FAQs
If an employee is injured on the job, whether it is the fault of the employee or not, the worker may be entitled to worker’s compensation benefits.
An injury may be something specific; the worker lifts something and injures his back. It can be something which occurred over a period; the worker bends and lifts all day long and his back pain has gotten worse over time. The employee has been exposed to chemicals and now has trouble breathing, has had an allergic reaction, or has developed another internal disease because of the exposure. Perhaps the worker has had a stroke or a heart attack, or is suffering from depression or anxiety. This too may be the result of an industrial injury.
If a person is injured on the job, the employer may agree that the injury occurred, or the employer many deny the injury in which case the matter will go before the Workers’ Compensation Appeals Board.
If it is determined that the applicant had an on the job injury (an industrial injury), the worker may be entitled to the following benefits:
After suffering an injury at work, your first action should be to report the injury either to your supervisor, the human resources department or to someone in authority at your employer. Within 24 hours of reporting the injury to your employer, California law requires your employer to give you a Claim Form that needs to be filled out and returned to your employer in order to start an investigation to determine if you had the injury on the job. Once your Claim Form is submitted, your employer has 90 days in which to investigate your claim and either admit or deny that your injury occurred at work.
The purpose of the investigation is to determine whether there is sufficient evidence in the eyes of the insurance company to confirm that you suffered and injury at work. Oftentimes that investigation is very limited and results in the insurance company denying your claim. If your claim has been denied, hiring an attorney to represent your interests is almost always the best choice, if not only option to prove that the insurance company was wrong and that you should be entitled to benefits.
If your workers’ compensation case has been denied, you should have received a written notice from the insurance company stating the basis for the Denial of your case. There is no more critical time to contact Turchin Law than this moment. An experienced attorney willing to fight for you can ensure that you get proper benefits while waiting to dispute your injury, during this waiting period. During the waiting period, your attorney can begin investigation to prepare the matter for trial, it that becomes necessary.
The insurance company/employer often uses the claimed failure to report a work injury as an excuse to Deny your case. There are a variety of reasons, however, why somebody does not report an injury as soon as it happens. Oftentimes the injured worker feels that he or she is going to get better and does not need to seek medical treatment. Other times, the injured worker fears the employer will discriminate against them or even fire him for reporting an injury.. Still other times, the employer will instruct the worker not to file a claim hoping that the injury will heal on its own. Sometimes, the worker does not even know that it was work that caused the injury such as injuries due to exposure to toxins or chemicals at work. Whatever the reason, having an experienced workers’ compensation attorney such as at Turchin Law arguing your case is an important part of the fight to prove to the Court that your injury was valid and benefits must be provided.
ONE OF THE MOST IMPORTANT THINGS TO REMEMBER IS THAT IF YOU DO NOT REPORT THE INJURY AND YOU WAIT TOO LONG, YOU MAY LOSE YOUR RIGHT TO PURSUE YOUR CASE, BECAUSE OF THE STATUTE OF LIMITATIONS.
If you report an injury to your employer and you are sent to a medical clinic, even though you do not feel physically able to return to work, the doctor may tell you that you should return to work. Sometimes, the doctor will send you back to work, but will say you have temporary restrictions, but the employer refuses to accommodate those restrictions. This is the time you really need to consult an attorney so that you get the benefits you are entitled to, including the opinion of another doctor.
Workers’ compensation benefits are not taxable.
If your employer provided a benefit to you prior to your injury, you have the right to be treated just as any other employee who had to miss time from work to be treated. For instance, if the policy of your employer is to continue paying medical premiums for 6 months after somebody is forced to leave work because of a disability, whether work related or not, then that same policy must apply to the person who is injured on the job. If you were required to pay any or all of the premium for your medical insurance prior to your injury, you would still be obligated to pay your share of the benefits owed unless the policy during a medical leave is specified.
As noted above there are many different types of injuries, some clearly industrial and others that are not so clear. If your own doctor tells you that your condition may be due to your work, then you need to determine this and at this point you probably need an attorney. If many of your co-workers have developed the same condition, it may be industrial. You will need a medical opinion.
Yes. You have the absolute right to control what doctor treats you for your work–related injury. But there are rules and restrictions, and again here, it is important to have an attorney familiar with workers’ compensation law.
In its most simple terms, a Medical Provider Network is a group of physicians throughout the State of California who have agreed to treat patients with regard to work-related injuries that are directed to them through the Network. Every self-insured employer or insurance company has the right to choose to be part of a certified MPN. The Network includes physicians who practice in all different types of medical specialties from orthopedics to neurology to gastroenterology to neurosurgery. So long as the insurance company has not denied your right to medical treatment by denying your claim, you will be required by law to either treat within the MPN or to pay for your own medical care outside of the MPN if you so choose. Because of our vast knowledge of the best physicians in California who belong to these MPN’s, at TURCHIN LAW we will help you choose the best doctor to treat your particular injuries.
It depends. As noted before, if you do not pursue your case in a timely way you may be later precluded from getting benefits. It is recommended that you get the opinion from TURCHIN LAW as soon as have a question or issue.
Your employer should provide you with the name of the insurance carrier, and according to law, it should be posted in plain view. If your employer refused to give you the information, consult TURCHIN LAW immediately.
A Claim Form is the initial step to the start of your workers’ compensation claim. The Claim Form, once completed by you and returned to your employer, officially begins your case moving forward. The Claim Form includes a section for you to complete identifying the date of your injury, where it occurred, how it occurred and the body parts you are claiming have been injured. The bottom section of the Claim Form is for your employer to complete and will identify the employer’s insurance carrier, the date your employer claims they were made aware of your injury and other basic information. From the date that the Claim Form is returned to the employer, it triggers a 90 day investigation period to either admit or deny your claim.
A State Panel Qualified Medical Evaluator (SPQME) is a physician who has applied to the Department of Industrial Relations to be placed on a list of doctors who evaluate cases to provide the Court with what is supposed to be an “independent” assessment of your claim. This person will not be a treater in your case, but will comment upon the treatment and the legitimacy of your claim. Once a dispute over any medical opinion arises, either you, the insurance company or both may object to the disputed issues and request that the State issue a panel of 3 SPQME physicians. The SPQME is chosen from a list of three physicians chosen randomly by the State of California. This is a critical part of your case and choosing the right physician can make a huge impact on your claim’s value and your right to benefits. Contact TURCHIN LAW immediately if you have been notified of your right to request a SPQME or if the process has already been initiated by the insurance company.
