Smart Law Blog

WHAT BENEFITS AM I ENTITLED TO AS AN INJURED WORKER?

Generally, the injured worker is entitled to the following benefits: past, present and future medical care for the work injuries; temporary disability benefits; permanent disability benefits; supplemental job displacement benefits-if the worker’s date of injury is 2004 or later; death benefits, to spouse, children or other dependents, if the worker dies from job injury or illness.

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WORKERS’ COMPENSATION: WHAT RESOLUTIONS/SETTLEMENTS ARE THERE?

Generally, your workers’ compensation case is ready to settle when the doctor determines that your medical condition has reached Maximum Medical Improvement (your condition is not going to get any better or worse).

There are three (3) ways for a workers’ compensation case to resolve.

The first way is by Stipulation with Request for Award.  In this method, the parties (you and the employer insurance company) agree to resolve/settle certain issues in the case: date of injury; occupation; body parts injured; wage amount; period of temporary disability; temporary disability rate; temporary disability payments; permanent disability; mileage reimbursement; future medical; doctor’s bills; etc. In most cases, the amount of the settlement is paid out over a period of time. If you hire an Attorney, the other side’s attorney’s fees are deducted from your settlement. This type of settlement must be approved of by the Workers’ Compensation Appeals Court Judge.

The second way a workers’ compensation case is settled is by Compromise and Release. This method also takes into consideration the above facts, but may result in additional sums being added to the settlement amount to buy out future medical benefits, etc. This type of settlement usually results in a lump sum settlement payment instead of a payment over a period of time. The Workers’ Compensation Appeals Court Judge must approve this type of settlement as well.

The third way to resolve your case is to go to Trial and have the Workers’ Compensation Appeals Court Judge issue Findings and an Award. This will usually require the injured worker to testify under penalty of perjury before the Judge who will consider the testimony and credibility of the witnesses, documentary evidence such as medical reports and records, depositions, and the like, and Stipulation and Award the parties reach on particular issues. If an Award is issued in the injured worker’s favor, then attorney’s fees will be deducted and the amount owed to the injured worker will usually be paid over a period of time. 

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WHAT TO DO IF INJURED AT WORK

If you have been injured at work you should notify your supervisor or person in charge to report the accident/injury as soon as possible. This type of injury is referred to as a Specific Injury.

If the injury occurs gradually, over time, be sure to report it to your supervisor as soon as you believe it is a result of a work injury. This type of injury is referred to as a Cumulative Trauma. 

Your employer must provide you with a DCW-1 Form (Claim Form). After you make your claim, the employer is required to provide medical care. You should be sure to keep a copy of any forms you fill out for your employer, including the claim form. Be sure to ask your employer to provide you with the name of the workers’ compensation insurance company. Your employer is required to post this information at your workplace.

Again, it is important to report the injury as soon as possible. You should not delay in notifying your employer of your injury. Many injured workers inform their employers but decide to wait to make a claim or wait to see a doctor. However, if you are injured you should notify your employer immediately and ask your employer to see a doctor. Do not take time off work and use sick or vacation days and then report the injury.

Generally, your employer will have a clinic that they will send you to for examination and/or treatment. Be sure to tell the doctor about each and every complaint (whether it is physical and/or emotional) that you have as a result of your work injury. If you fail to tell them about a part of your body that is injured, the insurance company may deny treatment and disability for that portion of your injury. Therefore, even if one part of your body, for example a broken arm, hurts the most and you are most concerned about that body part, be sure to advise the health care provider at your very first visit of all physical complaints that you have. If the employer refuses to send you to a doctor or clinic for medical treatment and you have medical insurance, be sure to seek medical care through your medical insurance. If you need medical care and do not have insurance and your employer refuses to send you to a clinic or for medical care, make sure to seek medical care anyway. You need to be sure to seek medical care when you need it and protect your rights. Be sure to advise the emergency room personnel that you were injured at work.

Please note that if you sustained serious injuries and require emergency care, call or have someone call 911 or get to an emergency room as soon as possible, so that you can be treated right away. Be sure to advise the emergency room personnel that you were injured at work.

 You may be eligible for workers’ compensation benefits including medical treatment even if your employer tells you that your injury is not related to your work or if your employer paid you in cash, or if you are a temporary or part-time worker. Please also note that you do not have to be a legal resident of the United States to receive most workers’ compensation benefits. If your employer refuses to provide medical care, or threatens to fire you if you report your injury claim, you should contact an attorney to discuss your rights. It is illegal to punish or fire an injured worker for being injured on the job or asking for workers’ compensation benefits.

There are time limitation periods for making a workers’ compensation claim. Failing to report an injury within thirty (30) days may affect your right to receive benefits in workers’ compensation. There are time limitations for filing an Application for Adjudication with the Workers’ Compensation Appeals Board. The statute of limitations for workers’ compensation claims is usually one (1) year from the date of injury. You are advised to file an Application for Adjudication with the Workers’ Compensation Appeals Board within one (1) year of the date of your injury. If an Application for Adjudication is not filed by that time, you can be forever barred from making your workers’ compensation claim and getting benefits. There are some exceptions to this rule, but do not delay. Consult an attorney as soon as possible.

Find the right legal resource in Southern California by contacting SmartLaw: (866)SMARTLAW.