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What Types of Benefits Can I Receive From Workers’ Comp?

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  1. What Types of Benefits Can I Receive From Workers’ Comp?

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    If you or somebody you care about sustains an injury while working, you should be able to count on the workers’ compensation system in California to help cover injury-related expenses. However, it is important to understand what kind of compensation is available to those who sustain on the job injuries. At DiMarco | Araujo | Montevideo, our Riverside workers’ compensation attorneys want to discuss what kinds of benefits injured workers are entitled to.

    1. Coverage of Medical Expenses

    One of the most pressing concerns that injured workers have is whether or not they will be covered for their medical expenses, as these can become tremendously expensive. Under California workers’ compensation laws, an injured worker is entitled to receive coverage of all medical treatment related to an on the job injury. This injury will be treated by a doctor inside of a network called the Medical Provider Network (MPN).

    Doctors in the MPN will follow a course of treatment through a process known as the Utilization Review. A doctor will treat an injured worker until they reach maximum medical improvement. These benefits will cover emergency medical treatment, extended care, physical therapy, medical devices, prescription medications, and more.

    2. Temporary Disability Benefits

    Temporary disability benefits are available to pay for lost wages if an employee is unable to work while they are injured. These benefits will pay for two-thirds of a worker’s average weekly wage (AWW), though they can only be paid for a maximum of 104 weeks within a five-year period from the date the injury occurs.

    3. Permanent Disability Benefits

    For more severe injuries, workers may be entitled to permanent disability benefits if they sustain a loss of future earning capacity. These benefits will be rated on a disability scale ranging from 0% to 100%. Any worker who scores the disability rating below 100% will be considered partially disabled. They would receive weekly benefits for only a set period of time. If a worker is considered 100% disabled, they will receive weekly payments at their temporary disability rate for the remainder of their life.

    4. Job Displacement and Rehabilitation Benefits

    If a worker is unable to return to the same job they were in due to their injury, they may be entitled to receive a $6,000 supplemental job displacement voucher. This voucher can be used on various expenses to help obtain alternative employment, including tools for training, computer equipment, licensing and exam fees, placement and resume services, etc.

    Employers can avoid paying this voucher, but they will need to offer the employee an alternate, regular, or modified work schedule under the following circumstances:

    • The job is 85% of the salary of their previous job
    • The job lasts at least 12 months
    • The job is in within a reasonable commuting distance of the worker’s home

    Will You Need an Attorney?

    If you have sustained an on the job injury, you may need to secure an attorney to help get the benefits you are entitled to. At DiMarco | Araujo | Montevideo, we are dedicated to helping injured workers secure full compensation for these claims. Let our Riverside workers’ compensation attorneys get to work on your behalf today. You can contact us for a free consultation by clicking here or by calling (951) 977-7787.

  2. Can I Receive Workers’ Compensation for COVID-19 in Riverside?

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    As COVID-19 (the coronavirus) continues to spread throughout the country and affect workers, many employers are looking for ways to help employees who have contracted the virus. One of these outlets may be a workers’ compensation claim depending on the situation. California’s workers’ compensation system provides financial benefits to make up for medical expenses and lost wages when an injury or illness takes an employee out of work. If COVID-19 has interfered with your ability to earn a living wage, you might be eligible for workers’ compensation in Riverside.

    COVID-19 Must Arise Out of the Course of Employment

    The main issue employees face during workers’ compensation claims for the coronavirus is whether the employer’s insurance policy covers the situation. In California, workers’ comp insurance only covers illnesses (or injuries) that arise out of or in the course of employment. It will be up to the employee, therefore, to prove he or she came into contact with the COVID-19 virus while performing job-related tasks. If it is only a possibility that the worker contracted the virus at work, he or she may find it difficult to qualify for insurance benefits.

    Your chances of qualifying for workers’ compensation insurance benefits in Riverside are higher if you work in a role that commonly comes into contact with people who have the coronavirus. As a nurse, doctor, first responder, medical office worker, clinician, pharmacist or someone at a testing lab, for example, you are at an increased risk of contracting the coronavirus while at work. Your place of employment likely has cleaning logs and protocols to identify potential points of exposure. You may be able to use these measures as proof during a COVID-19 workers’ compensation claim. Workers frequently in contact with the virus may find it easier to qualify for workers’ compensation benefits in California.

    What You Need for a California Workers’ Compensation Claim

    California’s workers’ compensation system does not require proof of someone else’s negligence in relation to your injury or illness. You must simply show with documentation that you suffered the harm in question while performing a job-related duty. A claim for COVID-19, for instance, may require you to prove that you have the virus because of your job.

    • A doctor has diagnosed you with COVID-19.
    • The virus led to damages such as medical bills or lost wages.
    • Your job put you at an increased occupational risk of contracting COVID-19.
    • You most likely did not contract the virus elsewhere.
    • You can identify a specific point of contact on the job that led to the virus.

    If you do not work in a high-risk occupation, your employer’s insurance company may need to analyze your case in more detail before accepting or denying or the case. Insurers around the country are treating these claims on a case-by-case basis. In general, you will need meticulous records to help you prove you contracted the virus while on the job. A Riverside workers’ compensation lawyer could help you with the burden of proof during your COVID-19 claim. A lawyer can gather evidence on your behalf and talk you through your legal options.

    Workers’ Compensation Benefits Available for the Coronavirus

    It may be possible for you to recover compensation through an insurance claim and/or a personal injury lawsuit for COVID-19 in Riverside depending on the circumstances. If your employer is guilty of negligence in reasonably protecting you from the virus, for instance, you may have grounds to bring a civil claim against your employer. This could lead to greater financial recovery than a workers’ compensation claim. Either type of case, however, could lead to the reimbursement of your losses.

    • Past and future medical expenses
    • Lost wages
    • Lost future capacity to earn
    • Disability expenses
    • Pain and suffering
    • Legal fees
    • Death benefits
    • Exemplary damages

    Learn more about your case with help from a workplace injury attorney near you. A workers’ comp claim might provide benefits for medical bills and two-thirds of your lost wages, while a civil claim could pay for 100% lost wages, pain and suffering, and other damages. The lawyers at DiMarco | Araujo | Montevideo are offering free consultations about potential workers’ compensation claims and personal injury lawsuits connected to the coronavirus. Discuss the specifics of your COVID-19 workers’ compensation claim with an attorney in Riverside as soon as possible.

  3. How Long Does a Settlement Take After a Demand Letter Is Sent?

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    After consulting with an attorney, evaluating your claim, crafting your demand letter and sending it in, it can be difficult to wait for an answer from the insurance company. You may be unable to fully move forward without knowing the insurance company’s response. Luckily, most insurance settlements in Riverside take just one to three months to resolve. If you have a complicated claim or the insurance provider is treating you in bad faith, however, your timeline could be much longer.

    Mandated Response Times Under State Law

    California is one of many states with laws determining how long an insurance company has to respond to its claimants. According to California Code of Regulations section 2695.5, an insurance company has to respond to a demand letter within 15 days of its receipt. Under state law, your insurer has a maximum of 15 days to notify you that it has received your demand letter.

    You should receive a letter in the mail or a phone call from a claims adjuster within about two weeks. Then, the insurer has 40 days from the receipt of your demand letter to issue an approval or denial. In most cases, expect a decision on your insurance claim by the 40-day deadline. Sometimes, however, an insurance company needs more time to investigate a claim. If this happens in your case, you might receive a notice from the insurance company within 40 days that it will need additional time.

    If you receive correspondence requesting more time, the insurer must explain why. The request must be a reasonable one, or else the company could be practicing insurance bad faith. Additional time often means a total of 60 days from the date of receiving your claim. Most clients receive settlement checks from insurance companies within two weeks of claim acceptance, making the total average timeline about one to three months long.

    Issues That Could Delay Your Claim

    An insurance claim requires a great deal of paperwork and red tape. A mistake on just one of the forms submitted could lead to a delay in the processing of your claim. If you submitted your demand letter without first running it by an attorney, it may contain errors that could make a settlement take longer to achieve. An issue could rest with your insurance company. The company might be dealing with a lot of claims or need additional time reviewing your case.

    • Missing information
    • Insufficient documentation
    • Refusal to sign medical release forms
    • Lack of cooperation with the investigation
    • The defendant refuting fault
    • Your employer denying your claim
    • Lack of eyewitnesses
    • Disputes over the terms of the policy
    • Complicating claim factors

    Insurance companies often have valid reasons for taking several weeks to reach a decision. However, the insurance provider in your case may be guilty of bad faith instead. Insurance bad faith means the company is treating your claim unfairly or dishonestly. A common bad faith tactic is to deny a client’s payout. If you suspect bad faith is what is making your settlement take so long, contact an attorney for a free consultation.

    Settlement vs. Court Trial

    If you and the insurance provider cannot agree on a fair and reasonable settlement, you may have to take your case to trial to obtain compensation. You might also have to take your claim to court if the insurance company responds to your initial demand letter with a claim denial. Rather than taking a few months, a personal injury trial takes a year or longer on average. At the end of the trial, you might not receive any compensation at all. If you win your trial, however, the verdict awarded could be more than what you would have received through an insurance settlement.

    No matter what unique issues, factors or delays your claim involves, a lawyer can help you work through them with efficiency. Hire a Riverside workers’ compensation lawyer to take over your insurance claim if you wish to avoid common mistakes and expedite the process whenever possible.

  4. How Long Do I Have to File a Workers’ Comp Claim?

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    Injuries at work happen often in Riverside, California. As an employee, you need to protect your rights by understanding how the state’s workers’ compensation system operates. One misstep during the claims process could bar you from recovery for your damages. While the system generally makes it easy for injured workers to recover compensation, a mistake such as a missed deadline to file could take away your chances of a settlement. You do not have an unlimited amount of time in which to file a workers’ compensation claim in California.

    Time Limits on California Workers’ Compensation Claims

    A workers’ compensation claim does not only involve one deadline. Unlike a civil claim such as a personal injury lawsuit, a workers’ compensation insurance claim does not have just one statute of limitations. Instead, it has multiple time limits you must know and obey as a claimant to have a valid claim. The two most important deadlines to know are the time limit for notifying your employer about your injury and the time limit on filing a workers’ compensation claim.

    • 30 days: You have 30 days maximum to tell your employer about your workplace accident and related injuries. This is one of the requirements for a valid workers’ compensation claim. While you should let management know about the incident as soon as possible, you must do so at least within 30 days. Failing to report the accident by this deadline generally means giving up the right to receive benefits.
    • One year: The other key deadline is for filing the workers’ compensation claim paperwork. You must file a workers’ compensation claim with the California Workers’ Compensation Board within one year of the date of your accident or the discovery of the injury or illness. Missing this deadline could bar you from recovery.
    • Five years: You might also need to know the extended deadline for injuries that cause long-term disabilities (lasting pain, immobility, limited range of motion, etc.). While you must still file the initial claim within one year, if your disability changes in the future, you have five years to file with the Appeals Board for a re-evaluation of benefits.

    Do your best to report your accident and injuries right away. Reporting your Riverside work accident promptly can have benefits such as the preservation of important evidence. It can also help the insurance process run more smoothly, eliminating potential delays and allowing you to receive benefits sooner. If your case involves a government entity as a defendant, your deadline to file a workers’ compensation claim could be as short as six months. Act quickly to get your claim in on time.

    Deadline for a Personal Injury Work Accident Claim

    Qualifying for workers’ compensation benefits means you could recover compensation without needing to prove anyone’s fault for your injury. Before you say yes to a settlement, however, realize what you are giving up. Once you accept workers’ compensation benefits, you cannot bring a personal injury suit against your employer for negligence. Discuss both options with a Riverside workers’ compensation attorney before you decide. If your employer caused your injury through negligence or carelessness, a personal injury lawsuit could result in greater compensation.

    You may be eligible for benefits through both workers’ compensation and a personal injury lawsuit if someone other than your employer caused the accident, such as negligent driver, product manufacturer, or property owner. This could maximize your financial recovery. If you wish to pursue a civil claim to damages in California, you must file within two years of the date of the workplace accident.

    The Division of Workers’ Compensation and the civil courts are strict with their time limits. Missing a critical deadline for reporting your injury, filing an insurance claim or bringing a personal injury lawsuit could mean giving up your right to receive any compensation. Contact a lawyer in Riverside right away after a work accident to make sure you meet the time limits. Acting quickly can help ensure you do not unintentionally forfeit your right to financial compensation.

  5. How to Report a Work Injury to Your Employer

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    California’s workers’ compensation system provides no-fault benefits to injured workers. An employee that suffers an injury while on the job can receive compensation for his or her losses without needing to prove anyone’s fault or negligence. The same employee must, however, take a few other steps before receiving a check. One of the main responsibilities an injured worker has is to report the injury to his or her employer. Failing to report an injury on time could lead to workers’ compensation claim denial.

    Stay Where You Are – Ask for Help

    After a workplace accident, stay where you are and request assistance from a co-worker. If you have serious injuries, moving the wrong way could make them worse. Ask a co-worker to call 911 to request an ambulance, if necessary. Have someone take photographs of the location of the accident while it is still set up the way it was when you got hurt. Have someone notify your supervisor or boss of the incident for you, if possible.

    Go to the Hospital

    Put your physical safety first. Even if you have not yet reported the injury to your employer, go to the hospital for treatment of serious injuries. Explain to your doctor what happened and where you notice symptoms. Follow the physician’s treatment plan exactly. Keep copies of your hospital reports, x-rays, and medical bills. Once you receive a diagnosis, take it to your employer if you have not already reported your injuries.

    Notify Your Employer

    If your injuries are not life-threatening, tell your employer about them before seeking medical care. Your employer may need to refer you to a doctor that is part of the insurance company’s medical provider network. Emergency care is an exception. If you need emergency medical attention, do not worry about going to a hospital in your employer’s network. Otherwise, ask your employer for the name of a doctor in the network when you report your injuries.

    Notify your employer within 30 days of the date of the workplace accident. This is a strict deadline you must obey if you wish to recover through the workers’ compensation system in California. If you wait longer than 30 days to tell your employer about your work-related injury or illness, you could lose all right to collect benefits. Notify your employer in writing to document the process.

    Submit Form 1

    Once you have received medical treatment, fill out the Division of Workers’ Compensation Form 1 and submit it to your employer. This form asks for details about your accident and injury, including your full name, address, the date of the injury, and a description of where you suffered the injury. Your employer will fill out the second half of the form, then submit it to the Division of Workers’ Comp. You should receive a copy of your filled-out Form 1 to keep for your records. Your employer should submit the form within one working day of receiving it from you.

    File the Application for Adjudication of Claim

    You may also want to file an application for adjudication of claim. You will only have one year from the date of your injury to file this claim before losing your right to file forever. You will need this form if your employer or its insurance company does not offer fair compensation for your injuries. Filing the claim form opens a case with the Workers’ Comp Appeals Board. Even if a dispute has not yet arisen, you may want to file this form if you are closing in on your one-year deadline, to be safe. File if you think you will need the Board to resolve a dispute in the future to avoid missing the time limit. If you need assistance bringing your workers’ compensation claim, contact a Riverside workers’ compensation attorney.

  6. Medical Fraud and Workers’ Compensation

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    California has a widespread problem with medical fraud in the state’s workers’ compensation system. Health care providers are racking up tens of thousands of dollars in unnecessary tests, procedures, and treatments – exploiting the system to make millions on the backs of workers who suffer injuries on the job. The holes in California’s workers’ compensation system make siphoning money from that system almost too easy.

    Exploring California’s Workers’ Compensation System

    State rules for workers’ compensation are loose in California, leading to plenty of opportunity for fraud. Anyone can pretend to be a medical provider by simply sending a letter to the state, without the need for any proof. Real providers can run meaningless tests and bill the system, knowing they won’t get caught because injured workers don’t see the bill. The weaknesses in the system make it impossible for the state to validate medical provider claims.

    There is a great division of power within California’s workers’ compensation system. The system spreads one job across multiple departments, leading to gaps in communication and dropped responsibilities. The state’s Department of Industrial Relations is in charge of administering workers’ compensation benefits, while medical boards oversee physicians. Hundreds of insurers and self-insured employers decide which medical bills to pay.

    Many states’ fraud strategies stop paying medical providers if a Medicaid agency determines there is reason to suspect fraud. Unfortunately, California has no such law. Medical providers are free to continue performing questionable surgeries, doling out complicated treatment advice, and otherwise exploiting the system at the expense of injured workers – most of which only speak Spanish. There is nothing to prevent this type of fraud from continuing, even if agencies suspect the worst.

    Federal laws have taken steps toward preventing “sham” medical facilities from cropping up. Now, Medicare uses data to check on medical offices and verify their authenticity. Medical officials visit providers when they open, three to five years after they open, and if they receive any complaints. This system dissuades fraudsters from opening false clinics, stealing patient data, and falsifying medical invoices. Once again, however, California has no data reviews or in-person checks that occur on a regular basis.

    The Risk to Injured Workers

    Workers’ compensation fraud hurts more than just the system. Criminal medical providers are getting rich at the expense of injured workers, who undergo unnecessary tests and even surgeries so the provider can make money. Many targeted workers don’t realize they are victims since they never see their medical bills. They trust the opinions of doctors when they say a patient needs surgery – unaware that nurses who get paid for their involvement may tamper with MRI results to encourage this diagnosis.

    Medical fraud also effects employers who pay for workers’ compensation insurance. If an employer is public, it’s the taxpayers who foot the bills for fake charges. In the fraud scheme involving California’s workers’ compensation system, nobody wins except the masterminds. These schemes are far from victim-less crimes. If you’ve been at the tail end of a medical fraud scheme involving workers’ compensation an attorney can help.

    Your Riverside Workers’ Compensation Attorneys

    Workers’ compensation fraud isn’t a new crime, but it’s one that’s currently breaking records in our state. Until lawmakers revise California’s workers’ compensation system to include anti-fraud strategies, injured workers and their employers are still suffering the costs. If you’ve been affected by a medical fraud scheme, get in touch with our workers’ compensation attorneys. We can help you sue fraudulent health care providers for your pain, suffering, and mental anguish.

    If you’re an employer whose business paid the price for a medical provider’s fraud, our attorneys can help you obtain financial compensation for your losses and damages. Nobody should suffer from the criminal activity of others. Contact our Riverside office for a free consultation today.

Covid 19 Update: We are accepting new cases and we handle everything electronically and remotely, so our clients never have to leave their homes.