Common Workplace Injuries that Could Lead to Benefits
Workers can be injured in a number of ways on the job. All it takes is one split second, and their lives could be changed for months or years. Some employers do take steps to protect their employees from injuries, but when it comes to workers’ compensation, what the employer does or does not do generally makes no difference. When you are injured on the job, you have a right to benefits.
Here are some of the most common injuries and illnesses that Orange County workers’ compensation claimants experience on the job:
- Muscle and back strains
- Fall injuries
- Repetitive strain injuries
- Traumatic brain injuries
- Crashes and vehicle accidents
- Fires and explosions
- Crush injuries
While many work injuries happen as a result of accidents, there are other ways to qualify for benefits. Injuries could also mean conditions that you develop over time or illnesses you contract from your work environment. These could include:
- Carpal tunnel syndrome
- Inhaling toxic fumes
- Exposure to loud noises
- Being sickened with a virus
These types of injuries may require some additional proof since there was no single accident that could connect the injury to your job. Nonetheless, these are considered workplace injuries for the purpose of applying for benefits.
What to Do After Your Workplace Injury
California has very strict requirements that you must follow to be eligible for benefits. The process is extremely important, and not following it could cost you the benefits that you need.
The first requirement is notifying your employer of the injury. The law requires that you do this within 30 days of the date of the injury. You should notify your employer of the injury in writing. The second requirement is that you file a claim for benefits within one year of the injury. There is a California claims form that you should use to file for benefits.
You should also see a doctor to get medical care as soon as possible. This may not be your own physician, since after you have reported a workplace injury, the insurance company is in control of your medical care. They can direct you to see one of their doctors, and you will need to visit who they tell you. This will continue so long as you are receiving workers’ compensation benefits. If you are not on the same page about your medical treatment, you have a legal right to another opinion.
Filing Your Claim with the Insurance Company
Every California employer is legally required to carry workers’ compensation insurance. This means that there will be an insurance company involved with your claim. These companies are not known for being claimant-friendly, and instead, they try to find every excuse that they can to reject or reduce your claim. Be sure to avoid these common mistakes when filing your claim.
The insurance company will receive and review your workers’ compensation claim. According to California law, they have 90 days to review your application and respond, and the insurance company is obligated to give you a decision about your benefits within this timeframe. They must give you an explanation of their decision if they deny your claim.
What the Insurance Company Is Looking For
The main legal requirement for workers’ compensation benefits is that you have suffered a workplace or work-related injury. The insurance company will look for the following:
- Medical documentation that establishes that you have suffered an injury
- Whether you followed the process for applying for benefits
- That you reported your injury in time
- Whether your injury was work-related
- If you had any illegal substances in your system at the time of the accident
- Whether the medical records match the accident report
The insurance company may deny the claim for reasons related to the above factors. In the best-case scenario, they will quickly reply to your claim, approving it and letting you know of your benefits.
What You Can Receive in a Workers’ Compensation Claim
Injured workers in Orange County who have their workers’ compensation claim approved may receive the following:
- Medical care – Workers’ compensation must cover the costs of all treatments that are necessary to cure or relieve your injury. This includes surgeries, medications, rehabilitation, and hospitalizations.
- Temporary disability benefits – You are entitled to lost wages that you would have earned while working. In California, this works out to two-thirds of your average weekly wages.
- Permanent disability benefits – You can also receive benefits when you are not able to work again. There is a maximum rate of these benefits.
- Supplemental job displacement benefits – If you cannot return to work within 60 days after losing temporary disability, and your employer does not offer you alternative work, you can receive up to $6,000 for job training for a new position.
- Death benefits – Surviving spouses can receive a death benefit up to $320,000 after a fatal work accident. Minor children can also receive a weekly death benefit until the age of 18.
How Are My Benefits Calculated?
For medical benefits, you do not have to worry about the amount. The law is that all of your medical needs related to the injury are covered.
For disability benefits, the calculation is based on your average weekly wage, which is your gross pay before taxes and deductions. There may be some complexities in this calculation, including:
- You are paid based on your annual earnings. This factors in your usual workweek.
- If you have more than one job, you can be paid for all of your sources of income and not just the job at which you were hurt.
- The insurance company may decide that you could still work part-time. Then, they would only pay you for the wages that you missed by not being able to work.
Can My Claim Be Rejected?
Your claim can be entirely rejected by an insurance company. Since they are the ones paying the benefits, they will go over your claim with a fine-tooth comb looking for ways that they can save money. These companies are well-known for making things difficult for employees. Our Orange County workers compensation lawyers can help with rejected, delayed, and denied claims.
The insurance company could reject your claim for the following reasons, among others:
- The claim was not filed within the necessary timeframe.
- You did not properly notify your employer by the deadline.
- The injury was not work-related.
- You were not really injured.
- You did not properly cooperate with the insurance company.
What to Do When Your Claim Is Rejected
The insurance company does not get the final say when it rejects your claim, as you have the right to appeal the denial. However, you must act quickly because the law gives you a very tight deadline.
If you do not already have an Orange County workers’ compensation lawyer, this would be the time to hire one. Filing a strong appeal on your first attempt will give you a stronger record throughout the process. A persuasive appeal could quickly end the stress that you are feeling from not having money coming in while you are injured. The good news is that many cases that initially resulted in a denial will eventually be paid. Up to half of the people who eventually receive benefits initially had their claim denied.
While California offers a way for denied claimants to file a challenge, that is often not the best thing to do at first. Sometimes, the insurance company has denied a claim because of a misunderstanding or a missing piece of documentation. All they need is a reason to deny your application in good faith, and they will do it.
Your attorney’s first letter or phone call after the denial should be to the insurance company directly. They could enter into settlement discussions with the insurer or do what is necessary to correct a paperwork error. Many denials are resolved through discussions with the insurance company or a settlement agreement. Some claimants will not even need to go to the state or have a hearing.
Workers’ Compensation Hearings and Appeals
If you cannot resolve your claim with the insurance company, there are multiple steps to the appeal process:
- The first step is filing an appeal with the Worker’s Comp Appeals Board. An administrative judge would hear your disagreement with your denial of benefits and would decide whether the insurance company denied you in error. If you do not get the decision you are looking for from the judge, you could file a request for reconsideration or ask a seven-member WCAB panel to hear your case.
- You can file a writ of review with the state appellate court. They would review the file to see if the WCAB made a mistake. This is a review proceeding, and you cannot introduce any new evidence.
- Your last step in the appeals process is to the California Supreme Court, but they do not hear every case that is brought in front of them.
The appeals process is where you get your say if the insurance company will not listen to you. It is critical to present your case clearly and carefully. Our work accident attorneys are experienced advocates who know the state system well and could effectively represent you in an appeal.
Why You Need an Orange County Workers’ Compensation Lawyer
There are many reasons why you need a lawyer during the workers’ compensation phase. An attorney can help you with the application paperwork to give you a better chance of having your claim approved at first.
You would definitely need an attorney if your claim is denied. The state hearing boards have very large caseloads, and they do not have the time to listen closely to a claim that is not carefully presented in detail.
You may also have an issue with your compensation, either in terms of the amount or duration of your benefits. Claimants who are represented by a lawyer could make a better case as to why they deserve higher benefits or for a longer period of time.
Finally, you may have an issue with medical coverage while your benefits are running. While workers’ compensation is supposed to cover everything necessary for care and recovery from your injury, the insurance carrier could refuse to authorize certain coverage or treatments. You may need an attorney to appeal the denial.
Contact an Orange County Workers’ Compensation Lawyer
The attorneys at the Cabral Law Group fight for the rights of injured clients. We are here to help hurt workers who are not getting a fair deal from the insurance company. We know your legal rights and are committed to fighting for them. Our lawyers will provide you with both effective representation and the service you need to know that your concerns are being heard. Contact us online or call us today at (949) 751-1198 to schedule your free initial consultation.