Workers Compensation - San Diego Work Injury Lawyers

Understanding California’s Workers’ Compensation Process: An Overview for Employees

Overview

California’s workers’ compensation process can overwhelm employees who have suffered an injury in the workplace. To ensure fair compensation and to protect their rights, employees should have a comprehensive understanding of the process. This article provides an overview of the workers’ compensation system in California, guiding employees through the necessary steps and emphasizing the benefits of seeking legal representation.

Reporting the Injury

The first step in the workers’ compensation process involves promptly reporting the workplace injury to the employer. Employees must report the injury within 30 days, but it’s advisable to report it as soon as possible. Failure to meet this deadline may result in benefits denial. Employees should provide detailed information about the injury, including the incident’s date, time, and circumstances.

Seeking Medical Treatment

After reporting the injury, employees have the right to receive necessary medical treatment for work-related injuries. California law mandates that employers provide medical care through workers’ compensation insurance. Informing healthcare providers about the work-related nature of the injury ensures proper documentation and billing.

Filing the Workers’ Compensation Claim

Initiating the workers’ compensation process involves filing a claim with the California Workers’ Compensation Appeals Board (WCAB). Employees must complete the DWC-1 claim form accurately and submit it within one year of the injury or the last date of employer-provided benefits. This claim form notifies the employer and the workers’ compensation insurer about the injury and the employee’s intent to seek compensation.

Evaluating the Claim

Upon filing the claim, the workers’ compensation insurer evaluates its validity and decides whether to accept or deny it. The insurer has 90 days to make this determination. Accepted claims entitle employees to benefits, including medical treatment coverage and wage replacement. Denied claims can be appealed.

Appealing a Denied Claim

Employees can request a hearing before a workers’ compensation judge to appeal a denied claim. This step allows employees to present additional evidence, testimonies, and medical reports supporting their claim. Having legal representation significantly increases the chances of a successful appeal.

Benefits and Compensation

Approved claims entitle employees to various benefits, such as medical treatment coverage, temporary disability benefits, permanent disability benefits, and vocational rehabilitation if necessary. These benefits cover medical expenses, lost wages, and potential future earnings losses. A workers’ compensation attorney can ensure employees receive the maximum benefits entitled to them under California law.

Free Consultation with a California Workers’ Compensation Attorney

Navigating California’s workers’ compensation process can be challenging for employees. Understanding the necessary steps, from reporting the injury to filing a claim and potentially appealing a denial, is crucial for protecting their rights and securing fair compensation. Seeking legal representation from an experienced workers’ compensation attorney is highly recommended. Navarro Law Firm can guide employees, provide valuable advice, and advocate for their best interests, ultimately maximizing their chances of a successful outcome in their workers’ compensation case. Contact us for a Free Consultation!

Medical Determination California Workers' Compensation

What Can an Injured Worker Do to Contest “Medical Determinations?”

Medical Determinations can be crucial in obtaining your rightful benefits for a workers’ compensation claim. But first, what exactly is a medical determination?

What is a Medical Determination?

In California workers’ compensation a ‘Medical Determination’ means that medical professionals specifically evaluate and diagnose work-related injuries or illnesses. When an injured employee files a workers’ compensation claim in California, their medical condition is assessed by qualified physicians or healthcare providers who specialize in occupational medicine.

Determining a medical condition involves comprehensive evaluation of the employee’s medical history, a physical examination, diagnostic tests, and any other relevant medical evidence for the claim. The healthcare provider examines the nature and extent of the injury or illness, its relationship to the employee’s work activities, and the impact it has on their ability to work.

The medical determination serves several purposes within the workers’ compensation system in California. It helps establish the connection between the employee’s condition and their job, determines the appropriate course of medical treatment, assesses the need for temporary or permanent disability benefits, and guides the overall management of the workers’ compensation claim.

In California, a medical determination plays a crucial role in determining the benefits an injured worker is entitled to receive. It influences the decisions made by the employer’s insurance company, the Workers’ Compensation Appeals Board (WCAB), and other parties involved in the claims process.

Can you contest a Medical Determination?

Contesting a medical determination in California workers’ compensation involves a formal process to challenge the findings or decisions made by the medical professionals involved in evaluating your work-related injury or illness.

Are you an injured worker in California who wishes to contest a medical evaluation done by a physician? For a smoother process, follow the steps below. Please note that the information provided is not legal advice. It’s important to note that an injured worker should consult with an attorney who specializes in workers’ compensation law to ensure that their rights are protected throughout the process.

1. Understand the Medical Determination

Familiarize yourself with the medical determination by reviewing the medical reports, evaluations, and any other relevant documentation. Understand the specific findings, diagnoses, treatment recommendations, and their implications for your workers’ compensation claim.

2. Request a Second Opinion

In California, you have the right to seek a second opinion from another qualified physician if you disagree with the initial medical determination. Your request for a second opinion can typically be made within the workers’ compensation system, following the appropriate procedures outlined by the Division of Workers’ Compensation (DWC).

3. Utilize Qualified Medical Evaluations (QMEs)

If the disagreement persists after the second opinion, you may request a Qualified Medical Evaluation (QME) from the DWC. A QME is an independent physician appointed by the DWC to evaluate your condition and provide an unbiased medical opinion. The QME process involves a selection of the QME from a panel or through a process called “Agreed Medical Evaluation” (AME).

4. Prepare for the QME Examination

When a QME is appointed, you’ll receive notification of the appointment along with the date, time, and location of the examination. It’s crucial to thoroughly prepare for the QME examination by compiling your medical records, documenting your symptoms, understanding your work-related activities, and being prepared to answer the QME’s questions.

5. Attend the QME Examination

Attend the scheduled QME examination and be prepared to provide an accurate and detailed account of your condition, symptoms, and limitations. Answer all questions honestly and provide any relevant documentation or medical records that may support your case.

6. Review the QME Report

Following the examination, the QME will prepare a report detailing their findings, opinions, and recommendations. Obtain a copy of the report and carefully review it to understand the QME’s assessment of your condition and how it may differ from the initial medical determination.

7. Addressing Disagreements

If you still disagree with the QME’s opinion, you can dispute their report by filing an objection with the DWC. This initiates a process called “Request for Reconsideration” or “Request for Qualified Medical Evaluator Reappointment,” depending on the circumstances. The objection should clearly state the reasons for the disagreement and provide supporting evidence, such as contrary medical opinions or additional medical records.

8. Utilize the Workers’ Compensation Appeals Board (WCAB)

If the dispute remains unresolved, you may file an appeal with the Workers’ Compensation Appeals Board (WCAB). The WCAB is an administrative court that handles workers’ compensation disputes in California. You will need to follow the specific procedures and deadlines set by the WCAB for filing an appeal.

9. Present Your Case

During the WCAB process, you’ll have the opportunity to present evidence; including medical records, expert testimony, and witness statements to support your position. It’s advisable to consult with an attorney experienced in workers’ compensation to guide you through the legal proceedings and help you build a strong case.

10. WCAB Decision

Following the presentation of your case, the WCAB will review the evidence and make a decision regarding the medical determination dispute. They may affirm the initial determination, accept the QME’s opinion, or provide an alternative resolution based on the merits of the case.

Consult with an Attorney

If you’re dissatisfied with the WCAB decision, you may have the option to further appeal to higher courts, such as the California Court of Appeal. This involves additional legal proceedings and should be discussed with your attorney.

Contesting a medical determination in California workers’ compensation can be a complex and lengthy process. It’s crucial to gather and present strong evidence, follow the established procedures, and seek legal advice to navigate the system effectively.

Remember, this information is a general overview, and consulting with an attorney who specializes in California workers’ compensation is recommended for personalized guidance tailored to your specific circumstances. Navarro Law Firm can help you determine your next steps. Contact us at 619-640-9200 for a free consultation or fill out a quick form.

Terms to Know When Treating Your Work Injury

There are several important terms you should know when treating your work injury in California. This can ensure that you understand the workers’ compensation system and your rights as an injured worker. Hearing terms like Maximum Medical Improvement, Permanent Disability and Temporary Disability can start to make your head spin. Even understanding the word ‘disability’ in this situation can become confusing, but this is where Navarro Law Firm comes in.

Workers’ Compensation Terms to Know

We broke down some of the most important terms that you’ll likely hear after you file a claim with your employer, or during your free consultation with us.

Some of the most common workers’ compensation terms are:

Medical Treatment

Medical treatment refers to the care that an injured worker receives for their work-related injury or illness. This can include visits to doctors, hospitals, physical therapy, and other forms of medical care. This one is pretty straight forward, but is a crucial step in the claim process.

Qualified Medical Evaluator (QME)

A Qualified Medical Evaluator (QME) is a doctor who has been certified by the state of California to perform evaluations of injured workers. QMEs usually resolve disputes about the extent of an injury or the appropriate course of treatment.

Temporary Disability

Temporary disability benefits provide wage replacement to injured workers who are unable to work while they recover from their injury or illness.

Permanent Disability

Permanent disability benefits provide compensation to workers who have sustained a permanent impairment as a result of their work-related injury or illness.

Supplemental Job Displacement Benefit (SJDB)

Supplemental Job Displacement Benefit (SJDB) is a voucher that provides funding for re-training and education to injured workers who are unable to return to their previous employment as a result of their injury. Use this benefit to its fullest extent.

Independent Medical Review (IMR)

Independent Medical Review (IMR) usually resolves disputes about the medical treatment provided to injured workers. If there is a dispute, an injured worker can request an IMR to review the decision made by their claims administrator.

Utilization Review (UR)

Utilization Review (UR) is a process used by claims administrators to review the medical treatment provided to injured workers to ensure that it is appropriate and necessary.

Maximum Medical Improvement (MMI)

Maximum Medical Improvement (MMI) is the point at which an injured worker’s condition has stabilized, and no further improvement in their condition is expected.

Return to Work

Return to work refers to the process of an injured worker returning to work after a work-related injury or illness. This can include modified or alternative work arrangements to accommodate any permanent impairments.

Understanding these terms is crucial when treating your work injury in California. These terms can helpvnavigate the workers’ compensation system and ensure that you receive the benefits and care that you are entitled to as an injured worker.

Where Can I Get Legal Advice?

It’s important to schedule a free consultation with an experienced workers’ compensation attorney who can guide you through the process and help you understand your rights and obligations under California law. Navarro Law Firm has helped people throughout California deal with their workers’ comp cases for over 30 years. Contact us today for more information.

Why Do I Need a Workers’ Compensation Attorney?

Injured at work in California? You’re probably wondering if you need a workers’ compensation attorney. Well, the short answer is, yes. The long answer? We broke it down for you below.

With our experienced attorneys on your side we can help you navigate the complex workers’ compensation system, protect your rights, and ensure that you receive the benefits and compensation you are entitled to. Below we’ve put together list of key reasons WHY you might need a workers’ compensation attorney if you were injured at your job.

Protecting Your Rights

One of the most important reasons to hire a workers’ compensation attorney is to ensure that your rights are protected throughout the claims process. Our attorneys can advise you on your legal rights and obligations, and help you understand what to expect at each stage of the process. They can also ensure that your employer and their insurance company are treating you fairly and following the law.

Maximizing Benefits

Another important role that a workers’ compensation attorney can play is in helping you maximize your benefits. Our certified California attorney will understand all the different types of benefits you may be entitled to, including medical care, wage replacement, and compensation for any permanent disabilities. We can help ensure that you’re receiving all of the benefits you are entitled to under the law, and can also help you negotiate a fair settlement if necessary.

Appealing Denied Claims

If your workers’ compensation claim is denied, our skilled attorney can help you appeal the decision and fight for your right to compensation. This can be a complicated and time-consuming process, but having an experienced attorney on your side can make all the difference in whether your appeal is successful.

Legal Representation

If your employer or their insurance company disputes your claim or challenges your right to benefits, having an attorney on your side can help you negotiate a fair settlement or represent you in court if necessary. Your attorney can help ensure that your legal rights are protected and that you receive the compensation you deserve.

Knowledge of the System

Workers’ compensation law in California is complex, and the claims process can be confusing and overwhelming. An experienced attorney has in-depth knowledge of the system and can guide you through the process, answer your questions, and ensure that you understand your rights and options. This can help relieve some of the stress and anxiety that comes with navigating a complex legal system on your own.

Free Consultation

Wrapping up our shortlist hiring our workers’ compensation attorney can be a crucial decision for your rights as a worker. Our experienced attorney, Raymond J. Navarro, can help protect your rights, maximize your benefits, appeal denied claims, provide legal representation, and help guide you through the complex workers’ compensation legal system.

Navarro Law Firm can assist you with the next steps to securing the compensation and benefits you deserve after a workplace injury. Call us at 619-640-9200 or request a free consultation to speak with a certified California workers’ compensation attorney.

California workers compensation vs disability

California Workers’ Compensation Benefits vs California Disability Benefits

California workers’ compensation and disability benefits are two different types of benefits available to workers who are unable to work due to an injury or illness. Often times injured workers confuse these two California benefits and place them in the same category. We are here to let you to know that there is a difference.

We put together a short list of the main differences between workers’ compensation benefits and disability benefits in California.

Eligibility

Workers’ compensation benefits are available to employees who are injured on the job. They are also available to employees who develop an occupational illness due to their work.

Disability benefits, on the other hand, are available to workers who are unable to work due to an injury or illness that is not work-related.

Coverage

Workers’ compensation benefits cover medical expenses, lost wages, and disability payments for temporary or permanent disabilities related to a work injury or illness. They can also cover death benefits if death occurs due to their work.

Disability benefits cover lost wages and some medical expenses for non-work-related disabilities.

Application Process

To apply for workers’ compensation benefits, the injured worker must notify their employer of the injury, fill out a claim form, and provide medical evidence to support their claim.

Disability benefits are administered by the state of California and require the worker to apply through the state’s Employment Development Department.

Benefit Amount

Workers’ compensation benefits typically pay two-thirds of the worker’s average weekly wage, up to a maximum amount set by law.

Disability benefits pay a percentage of the worker’s earnings, up to a maximum amount set by law.

Conclusion

In conclusion, workers’ compensation benefits are available to employees who are injured or become ill on the job, while disability benefits are available to workers who become disabled due to a non-work-related injury or illness.

Both programs provide financial support to help workers cover medical expenses and lost wages, but the eligibility requirements and application processes differ.

If you need help determining which benefits you should be receiving contact Navarro Law Firm at (619) 640-9200, or fill out our free consultation form. We’ve been helping people in and around San Diego for over 30 years.

COVID-19 Workers’ Compensation Coverage in California

During these unprecedented times several questions have come up throughout our law firm regarding COVID-19 in the workplace. It is unfortunate COVID-19 took our country by surprise, however with a little bit of knowledge and general facts we can try to help give you some peace of mind as we navigate through these trying times.

When it comes to the correlation of workers’ compensation and the novel Coronavirus known as COVID-19, Navarro Law Firm has your questions covered!

For general information regarding COVID-19 and workers’ compensation see below.

If you are unable to do your usual job because you were exposed to and contracted COVID-19 during the regular course of your work, you may be eligible for workers’ compensation benefits.
Benefits include temporary disability (TD) payments, which begin when your doctor says you can’t do your usual work for more than three days or you are hospitalized overnight. You may be entitled to TD for up to 104 weeks. TD stops when you return to work, your doctor releases you for work, or your doctor says your illness has improved as much as it’s going to.
TD generally pays two-thirds of the gross wages you lose while you are recovering from a work-related illness or injury, up to maximum weekly amount set by law.
In addition, eligible employees are entitled to medical treatment and additional payments if a doctor determines you suffered a permanent disability because of the illness.
Essential employees, such as healthcare workers, grocery store checkers, and public safety employees, are at greater risk for exposure and contracting COVID-19.

Do you need more information or legal guidance regarding COVID-19 workers’ compensation claims? Contact us immediately using the form below for a free consultation.

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Common Occupational Illnesses in the Workplace

Occupational illnesses occur when an event or exposure occurs in the workplace, resulting in the development or worsening of a medical condition. An occupational illness differs from a workplace injury but is still eligible for workers’ compensation insurance. Nobody plans on getting injured at their workplace, but remember accidents happen! There are occupations where workers are more prone to an Occupational Injury. Occupational Illnesses on the other hand, can occur in an everyday office environment and where you’d least expect it.

An illness which occurs at your job should be reported and treated by a doctor immediately. According to documents from a hearing before the US House of Representatives Committee on Education and labor, as much as 69% of workplace injuries and illnesses are not reported.

Examples of Occupational Illnesses

There are numerous illnesses that can occur due to certain work environments. Don’t let a work injury or work illness go unreported. Report it immediately to your employer and fill out a DWC-1 claim form. If you’re not sure the work illness should be reported, below are some examples of occupational illnesses.

Respiratory Illnesses

Asthma (most common)
Mesothelioma
Pneumonia
Tuberculosis
Silicosis
Pharyngitis
Chronic obstructive pulmonary disease (COPD)

Carpal Tunnel

A condition that often occurs in workers who complete repeated tasks using their wrists; such as writing or typing. Carpal tunnel is one of the most-common office injuries and can often return after treatment.

Skin Disease

Consistently exposing your skin to the sun while working can cause serious damage and disease. Construction workers and lifeguards are just two of many occupations that can do this. Working with chemicals in manufacturing plants or cleaners expose your skin to harmful chemicals that can lead to some of the following:

Eczema
Skin cancer
Skin infections
Contact dermatitis
Rashes
Ulcers
Skin inflammation
Burns

Hearing Loss

Jobs that involve heavy and loud machinery can lead to small or even large amounts of hearing loss over time. Farming equipment, construction, airports and even music venues.

Overexertion

This doesn’t only apply to heat illnesses. Overexertion is one of the most common workplace illnesses and can include the following:

Hernias
Strains
Sprains
Joint injuries
Shoulder and back injuries
Death

What to do next?

Workplace injury or illness can occur over time, but can also occur without notice. If you or a family member suffer a workplace illness it is very important that you report the situation to your employer. Maximizing your benefits from your employer is imperative to your recovery should the illness occur at work.

Maximize Benefits

Raymond J. Navarro has over 25 years of California workers compensation law experience. Located in San Diego, contact Raymond for a free consultation.

Category Archives: Workers Compensation