute. If no settlement can be reached, the claim may be set for trial. Often, claims are resolved at the pretrial conference in favor of the injured worker.

The hearing is similar to an informal trial. There is no jury. Instead, an administrative law judge hears the case, allows both sides to submit evidence and arguments and then decides whether the insurance company should accept your claim for benefits. If the Workers’ Compensation Appeals Board denies your claim, you and your attorney can also appeal that decision through a Petition for Reconsideration.

If you do end up going to trial, it will be held before a different WCAB judge than the judge who handled the pretrial conference. Again, there is no jury and your attendance at the trial is mandatory. Once completed, the WCAB will issue a written decision within 30 to 90 days.

Should I Retain a Workers’ Compensation Lawyer?

Contrary to what the commercials would like you to believe, insurance companies are not your friend. That coupled with employers who are often skeptical when dealing with a workplace injury or illness can make the workers’ compensation process extremely difficult for you, the employee to navigate.

An experienced workers’ compensation attorney handles and negotiates workers’ compensation claims every day. They know the process and can make it go much more smoothly while protecting your rights. Also, most workers’ compensation attorneys work on a contingency basis. That means you incur no out of pocket expenses and you only pay if they win your case.

In fact, not hiring an attorney can cost you dearly, especially if your claim falls into one of the following categories:

• You have a pre-existing condition – Odds
  are, the insurance company and even your employer will try to say that your
  workplace accident or illness was caused by your pre-existing condition. A good
  workers’ compensation attorney can help you prove that your injury or illness
  was indeed caused by your job. They can also pressure the insurance company
  into making sure you receive the crucial medical treatment you need promptly and
  at no cost to you.

• The insurance company has denied your
  claim/made a lowball offer/won’t even negotiate with you – Attorneys who
  focus on workers’ compensation cases know all of the intimidation tactics that
  the insurance companies and employers use—and how to counteract them.

• You need benefits for an extended period of
  time – If you’ve suffered a serious injury or are extremely ill, the period
  of recuperation that you need may last longer than what your employer and their
  insurance carrier are willing to offer. A skilled workers’ compensation
  attorney can calculate the time frame you’ll need to recover while making sure
  you receive benefits during that entire time. If needed, they can help you secure
  education and training benefits so that you can learn new skills. These
  benefits are vital for giving you more flexibility at your current job or in
  the general job market.

• If you receive other government benefits for
  your injuries – Benefits, such as Social Security Disability Insurance (SSDI)
  run the risk of being reduced if you begin receiving workers’ compensation
  benefits. Your workers’ compensation lawyer would be well aware of this and would
  make sure it doesn’t happen.

• Your permanent disability rating is under
  dispute – A permanent disability rating is assessed once an injured or ill
  employee’s medical condition has stabilized and no further treatment will
  improve your health. That all-important rating determines the amount of
  benefits you’ll receive. A low rating can severely cut your benefits. Having a
  knowledgeable workers’ compensation lawyer by your side will make sure this
  doesn’t happen.

Going it alone and not hiring an experienced workers’ compensation lawyer can quickly become overwhelming, especially if you find yourself in one of the situations described above. There are no up-front costs to you, so there’s no reason to take the process on yourself.

What if a Third Party is at Fault?

In some types of workplace accidents, third parties are partly or totally to blame. A third party is someone besides your employer or yourself. If a third party is partly or totally at fault for your workplace accident, you can file a workers’ compensation claim with your employer while also filing a civil lawsuit against that third party. These types of cases are known as crossover claims. Some common examples of crossover claims include:

• Motor vehicle accidents where you were driving
  for your employer and a third party hit your vehicle.
• Accidents on construction sites caused by
  third-party subcontractors, resulting in injury.
• Accidents involving defectively designed
  products.
• Accidents caused by hazardous conditions on a
  third party’s property when you are there working for your employer.

Third-party crossover claims differ from workers’ compensation claims in a couple of important ways. While you don’t need to prove negligence or fault in your workers’ compensation claim, you must be able to prove that the third party acted negligently or intentionally and caused your accident and resulting injuries.

Third party crossover claims are civil lawsuits that are filed in court. By contrast, workers’ compensation claims are filed with an insurance company and go through an administrative process. If you prevail in your third-party crossover claim, the workers’ compensation insurance company may go after the liable third party for their costs as well.

Several categories of damages might be available to you through your claim against a third party. Damages may be divided into special and general damages.

Special damages are meant to compensate you for your economic losses and might include the following:

• Past and future medical costs
• Past income losses and future reductions in your
  earning capacity
• Out-of-pocket costs
• Property losses
• Any other expenses you’ve incurred due to your
  accident injury

General damages are meant to compensate you for losses that are more difficult to value. These types of damages, in no particular order, might include the following:

• Physical pain and suffering
• Reduction in your ability to enjoy life
• Emotional distress
• Many types of damages associated with a wrongful
  death
• Loss of consortium for spouses
• Scarring and disfigurement
• Other non-economic losses
• Punitive damages, which the court may award if
  the actions of the defendant that led to the employee’s injury or illness were
  so reckless or intentional that they must be additionally punished for their
  actions. This is done in the hopes of preventing the defendant from acting in
  this way again.

When it comes to employers, the general rule is that your sole remedy is through the workers’ compensation system. However, some exceptions allow you to file a lawsuit against your employer directly. For example, if your employer failed to purchase workers’ compensation insurance, you can file an injury lawsuit against them. Other situations that qualify as exceptions to the exclusivity rule include the following:

• Assaults committed by or encouraged by your
  employer.
• Any injuries you sustain because your employer
  removed a guardrail on a power press or failed to install it.
• If your employer fraudulently conceals the cause
  of your injury or your injury itself.
• When you work for your employer in a dual
  capacity outside of your normal job duties.

Sometimes, an employer’s conduct is so egregious that it results in the Occupational Safety and Health Administration (OSHA) deciding that they have engaged in willful and intentional violations. OSHA may then assess severe penalties and issue reports. An OSHA report of a violation can be helpful in an investigation when an exception to the exclusivity rule applies. However, an experienced workers’ compensation attorney will also conduct their own investigation to further develop the evidence in support of your claim against your employer.

What are the Most Common Workplace Injuries?

While many different types of injuries can happen while you’re on the job, certain injuries happen more frequently. Here is an in-depth look at some of the most common work injuries that lead to workers’ compensation claims, along with a few of the defenses that might be raised by your employer and/or their insurance company. Note that there were 2.8 million work injuries and illnesses in 2022, a 7.5% increase from 2021, according to the U.S. Bureau of Labor Statistics.

Slip and Fall

A slip and fall accident occurs when a person slips or trips because of a hazardous condition at the premises of another person or business. Slip and fall accidents are a type of personal injury claim that happen to people when they are visiting a premise, such as a store or restaurant. Of course, they can happen in the workplace as well.

The owner or operator of the premises where a slip and fall accident happens may be liable to pay compensation in some situations. Property owners and operators owe duties of care to keep their premises in a relatively safe and hazard-free condition for visitors to their properties or employees. If a property owner knows of a dangerous condition or should have reasonably known of its existence and fails to warn employees and/or visitors about it or correct it, the property owner or operator may be liable when someone is injured due to the condition.

When a slip and fall accident happens and causes an injury, the employer might argue one of the following defenses:

• They weren’t negligent in creating the dangerous
  condition that caused the victim to slip or trip.
• They weren’t negligent in failing to correct the
  condition before the injury accident happened.
• And of course, you, the employee, was negligent
  and caused your own fall and subsequent injuries.

Unless there was horseplay involved or the victim was intoxicated, slip and fall victims are generally entitled to recover workers’ compensation benefits from their employer.

Falling Objects and Crush Injuries

Many workplace injuries happen when employees are struck by falling objects or sustain crush injuries when they are caught between hazards. A large number of those injuries occur within the construction industry.

Catastrophic injuries can result from these types of injuries, including:

• Traumatic brain injuries
• Eye injuries and blindness
• Severe lacerations
• Scarring and permanent disfigurement
• Back, neck and spinal cord injuries

Fatalities are common in accidents involving workers becoming caught in equipment or between hazards. Because of how dangerous and common falling object and crush injuries are, OSHA has multiple regulations in place for employers to follow to prevent these types of accidents from happening:

• Follow lockout and tagout procedures for
  dangerous machinery.
• Install and use guardrails.
• Secure equipment to avoid hurting employees
  working on lower levels.
• Training programs to make sure workers are aware
  of any dangers and to prevent these types of accidents from happening.

Auto and Vehicular Accidents

Vehicle accidents involving victims who are on the job are treated differently than vehicle accidents that are not related to work. When an employee is injured in a motor vehicle accident that was someone else’s fault while they were on the job, they may file a workers’ compensation claim with their employer’s insurance carrier as well as a civil lawsuit against the third party or parties responsible for the accident.

On average, 16% of workers’ compensation claims involve injuries sustained while workers are operating vehicles or machinery. And 40% of workplace fatalities each year are caused by transportation accidents.

People who work for rideshare companies typically have rideshare insurance coverage beyond their own personal auto insurance coverage. Companies such as Uber and Lyft offer their own insurance to protect drivers and passengers. Uber’s insurance for rideshare drivers includes uninsured and underinsured motorists’ coverage, which can pay for your injuries and losses as well as those of your passengers if you are in an accident with an uninsured or underinsured driver. If you’re an Uber driver, you might be able to file a personal injury claim against the other driver, another claim under your Uber insurance and workers’ compensation claim, depending on the circumstances under which you were driving.

Workers’ compensation won’t cover all accidents while you are out driving for work. It generally doesn’t cover you if you are commuting to or from work. It’s also not likely to cover you if you run a personal errand not related to work.

Several factors will be considered when determining whether your accident occurred while you were acting in the course and scope of your employment, including:

• Whether you were driving from one work site to
  another
• Whether you were running errands or making
  deliveries for your employer
• Whether you are a remote worker who is
  compensated for traveling from your home to a work location
• Whether you were transporting a different
  employee for business purposes

If you were driving while under the scope and course of your employment, you may be entitled to file a workers’ compensation claim even if you were at fault for causing the accident. The workers’ compensation system isn’t based on fault, instead, it is designed to compensate workers who are injured while working for their employers. This comes from the idea that employers derive benefits from the work their employees complete for them.

Ergonomic Overuse Injuries

Ergonomic and overuse injuries are often called cumulative trauma disorders (CT) or repetitive stress injuries (RSIs). Some common examples of repetitive stress injuries include carpal tunnel syndrome and tendonitis. Carpal tunnel syndrome occurs because of repetitive stress placed on the wrist. This can cause a narrowing of the carpal tunnel. When the carpal tunnel is narrowed, it can place pressure on the nerve that runs through it, causing pain and mobility problems.

Employees with desk jobs requiring them to type on computers for hours a day are most susceptible to carpal tunnel syndrome. Some of the most common symptoms of overuse injuries are:

• Numbness or tingling
• Decreased joint mobility or stiffness
• A burning sensation
• Pain that worsens while you work
• Aching
• Trouble maintaining your posture while at work
• Clumsiness or weakness
• Difficulty typing, gripping and carrying objects

Overuse injuries can happen to your musculoskeletal system, causing damage to your tendons, nerves, joints, muscles, ligaments, spinal discs and cartilage. Many of these kinds of injuries can be prevented by having an ergonomic workplace. This means the workplace is designed and set up to an employee’s needs. This helps lessen any strain, muscle soreness or repetitive motion injuries while improving productivity.

According to OSHA, $1 out of every $3 spent on workers’ compensation claims stems from ergonomic issues. But it’s not just office workers who can suffer from repetitive stress injuries. For example, workers who regularly use power tools may develop repetitive stress injuries as well.

Sometimes, RSIs are difficult to prove medically. To recover workers’ compensation benefits, you’ll have to prove that your injury exists and that it resulted from your job. Unfortunately, damage to the musculoskeletal system can be difficult to connect with an employee’s job. Another issue that frequently arises is that employees delay reporting their injury or seeing a doctor for their RSI. Experienced workers’ compensation attorneys are well aware of these obstacles. They can combat your employer’s and insurance company’s objections and help you obtain your workers’ compensation benefits because of overuse injuries.

Overexertion

Workplace overexertion injuries are fairly common as well. Probably the most well-known example of this type of injury occurs when someone hurts their back by lifting something improperly or lifting something too heavy. Workplace overexertion injuries can happen from just one incident. They can also be the result of the excessive physical effort involved with lifting, pushing, pulling, turning, carrying, throwing or holding something. In 2013, overexertion injuries were the second leading cause, after falls, of emergency room visits for adults aged 25 to 64.

On average, overexertion causes 35% of all work-related injuries. It’s the single largest contributor to workers’ compensation costs. It’s common for employers and insurance companies to argue that employee overexertion injuries happen because of activities the employee has engaged in outside of work. Experienced workers’ compensation lawyers, however, can overcome this well-worn tactic because they know and understand the types of evidence that must be gathered to prove that the overexertion injuries happened at their clients’ jobs.

Fingers, Limbs and Body Parts that Become Stuck in Machinery

Every year, thousands of workers across the U.S. lose feet, toes, hands, fingers and other body parts while working. These severe injuries often happen when body parts are caught between objects or machinery, or when they are struck by objects. When limbs, fingers, hands, feet or other body parts get stuck or caught, it can crush or compress that body part. Severe damage can happen, and an amputation might be necessary.

If an amputation is needed, establishing temporary or permanent disability status is usually not very difficult. If there is no amputation, eligibility for temporary or permanent disability may not be as easy to obtain. As an example, say you suffer permanent nerve damage to your hands. You may not have suffered an amputation, but you might be unable to use them. An experienced workers’ compensation lawyer can help you prove that you should be entitled to receive temporary or permanent disability benefits when you lose the ability to use a limb or other body part, thus preventing you from returning to your former job.

Exposure to Toxic Environments

Sometimes, workers are injured when they’re exposed to toxic chemicals, dust or minerals in their work environments. People who work with dangerous chemicals may suffer the effects of chemical exposures if they are not provided with adequate safety equipment. And office workers can also suffer from toxic exposures when the areas they work in are painted or cleaned with harsh chemicals, especially if those areas are not properly ventilated.

Toxic exposures include exposure to asbestos fibers. Asbestos exposure can lead to mesothelioma many years after the initial exposure. If you’ve become ill or injured due to exposure to toxic materials at your job, you may be entitled to file a claim for workers’ compensation benefits.

Electrocution

Electrocutions claim U.S. worker lives every year. According to OSHA, 71 workers in the construction sector were killed in electrocution accidents in 2018. These types of accidents occur when a worker comes into contact with a live electrical current. In addition to fatalities, electrical injuries can also occur. These include electrical burns, paralysis, neurological damage and brain injuries.

If a worker is injured in an accident involving electricity, multiple parties may be liable, in addition to the direct employer. If you’ve suffered an electrical injury or lost a loved one due to an electrocution accident at work, you may be able to file a workers’ compensation claim with the direct employer as well as a third-party lawsuit against any other parties responsible for causing the accident. A knowledgeable workers’ compensation crossover lawyer can investigate the facts and circumstances of what occurred to identify all potentially liable parties that should be named in a third-party lawsuit while also helping you with your workers’ compensation claim. This can help maximize the recovery of compensation to which you should be entitled.

Intentional and Violent Conduct

Workplace violence is a real problem that is often featured in the news. According to OSHA, workplace violence can be defined as “any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site.” Sadly, every year, almost 2 million U.S. workers report that they have been the victims of workplace violence at their jobs.

In general, you are covered when you are the victim of workplace violence by your employer’s workers’ compensation insurance policy. However, there is one important exception. If you were deemed to be the initial aggressor in a fight at your job that resulted in you injuring yourself, you probably won’t be able to recover workers’ compensation benefits for those injuries.

Burns from Heating Sources, Fires or Explosions

Burn injuries are one of the most traumatic injuries a victim can suffer and may result in death. Burns can happen when you come into contact with heat sources, hot liquids, chemicals, fires or if there is an explosion.

Burn injuries are classified into four levels that range from first degree to fourth degree.

• First degree burns – are minor and
  usually only affect the first layer of your skin.

• Second-degree burns – can cause
  blistering and some thickening of the skin.

• Third-degree burns – The skin thickness
  is more widespread. The skin may appear waxy and textured.

• Fourth-degree burns – go through both
  layers of skin and sometimes even tendons, muscle, and bone.

Fourth-degree burns are severe enough to sometimes require an amputation. Third and fourth-degree burns can also cause shock, infections and even death.

You can also suffer a burn injury if you inhale smoke during a fire at your place of employment. Thermal burns (contact with heated objects) are also common and may result from contact with a heat source. Electrical burns as the name implies, happen when you come into contact with electricity. Chemical burns can happen when you are exposed to harsh chemicals.

Burn injuries that happen while you are on the job can be compensated through your employers’ workers’ compensation insurance coverage. These types of injuries often require extensive medical treatment. If the insurance company tries to deny a needed procedure, your lawyer will push to get you the crucial treatment you deserve.

What is My Workplace Accident Compensation Claim Worth?

The value of your workers’ compensation claim will depend upon several factors:

• The extent and severity of your injuries
• Your likelihood of recovery
• Whether your injuries will force you to miss
  work temporarily or permanently

Once these factors are determined, you may be entitled to several of the following benefits:

• Medical benefits
• Temporary disability benefits
• Permanent disability benefits
• Supplemental job displacement benefits
• Death benefits when the worker is killed

Under the law, your employer’s insurance company must cover up to $10,000 in medical treatment after you have filed your claim and it is pending. The company must cover this amount even if your claim is ultimately denied. If the insurance company doesn’t notify you of a denial of your claim within 90 days of its receipt of your claim form, your benefits will be presumed accepted by the state under Cal. Labor Code § 5402.

Upon approval of your claim, you’re entitled to receive medical benefits to pay for all medical treatment reasonably required to treat your injuries and their related symptoms, including:

• Hospital bills
• Doctor bills
• Prescriptions
• Acupuncture
• Medical equipment and supplies
• Up to 24 sessions with a physical therapist,
  chiropractor, or occupational therapist

All of these expenses should be paid for by workers’ compensation without any copays or deductibles. Before you’re able to get some types of treatments recommended by your doctor, you may need to secure authorization from the insurance company through a process called a utilization review.

Your worker’s compensation claim might also include temporary disability benefits. If your injury forces you to miss more than three days of work, you may receive temporary disability payments. Temporary disability benefits don’t replace all of the income that you have lost because of your inability to work. Instead, it will replace a portion of your income for the time that you aren’t able to return to your job because of your injury.

Temporary disability benefits are subject to minimums and maximums that are adjusted each year. For 2019, the minimum temporary disability benefits amount is $187.71 per week while the maximum amount is $1,251.38 per week. If you receive temporary disability benefits, you will receive two-thirds of your regular income up to a maximum disability amount.

If your doctor determines that your injuries have left you with permanent disabilities that will impact your ability to work, you may be entitled to receive permanent disability benefits. You won’t be eligible for permanent disability benefits until your doctor determines that you’re permanently disabled with no chance of improvement. You’ll then be given a permanent disability rating, which will be used to determine the value of your permanent disability benefits using the current disability schedule. The most recent Department of Industrial Relations’ disability schedule can be found here.

If you receive a report that you have suffered a partial disability and your employer doesn’t offer you a modified position within 60 days, you may be eligible for a supplemental job displacement benefit of up to $6,000. This benefit is to be used to pay for training or certifications that you need for you to secure a different job that you can perform.

If you lost a loved one in a workplace accident, you may be entitled to death benefits. These benefits are meant to compensate you for the reasonable burial and funeral expenses that you incur. They might also provide benefits to a surviving spouse and minor children of the deceased worker.

When Does Workers’ Compensation Stop Paying?

Workers’ compensation benefits will end once certain milestones have been reached. Here’s what you need to know about the end of temporary disability and permanent disability payments in California.

Temporary Disability

Temporary disability (TD) benefits will start when you’re hospitalized overnight or when your doctor says that your injury will prevent you from working for three or more days. TD benefits are paid every two weeks up to a total of 104 weeks. These benefits will end when you return to your job or when the doctor says that you’re unlikely to recover any further. If you were injured after January 1, 2008, you can receive up to 104 weeks of temporary disability benefits within five years.

If you suffer from chronic lung disease or serious burns, your temporary disability benefits may last longer. For this condition, you may be eligible to receive TD benefits for up to 240 weeks out of five years.

Permanent Disability

If your doctor determines that you are permanently disabled (PD), the insurance company’s claims administrator will estimate what you should receive and will begin to make payments to you. These benefits will be payable to you in addition to any TD benefits that you are receiving until your final disability rating is determined. When the amount is determined, any amount that exceeds the estimate you receive must be paid by you.

If your permanent disability is ratable, that is, it can be assessed or adjusted by using a formula or percentage, you won’t receive permanent disability payments if you return to a regular, alternative or modified work schedule as long as you are receiving 85% of your former salary. When your PD award is paid, you will start receiving a payment beginning when your TD benefits end.

Once the amount of your permanent disability has been determined, you’ll likely receive a settlement and award of your benefits. This can be payable as a lump sum or in a stipulation and request for award. A stipulation settlement will normally include a monetary payment and a promise for the payment of your future medical payments. The payments will be made to you over time.

California’s Workers’ Compensation Laws

Several important statutes apply to most workers’ compensation claims. Cal. Labor Code § 3600 establishes the rules that govern the injuries that must be covered by workers’ compensation. In general, injuries suffered during the course and scope of your job are covered.

Cal. Labor Code §§ 5400-5405 contains the deadlines and procedures that must be followed when you have been injured and how you must report your injury. If you fail to adhere to these deadlines, you could lose your right to recover workers’ compensation benefits.

Cal. Labor Code § 4600 includes the rights that you have to receive payments for your medical expenses. It also discusses when you’re able and unable to choose your own doctor.

Cal. Labor Code §§ 5500-5507 covers the requirements for filing an application to appeal a denial that you receive from the insurance company. These statutes also outline the procedures for a hearing. Cal. Labor Code §§ 4060-4062 and § 4616.3 include rules for medical evaluations when you have different types of disputes with the insurance company. Finally, the rules for computing temporary and permanent disability benefits are found in Cal. Labor Code §§ 4650-4654.

There are several workers’ compensation exemptions that you should be aware of. Employers are not required to provide workers’ compensation coverage for the following types of workers:

• Independent contractors
• Casual workers, who are employed occasionally or
  sporadically
• Domestic workers
• Certain agricultural workers
• Real estate agents that are paid on a commission-only
  basis

Conclusion

If you’ve been injured while you were working at your job or have developed an illness or condition because of your work environment, you may be entitled to recover workers’ compensation benefits. Depending on the complexity of your case and the severity of your injuries, it can be difficult to figure out your workers’ compensation claim on your own. If you also need to concentrate on your recovery and rehabilitation, it can be even more difficult and stressful to handle your claim and the negotiations with the insurance company.

Don’t be surprised if your employer and their insurance company use every tactic at their disposal to dispute, diminish or flat out deny your claim. You need the help of an experienced workers’ compensation lawyer to combat them. A lawyer is also necessary when the insurance company denies your request for necessary medical treatment or when you disagree with your permanent disability rating.

To make sure your claim is handled properly, seek the advice of a powerhouse law firm that knows the specifics of workers’ compensation by contacting the experienced workers’ compensation attorneys at The Dominguez Law Firm at 800-818-1818 for a free case evaluation. We’re available 24/7 to take your call. And we promise: no recovery, no fee, so call us today.