What Does the State of California Consider as Workers’ Compensation Injuries?

Any injury that you suffered after an occurrence while on the job, which then gave rise to, or created the following conditions, is categorized as a work-related injury. Suffering an injury while at work might lead to; reduced productivity, want for medical care, unconsciousness or even worse, death. The extent of the damage that you suffered is rated by the percentage of your body parts that lost their functions.

Under the state of California workers' compensation laws, workers’ compensation injuries are the job-related injuries that meet the requirements for compensation as per section 4 of the labor relations article in the California constitution. The constitution also mandates that every employer in California hold workers’ compensation insurance. Failure to do so will have the employer facing civil and criminal penalties.

The California labor code 3208.1, states that job-related injuries may be classified either as cumulative or specific. Specific injuries are injuries that you sustain after an incident at work and necessitate immediate medical attention. Cumulative injuries, however, are used to refer to damages that result from recurring physical or psychologically traumatic activities. These injuries usually last for an extended period and increase the need for medical attention or risk of disability. They rarely exhibit specific symptoms and can only be diagnosed by a professional doctor.

Some of the definite injuries that are entitled to workers’ compensation include cuts, bruises, fractures, inflammation, sprains, and strains. Neck, back, shoulder and knee injuries are covered as well. You are also eligible for compensation if you suffer wrist, hand, elbow, heart, psychiatric and gastronomical injuries.

Cumulative injuries may also be known as cumulative trauma. Such damages eligible for workers’ compensation in California include disc herniation in the neck and back, breathing issues as well as heart disease.

If you are injured while on the job, you are entitled to workers’ benefits but only if your injury was justified. These benefits include; medical care for your injury, provisional disability benefits, supplemental job displacement benefits in some instances, and long-term disability benefits. If your injury brings about death, your better half and children are entitled to death benefits. Below is a detailed breakdown of these benefits.

1. Medical Treatment

   The workers’ compensation benefits will usually cover the entire costs of treating your work-related injury and the rehabilitation cost in some cases. Benefits include hospital costs, dentist visits and any surgical procedure meant to relieve you of your injury. You are obligated to choose your preferred doctor, working either within or from out of state. The workers’ compensation, however, only covers reasonable treatments in its benefits.

   If your claim is turned down, you have the option of getting medical attention on a lien rationale. A lien means that your health care provider will treat you for free and will charge your insurer instead. If considering traveling to a different state for treatment, ensure that you fill out a medical mileage expenditure document to reimburse you for any expenses incurred when traveling from and to your health care provider.

2. Temporary Disability Benefits

   In case you are incapable of performing your job efficiently, you may claim provisional disability benefits. These benefits usually total to two-thirds of what you earn every week and provide a maximum of one hundred and four (104) weeks. Temporary Disability Benefits is under the California labor code 4656. The total amount that you are eligible for is typically determined by the kind of injury sustained and your rank at work.

   In the state of California, the Employment Development Department (EDD) makes it possible for employees to access the State Disability Insurance (SDI) benefits for injuries that are not related to your work. It is important to note that your insurance provider pays temporary disability benefits. If the workers’ compensation claim is turned down, you can register to receive SDI benefits. If your claim for workers’ compensation benefits is approved at a later date, the SDI reimbursements that you received are deemed as the disability benefits for your job-related injury.

3. Permanent Disability Benefits

   If, as an employee, you happen to suffer a job-related injury that ends up permanently changing your medical state, you are eligible to receive compensation in the form of money. If your doctor determines that your medical condition cannot improve any further, they will assess the permanent disability payments you are entitled to receive. In those calculations, the doctor considers factors such as; your kind of job, age, changes in your subsequent earning potential and the specific injury.

4. Supplemental Job Displacement Benefits

   If you sustain a work-related injury which results in your inability to perform your regular or even customized job, these are the benefits that you are entitled to receive. These benefits are according to the California Labor Code 4658.7. The reimbursement typically provide a six-thousand-dollar ($6,000) receipt that is meant to cover the cost of your workplace training program. You could use this money to support yourself as you look for a new job.

5. Death Benefits

   As per the California Labor Code 4702, death benefits are only applicable to injuries resulting in the death of a worker. Members of your family are eligible to receive a maximum amount of three hundred and twenty dollars ($320,000) as death benefits if you pass away as a result of your work-related injury. Your family is also entitled to a maximum of ten thousand dollars ($10,000) to cater for your funeral expenses.

If you suffer an injury or illness while at work and it makes you incapable of performing your duties efficiently, you should consider filing a workers’ compensation claim. It is important that your employer has specified workers’ compensation forms and notices in both English and Spanish. These forms will detail your rights as an employee, and the documents that you are supposed to attach when filing your compensation claim. The following are the three steps to filing a California Workers’ compensation claim;

1. Inform your employer of the injury

   The first step you should take after suffering an injury at work is to seek fast medical attention. In the case of an emergency, getting medical treatment at your most convenient health facility is allowed. If, however, your employer possesses workers’ compensation coverage, you can see the doctor specified. It is of utmost importance that you let the doctor treating you know that your illness or injury is work-related.

   At your earliest convenience, you need to inform your employer regarding your illness or injury. Failure to do so might result in the loss of your rights to claiming the workers’ compensation benefits. You are usually given thirty (30) days from the date of your injury to issue a written notice to your boss. There are some cases where there will be an exemption, such as; if your employer was aware of your injury or illness. Furthermore, delay in notifying your employer could result in delayed benefits as well.

2. Filing the actual workers’ compensation claim

   After reporting your injury to your employer, they are obligated to issue you with a workers’ compensation claim form, also known as Form DWC-1 within one (1) working day. In addition to this, they will also provide you with documents detailing your rights and probable entitlement for benefits. If your employer has no copies of this form, you have the option of downloading and printing one from the California Workers’ Compensation website forms page.

   Make sure that you adhere to the given rules when filling out your part of the document as directed. You will be required to write down every injured part of your body. After completion, you are then to either deliver the form to your employer personally or mail it using the U.S Postal Services. Your employer is then supposed to fill out their part of the document and send the completed form to the insurance provider and issue you with a copy for yourself.

   After submitting the claim form, your boss’s insurance agency is mandated to pay for the treatment of your injury. Payment is processed as they proceed to probe the validity of your claim. Until the insurance company reaches a verdict, they are obligated to pay a maximum of ten thousand dollars ($10,000) for your hospital bills. If they do not reach an agreement or deny your claim within ninety (90) days from the date you submitted the claim forms, your claim is considered approved. If your injury causes you to miss out on work, the insurance company must start paying you temporary disability benefits in the first two (2) weeks after learning of your injury. Failure to make the payments or issue a response within the stipulated timeframe will lead to a penalty. The penalty is usually 10% of the total amount of temporary disability benefits you are to receive.

3. Filing a request for adjudication of a claim

   Your boss’s insurance agency might pay for the treatment of your illness, injury and temporary disability payments, but that does not mark the end of the settlement. If you, however, suffered minor injuries, made a quick and full recovery and agreed with the insurance provider regarding your treatment as well as the number of days you need to take away from work, you do not have to worry. If on the other hand, your medical condition changes for the worse, it may become virtually impossible to resolve the matter with your employer.

   It is thus advisable that you file an adjudication of claim with the Workers’ Compensation Appeals Board (WCAB) which will enable you to open a case in the event of future disputes with your employer. Typically, the application of the adjudication of claim must be filed within twelve (12) months after;

   • The day of your injury,

   • The day when your boss provided medical payments last, and;

   • The last day you receive any temporary disability benefits.

   Some employers or their insurance providers will advance the remittance for medical expenses while aware that the treatment might link to a possible workers’ compilation claim. In such an instance, a worker is expected to file their application within five (5) years of their injury. If the insurance provider, however, issues notice on denial of the claim, then a worker is expected to file their application within one (1) year.

   If you are seeking death benefits after a relative, you depended on, succumbed to work-related injuries, the state of California grants you up to one (1) year from the day of death to put in the application for adjudication claim.

After sustaining injuries at your place of work, workers’ compensation guidelines aid in your appropriate compensation. This policy is, however, only applicable if you sustained the injuries while on the job or were caused by your responsibilities at work. The benefits provided by the workers’ compensation claim are the most basic, and for this reason, all you need to do is provide the relevant evidence that you sustained the injuries while on the job. Under the California Constitution, a worker who is injured while working is entitled to compensation.

Not every employee who seeks compensation is guaranteed to receive it. Your claim may be rejected if you; were intoxicated, intentionally inflicted harm on yourself, started a fight deliberately, were on your break, perpetrated a felony, or were commuting to or from work, or voluntarily engaged in a work activity.

Independent Contractors

In the state of California, independent contractors are described as persons who perform a given task for a particular amount of money intending to achieve specific results. Employees, on the other hand, are termed as individuals who work under an oral or written contract of an employer. As opposed to employees, independent contractors are responsible for the safety of their work environment. With that said, the California workers’ compensation does not provide reimbursement for independent contractors.

Under the California labor code, every employer is obligated to provide workers’ compensation insurance for their employees. The law further demands that part of each employee’s social security taxes and Medicare be paid for by the employer. Some employers, in an attempt to avoid paying workers’ compensation benefits, may classify some of their workers as independent contractors. If this happens to you, you could file a lawsuit against your employer through your lawyer for wrongly categorizing you and denying your reimbursement for work-related injuries.

Public Workers

Individuals who work in law enforcement or firefighting sectors are the ones referred to as public employees in the state of California. The California Labor Codes 4850 through 4856 explain regular benefits, special benefits as well as other advantages that these employees receive. If a public employee gets injured while on the job, and the injury results in a temporary leave, they are entitled to their full salaries for an entire year. If a work-related injury caused a public employee to retire early, they get to enjoy exclusive retirement benefits.

Public employees in California have an advantage in the sense that they do not need to prove their injuries or illnesses are work-related and will still receive the benefits. If a public employee succumbs to work-related injuries, their spouse and children aged twenty-two (22) and younger are entitled to a portion of their salary. Also, all public employees are eligible for government health insurance payments.

Undocumented Employees

The California Labor Code recognizes anyone living and working in the country illegally as an undocumented employee. These employees are, however, covered and eligible for workers’ compensation benefits in case they are injured on the job. Still, knowingly employing undocumented employees could have an employer facing multiple charges.

If you happen to be an undocumented worker in California, filing false employment documents is illegal. However, it will not be considered as workers’ compensation fraud. Getting yourself a competent attorney to argue in your defense in court might get you temporary disability benefits.

What should I do if I was fired from my job before filing my claim?

If this happens to be your case, you will be expected to present medical records exhibiting evidence of the injury you sustained before the termination of your employment. Additionally, you will also need to prove that you informed your employer of your injury before they fired you. The need for proof applies to the case of a cumulative injury as well. Your claim could still be valid even if you filed it after getting injured on the job then receiving the notice on your job termination.

I got hurt on the job, and my employer is not insured, what should I do?

According to the California Labor Code, the failure of an employer to provide workers’ compensation coverage to their employees is a misdemeanor crime. The penalties include legal fees amounting to ten thousand dollars ($10,000), a twelve (12) month jail term in the county jail, or both. The penalty can amount to a maximum of one hundred thousand dollars ($100,000) in the case of uninsured employers operating illegally.

If you happen to suffer a work-related injury and your employer does not possess insurance cover, they are obligated to cater to your hospital bills related to the injury you sustained while working for them. In order to receive workers’ compensation benefits, your employer needs to be appropriately insured and operating within the law.

How long will the treatment of my work-related injury last?

You are entitled to receiving treatment for as long as it is needed to get better. There, however, are a couple of procedures that the California law limits, and require substantial evidence before being administered.

In the state of California, the Medical Treatment Utilization Schedule (MTUS) outlines the treatment programs that have over the years been proven scientifically to heal or soothe work-related illnesses and injuries. This schedule also directs on the frequency with which each treatment is administered and the specific injuries treated.

As an employee, having a workers’ compensation coverage is one of the most valuable assets your job could offer. However, the various guidelines in place can complicate the entire matter to an ordinary person. Additionally, nursing your job-related injury and getting appropriate treatment will be your top priority as opposed to meeting up with officials when claiming your rightful compensation. It is only right that you have legal backing to help you out when it comes to dealing with insurance companies or even a stubborn employer. At Workers Compensation Attorney in Orange County, we work closely with our clients to help relieve the burden that comes with filling out mountains of paperwork and following up on it as well. Call us today at 562-485-9694, for a free consultation regarding all your options and the best possible solution.