The Law Offices of Dr. Peter M. Schaeffer

A Dedicated Workers’ Compensation Lawyer Attorney for Riverside and the State of California

If you have been hurt on the job in the State of California, you have the right to file a workers’ compensation claim. California law requires that every employer must carry workers’ compensation insurance, and employers who do not can be charged with a criminal offense.

The workers’ compensation system was originally established to serve as a kind of compromise between employers and employees. Before it was instituted, an employee’s only option for getting financial compensation in the wake of a workplace injury was to file a personal injury suit against their employer. The modern workers’ comp system guarantees cash benefits for workers to help address their medical bills and the cost of lost income in the event of a workplace accident, but at a price: employees covered by workers’ comp insurance usually cannot initiate legal action against their employers directly. The good news is an injured worker can file a workers’ comp claim regardless of what caused an accident; unlike in personal injury cases, most of the time employees can file claims even if they themselves were responsible for causing their injuries.

When an employee’s injuries are fairly minor, the workers’ comp system works quite well. However, when significant injuries are involved that require surgery or may prevent a worker from returning to their job for a long period of time, there can be financial incentives for employers and insurance carriers to find ways to reduce, delay, or deny legitimate claims for the sake of their bottom line. Under such circumstances, it’s best for injured workers to consult a dedicated Riverside workers’ compensation lawyer about their situation and find out what they can do to protect their rights and their financial stability during the recovery process. Under the law, workers’ comp attorneys are entitled to only a small portion (about 15%) of the total amount of benefits they are owed, and this can be a real bargain for employees who can’t get financial justice on their own after a serious workplace accident.

There are several different kinds of insurance benefits available to injured workers. Schedule a free consultation with a knowledgeable workers’ compensation lawyer to learn more about the different kinds of benefits that you may qualify for and how to ensure that your rights and your interests are protected when it comes to your claim.

Temporary Disability and Temporary Partial Disability

The most basic kind of benefits available to injured workers is Temporary Disability (TD). Temporary disability payments are generally paid weekly until the worker is able to return to their job. Workers can apply for TD if they:

(1) Were hospitalized or missed three or more days of work because of their injuries AND

(2) Have not been offered another job to do in the meantime by their employer.

The law stipulates that in 2014 an employee’s temporary disability payments are equal to two-thirds of their gross earnings up to a maximum of $1064. This amount increases slightly each year. Workers don’t pay taxes, union dues, or Social Security payments on their TD. Most of the time you will receive your first TD payment about two weeks after your claim is accepted.

It’s important to understand that in some cases, employees who are able to do some kind of work while in recovery and are offered such a job by their employer can still apply for Temporary Partial Disability (TPD) benefits if the wages they receive during this time are below a certain amount established by state law.

Calculating the amount of TD a worker can get very complicated when other variables are involved. If you had a second job at the time of your injury, had a seasonal job, had wages that rose or fell regularly, had other income besides wages (such as tips or bonuses), were scheduled for a wage increase, or received TD benefits for a period of over two years following the date of the injury, you should speak with a skilled workers’ compensation attorney about how your TD benefits should be calculated.

In the event that your employer’s insurance company is unwilling to pay TD benefits, you may be able to obtain State Disability Insurance payments from the Employment Development Department. In order to do this, you need to inform the person handling your case at the EDD that your request for workers’ comp benefits was denied. Workers are prohibited by law from receiving benefits from both their employers’ insurance carrier and from the EDD.

Permanent Disability

Permanent Disability (PD) payments are available to workers whose injuries have left them with residual disabilities. If your doctor is telling you that you will always be limited in the kind of work you can perform or that you will never fully recover from your injuries, you should ask them to fill out what is called a Permanent and Stationary (or P&S) report. The P&S report simply states that your condition is not getting better or worse because you have reached Maximum Medical Improvement (or MMI). Your P&S report will also list any work restrictions you are subject to, your specific medical problems (including how much pain you have and what range of motion you have in the parts of your body that have been injured), what kind of medical care you may require in the future, whether or not you are able to go back to your previous job, and your physician’s rough estimate of to what degree your disability was caused by your job as opposed to other factors.

Once your physician has written your P&S report, you should share it with your workers’ compensation attorney and the claims examiner handling your case. Your attorney can then help you reevaluate your claim in light of the P&S report and assist you in applying for Permanent Disability if it is feasible.

Medical Consultations

At some point after your workplace injury, your physician will either decide that you are able to go back to work or will write a P&S report as noted above. At this point, your workers’ comp lawyer can make arrangements for you to be seen by a medical professional who specializes in the kind of injuries you suffered. During this consultation, the examiner will evaluate your physical and medical condition. It is very likely that your employer’s insurance carrier will also request that you be evaluated by a medical examiner of their choosing. You need to make sure that you attend all these consultations in order to prevent jeopardizing any future or present workers’ comp benefits.

The physicians concerned will then issue medical reports that document the extent and nature of your disability, whether you need further medical attention, and whether or not you can return to work. This process usually takes about four to six weeks. Once your workers’ comp lawyer receives your reports, they can review, evaluate, and rate them on your behalf, giving you a much better idea as to what your claim is worth and what kind of outcome you should expect. Rating a report involves assigning a percentage of disability based on the information in it. The guidelines for rating medical reports in workers’ comp cases are uniform throughout the State of California. Workers’ comp benefits are based on this rating rather than on your pain and suffering, your loss of income, or the extent of the medical treatment you received. This is why the medical consultation is the most important part of the entire claims process.

The Workers’ Compensation Appeals Board

All industrial injuries that involve your employer and cannot be resolved through negotiation with an insurance carrier alone are handled by the Workers’ Compensation Appeals Board. The WCAB is the trial court that oversees administrative law proceedings related to workers comp claims. Unlike in other courts, there is no jury – if your case goes to trial, all decisions will be made by a workers’ compensation judge. Sometimes there workplace injuries that involve third party lawsuits, such as when equipment manufacturers or other entities are implicated in an accident. Under such circumstances, you have recourse to the civil courts outside of and in addition to any claims you are filing through the workers’ compensation insurance system.

When addressing a new case, your workers’ compensation lawyer will initiate a formal claim with your employer’s insurance carrier or administrator. The WCAB cannot move forward on your claim until your attorney asks them for a hearing in order to resolve any issues that cannot be settled with the insurance carrier. We never settle cases without our clients’ permission and we keep them informed about both our own evaluations of their claims as well as any negotiations that are underway.