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According to state law, all employers who have at least one employee in California must offer workers’ compensation benefits. Until you experience an injury at work, you may not fully understand the workers’ compensation system or the requirements. At DiMarco | Araujo | Montevideo, we specialize in workers’ compensation cases in Riverside. Anytime you run into an obstacle with your workers’ compensation case in Riverside or the Inland Empire, contact our Riverside workers’ compensation lawyers today at (951) 977-7787 for a free case consultation.
Workers’ compensation provides medical and wage benefits to those who have been injured or ill at work. Workplace accidents can happen due to a variety of reasons. Workers’ compensation is insurance that presents employees with the resources necessary to recover from a personal injury or incident at work without having to give up their salary.
You may need legal assistance during the workers’ compensation claim process. Employers, medical providers, and insurance companies do not always act ethically or appropriately after a workplace injury. If you have trouble getting your claim approved or are unclear about your rights, contact us to speak with our qualified work injury attorneys. Our law firm routinely helps injured workers by:
You will qualify for workers’ compensation benefits as long as you are an employee and your injury or illness is work-related. Any activity that benefits your employer financially is typically considered work-related, regardless of where you are physically located at the time of the accident. To successfully file a workers’ comp claim, an injured worker typically needs to demonstrate that the injury has affected your life or work. In other words, a small cut or a bruise that does not require medical treatment will not typically qualify you for benefits.
It is not just full-time employees who are eligible for workers’ compensation benefits in Riverside. Even part-time employees, regardless of how many hours they work each week, are also entitled to full workers’ compensation benefits if they sustain an on-the-job injury. Any person who works as an employee in the state of California is generally able to recover workers’ compensation benefits.
However, there are many individuals who work as independent contractors in this state. The “gig economy” is fully operational, and the state has taken steps to address what happens to workers who sustain injuries if they are independent contractors. We are not just talking about Uber and Lyft drivers – there are individuals in just about any industry who work as independent contractors as opposed to employees. This means that the employer does not have direct control over how a person completes their work.
Independent contractors will typically not receive workers’ compensation benefits if they sustain an on-the-job injury. However, the reality is that many employers in this state purposely misclassify a person as an independent contractor as opposed to an employee to avoid having to pay various types of benefits, including workers’ compensation insurance. Misclassifying an employee is illegal, and an employer could face significant fines and even criminal penalties.
Any independent contractor who sustains a work-related injury should consult an attorney about whether or not they are entitled to workers’ compensation benefits.
However, there are some gray areas regarding eligibility, and every case is different. Reach out to one of our attorneys in Riverside for a free case evaluation if you have any questions regarding your specific situation.
Benefits are designed to help employees financially cover the costs associated with a workplace injury or illness. Specific benefits you may qualify for under workers’ comp insurance include:
If you have been injured at work and have medical expenses you cannot keep up with, filing a workers’ compensation claim may help cover the costs of hospital stays, exams, treatment, prescriptions, and travel. Workers’ compensation allows you financial freedom from copays and medical bills that occurred due to a work incident.
We can see that the Medical Treatment Utilization Schedule (MTUS) is the set of regulations that contain the rules and guidelines for determining reasonable and necessary medical care after a person sustains an on-the-job injury. The MTUS has adopted treatment guidelines set forth by the American College of Occupational and Environmental Medicine (ACOEM), which indicates that the state of California is following medical professionals when it comes to worker medical decisions.
The MTUS also has rules for how to determine what is reasonable and necessary care for any treatment outside of their guidelines. There is a medical evidence search sequence that should be applied in all situations by reviewing physicians when they evaluate conflicting recommendations for patient care.
If you are waiting to see a doctor and are unable to work, you may be missing out on your regular paychecks. Workers’ compensation will help pay for lost wages that you miss due to your work accident.
Depending on your time away from work, you may qualify for temporary or permanent disability. Disability payments cover a certain percentage of your average weekly wage while you are unable to work.
When a person sustains a temporary or permanent disability as a result of an on-the-job injury, there are various protocols in place that guide what they can expect to receive when it comes to benefits through the workers’ compensation system.
Temporary disability benefits. When a person cannot perform their job duties while recovering from their injuries, they can expect to receive temporary disability benefits. TDB will pay two-thirds of a person’s pre-tax wages that they lose while they are recovering from their injury. However, state law does set a maximum weekly amount that a person can receive, though this amount changes annually. Individuals are requested to report all forms of income they typically receive from their job. This includes wages, food expenses, lodging, commissions, overtime, tips, and more. Individuals should also report any earnings they earned at another job. These benefits will begin when a doctor says that a person cannot perform their usual work duties for three or more days or if they get hospitalized overnight. Typically, payments are made every two weeks and stop when a person returns to work or when the doctor releases an individual for work.
Permanent disability benefits. If a person sustains any type of lasting disability that affects their ability to earn wages, they may be entitled to permanent disability benefits, even if they are able to go back to work in some capacity. Permanent disability benefits are limited, and they may not cover all of a person’s last income. Permanent disability benefit amounts are determined by various factors, including:
In some cases, an employee may not be able to return to work in the same capacity. Benefits cover the costs of vocational rehabilitation including skills and job training.
If a work accident leads to the wrongful death of an employee, workers’ compensation also has death benefits to help. The family of an employee is entitled to certain benefits after a work-related death. These benefits could help cover unexpected funeral costs. In California, you have one year to file for workers’ compensation benefits, so it is important to speak with a workers’ compensation lawyer in Riverside as soon as possible to get the legal advice you need.
As stated above, California employers are responsible for their workers and are required to carry workers’ compensation for all employees. Typically, employees are unable to sue their employers for a work-related injury, as employers are required to pay for employees’ injuries regardless of who is at fault. If a company fails to have workers’ compensation benefits for its employees, employers could be held liable for the work injuries endured, resulting in a workplace injury lawsuit.
Work injuries can occur in a wide variety of ways. Not only do individuals have to worry about the “typical” ways to get injured, but they also usually have to navigate specific hazards related to each particular workplace, such as an Amazon warehouse. Some of the most common workplace accidents include the following:
Workers can sustain a wide variety of injuries as a result of the incidents mentioned above, and other incidents. Some of the most common injuries that we help clients recover compensation for include the following:
In addition to acute traumatic injuries, individuals can also sustain occupational illnesses as a result of workplace exposure to hazardous environments, chemicals, and particulates. This can include, but it’s not limited to, lung diseases, various types of cancer, cardiovascular disease, high blood pressure, and more.
Every workers’ compensation case begins with an injury report. Always file an accident report, even if you do not think you suffered a serious injury. Some injury symptoms do not arise until after the incident, and having the incident on record will help you obtain benefits later. If you do not tell your employer about your injury, you may lose your right to file for workers’ compensation benefits. Give notice to your employer within 30 days of the incident or within 30 days of suffering from a work-related disability.
If you do not meet the deadline, you may still qualify for benefits if your employer should have reasonably known about the injury during that time. An employer must provide an injured worker with a workers’ compensation (DWC-1) claim form within a day of learning about an employee’s injury. While an injured employee does have a year to file a claim, we recommend starting the process as soon as possible. For even more information, please visit the Riverside District Office page on the California Department of Industrial Relations website.
Even though the workers’ compensation insurance system in California is a no-fault system, there are still times when workers’ comp claims could be denied. In some cases, denials are legitimate, but there are also times when a workers’ comp denial is not legitimate, and those involved in these claims need to know the difference. Some of the main reasons that Riverside workers’ compensation claims may be denied include the following:
If your workers’ compensation claim is denied, you will have options. There is a way to appeal a workers’ comp denial in California, but it is crucial that you speak to an attorney. There are various steps that you will have to follow in order to go through the appeals process, and these steps can be complicated.
When you receive a letter about your work injury claim denial, there will be information about how to appeal the denial. You will file an “Application for Adjudication of Claim” in order to have your claim heard by a judge. This will create a case with your local Workers’ Compensation Appeals Board.
You should then receive a notice of filing, and then you and your lawyer will file a “Declaration of Readiness to Proceed.” this is a request to have your hearing heard in front of a judge, where you and your attorney will sit down with the insurance claims adjuster and try and reach a settlement. In the event no settlement agreement is reached, the judge will schedule a time for a trial with another judge altogether.
Please do not try to go through this process by yourself. An attorney with experience handling Riverside workers’ compensation denials can significantly increase your chances of recovering the benefits you need.
We want to meet you and help with whatever means we can. We offer free consultations at our law firm and you will not incur any legal fees until we do our job and win your case. If you cannot make it to our office, a workers’ compensation lawyer in Riverside or San Bernardino will come to you.
If you would like to learn more about workers’ compensation, visit our statistics and facts page to get started or you can call us seven days a week at (951) 977-7787.