California Workers' Comp: How To Take Charge When You're Injured On The Job


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Orange County Register
"A great hands-on guide for dealing with workers' compensation cases."
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Product Details

  • ISBN-13: 9781413311969
  • Publisher: NOLO
  • Publication date: 6/5/2010
  • Edition description: Eighth Edition
  • Edition number: 8
  • Pages: 597
  • Product dimensions: 11.14 (w) x 11.28 (h) x 1.03 (d)

Meet the Author

Attorney Christopher A. Ball is the author of California Workers' Comp: How to Take Charge When You Are Injured on the Job, now in its fifth edition. Since 1991, Mr. Ball has practiced workers' compensation law exclusively. He is certified as a Worker's Compensation Specialist with the State Bar of California. Mr. Ball received his bachelor's degree in Business Administration from Long Beach State in 1972 and graduated law school from Western State School of Law in 1975.
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Read an Excerpt


If you've been injured on the job, your workers' compensation claim will stumble and saunter its way through the workers' compensation system. It will seem that all you do is wait for something to happen. When you request medical treatment, you may wait weeks for a response. You may wait for a doctor's appointment, then wait for the medical report. And if you file for a hearing before the Workers' Compensation Appeals Board, you may wait months for your hearing date.

And so it will go. At every turn, it is likely to take months before anything is accomplished. Unfortunately, it probably won't make you feel much better to realize you are not alone. An average workers' compensation case takes two to three years to be resolved. And many cases take much, much longer.

It probably won't come as a surprise that the workers' compensation system is bureaucratic: Lots of forms, reports, and other documents are shuffled through what sometimes seems like an endless maze. Above all, the workers' compensation system is confusing. It's fraught with rules and regulations-and it sorely lacks understandable information for the injured worker.

This chapter helps take the mystery out of the workers' compensation system by clearly outlining the steps involved in a "typical" workers' compensation case. Inevitably, there will be some variations depending on your particular situation and whether or not you're represented by an attorney. But the basic steps are usually similar in all workers' compensation cases.

Death Claims. If you were totally or partially dependent upon someone who died due to an industrial injury, you may have a workers' compensation claimfor death benefits. Skip ahead to Chapter 15.
Step 1. Notify Your Employer of the Injury

If you sustain a work injury, notify your supervisor or boss of the injury at your first opportunity. If your injury developed over a period of time, as with a repetitive stress, or cumulative trauma, injury, notify your employer as soon as you have symptoms and realize you've been injured as a result of your job.

Although you may initially tell your supervisor orally of the injury, it is important that you also give your employer written notice within 30 days of the injury. This will prevent any misunderstanding about whether or not you reported the injury and will protect your right to workers' compensation benefits.

If you have a union representative, contact that person right away; you may need help obtaining additional benefits that are secured by a union contract. (Your union representative may be instrumental in protecting your legal rights should your employer attempt to terminate you because you can't return to work for a while. Also, some employers may have salary continuation agreements for union members injured at work.)

Make certain that you complete any required inhouse accident reports. Also, review any accident reports prepared by your supervisor or employer for accuracy, and obtain a copy for your records. If you disagree with the report, write your employer a letter explaining your position. (Chapter 5 takes you through all the rules and procedures involved with reporting your injury and filing a claim.)
Step 2. Get Medical Treatment If Needed

It is important to promptly seek medical treatment if needed. Not only will prompt medical treatment protect your health, but it will establish a medical record of your work injury.

If you gave your employer the name of your own doctor before your injury ("predesignated your treating physician," in workers' compensation jargon), you may go to that doctor under certain conditions (see Chapter 9, Section B1).

If not, the employer usually has the right to send you to a doctor the employer chooses, which often turns out to be the "company doctor" or "medical provider network"-a doctor or medical clinic that the employer sends its injured workers to on a regular basis.

If you have a medical emergency that requires immediate medical attention, you may go to the nearest emergency room for treatment. But after your emergency medical condition has been stabilized, you must continue follow-up medical treatment with the physician selected by your employer, unless you designated a doctor in advance. (See Chapter 9 for a detailed discussion of medical care.)
Step 3. Paying for Medical Treatment If Employer Denies Your Claim

If you report what you believe to be a work-related injury to your supervisor, your employer will most likely agree to accept responsibility. Authorization for medical treatment may be given orally or in writing to the doctor by your employer or its workers' compensation insurance company.

Within one day of your filing the DWC-1 claim form (see Step 6), your employer or its insurance company is required to authorize and agree to pay for your medical treatment until your employer or the insurance company either accepts or denies your claim. The insurance company is liable only for $10,000 in medical treatment until it accepts or denies your claim. (LC 5402(c).)

If your claim is eventually accepted, the employer or insurance company will continue to pay for your treatment. If your claim is denied, the employer or insurance company will not authorize further medical treatment. This may work to your advantage (assuming that you have a valid claim): By denying your claim, your employer gives up its right to control your medical treatment. If your claim is denied, you are not bound to go to the company doctor for treatment and may be treated by a doctor of your choice. (See Chapter 9, Section B, for details.)

If your employer denies your claim right away, seek prompt treatment by relying on private health insurance, if you have it. If you do not have medical insurance and your employer refuses to pay, you have three choices. You may pay for treatment yourself and seek reimbursement later. You may find a doctor to treat you on a "lien basis," where the doctor waits for payment until your workers' compensation case is settled. (See Chapter 9, Section B2b, for more on liens.) Or you may get a judge to order your employer's insurance company to pay for treatment. An information and assistance officer can help with this procedure. (See Step 10, below.)

Always apply for state disability insurance (SDI). Whenever you have an injury that results in your inability to work, always-and immediately-apply for SDI from the Employment Development Department (EDD). That way, you'll receive income from this source in case of a delay or denial of your claim. When your workers' compensation benefits begin, it's important that you promptly inform the EDD, so it will discontinue SDI payments. (You may also be entitled to retroactive temporary disability benefits from the insurance company if you received less in SDI payments than you would have from the workers' compensation insurance company.) We cover SDI in Chapter 17, Section A.
Step 4. Tell the Doctor About Your Injuries

The doctor's first report will often be relied upon by the insurance company to determine the extent of your injuries and whether they resulted from your employment. Tell the doctor that you injured yourself at work (if that's true) and how the injury occurred (if you know). In addition to giving the doctor a complete history of your medical problems (if asked), be sure to cover all your symptoms and sources of pain. For instance, even if most of your pain is in your back, if your arm hurts even a little, tell the doctor! You'll find detailed information on dealing with doctors in Chapter 9.
Step 5. The Doctor Decides If You Need Time Off

The first doctor you see will probably determine whether or not you need some time off from work to recover from the effects of your injury. Depending on the doctor's findings, you will receive one of the following:

* off-work order
* limited duties work order (also called a light duty work order or modified work order), or
* return to work order-that is, you can return to work with no restrictions.

Especially if you are given an off-work order, it's essential that you keep your employer advised of your medical status. If you neglect to do so, you may be fired for failing to report to work without a valid excuse. If, however, you keep your employer informed, you cannot legally be fired for injuring yourself, filing a workers' compensation claim, and obeying doctor's orders.
Injured Workers Who Are Fired

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Table of Contents

Part I: All About Workers' Compensation
1. Introduction to Workers' Comp
A. What Is Workers' Compensation?
B. What an Injured Worker Is Entitled To
C. Where to Get Additional Information and Help
D. How to Use This Book
E. What This Book Does Not Cover

2. Overview of a Workers' Compensation Claim
Step 1. Notify Your Employer of the Injury
Step 2. Get Medical Treatment If Needed
Step 3. Paying for Medical Treatment If Employer Denies Your Claim
Step 4. Tell the Doctor About Your Injuries
Step 5. The Doctor Decides If You Need Time Off
Step 6. Complete Workers' Compensation Claim Form and Application for
Adjudication of Claim Form
Step 7. Secure Control of Your Medical Care
Step 8. You May Receive Temporary Disability Benefits
Step 9. Handling a Denial of Your Claim or Benefits
Step 10. Taking Problems to the Appeals Board
Step 11. After You Are Determined to Be Permanent and Stationary (P&S)
Step 12. You May Recover Completely and Return to Work
Step 13. You May Be Entitled to Vocational Retraining
Step 14. You May Be Permanently Disabled
Step 15. Go to Trial If There Is No Settlement
Step 16. Judgment Is Paid or the Matter Is Appealed

3. Is Your Injury Covered by Workers' Compensation?
A. Is Your Job Covered by Workers' Compensation?
B. Do You Have a Compensable Injury?
C. Injuries Not Covered by Workers' Compensation

4. Cumulative Trauma Disorders
A. What Is a CTD?
B. Becoming Aware of Your Injury
C. Diagnosis and Treatment
D. Recovery and Permanent Injuries
E. Returning to the Workforce
F. Further Medical Treatment

Part II: Protecting Your Rights
5. What to Do If You're Injured
A. Request Medical Treatment
B. Report the Injury Within 30 Days
C. File Your Workers' Compensation Claim
D. The Insurance Company's Answer
E. Take Steps to Protect Your Rights

6. Keep Good Records to Protect Your Claim
A. Set Up a Good Record-Keeping System
B. Read and Understand What You Receive in the Mail
C. Gather Important Records Pertaining to Your Claim
D. Request Copies of Documents and Evidence
E. Keep Your Address Current

7. The Insurance Company's Role
A. Self-Insured Employers
B. The Insurance Company's Responsibilities
C. Your Responsibilities as an Injured Worker
D. Who's Who in the Insurance Company
E. How to Deal With the Insurance Company
F. Tactics Insurance Companies Use to Deny or Minimize Claims
G. Settling Your Case

8. Dealing With Your Employer
A. Self-Insured Employers
B. The Employer/Insurance Company Relationship
C. The Employer's Responsibilities
D. If You're Out of Work Due to the Injury
E. Bankruptcy or Other Employer Financial Problems

9. Taking Charge of Your Medical Case
A. What the Treating Doctor Does
B. Choose Your Treating Doctor (Get Medical Control in Your Case)
C. Be Sure You Receive Excellent Medical Care
D. Changing Treating Doctors
E. When Your Condition Becomes Permanent and Stationary (P&S) or Has Reached Maximal Medical Improvement (MMI)

10. Medical-Legal Evaluations
A. Rules for Medical-Legal Evaluations
B. Compensability of Injury (Labor Code § 4060)
C. Nature and Extent of Permanent Disability or Need for Future Medical Treatment (Labor Code § 4061)
D. Other Issues to Be Resolved by Medical-Legal Evaluations (Labor Code § 4062)
E. Picking a Qualified Medical Evaluator (QME)

Part III: Workers' Compensation Benefits
11. Medical Benefits
A. Limitations on Medical Treatment
B. Payment for Current Medical Treatment and Evaluations
C. Future Medical Care Costs
D. Penalties

12. Temporary Disability Benefits
A. Qualifying for Temporary Disability
B. Amount of Temporary Disability Payments
C. How Payments Are Made

13. Permanent Disability (and Life Pension)
A. How Permanent Disability Payments Compensate You
B. Kinds of Permanent Disability Awards
C. Establishing Your Permanent Disability Status
D. How Permanent Disability Benefits Are Paid
E. Amount of Permanent Partial Disability Benefits
F. Life Pension Benefits
G. Permanent Total Disability Benefits

14. Vocational Rehabilitation/Supplemental Job Displacement Benefit
A. Vocational Retraining and Offers of Alternative or Modified Work
B. What Is Vocational Rehabilitation?
C. Six Steps in a Vocational Rehabilitation Plan
D. Eligibility for Vocational Rehabilitation (QIW Status)
E. How to Start Vocational Rehabilitation
F. Delays and Failure to Provide Rehabilitation Services
G. Preparing a Vocational Rehabilitation Plan
H. Completing a Vocational Rehabilitation Plan
I. Where to Get Help With Vocational Rehabilitation
J. Supplemental Job Displacement Benefit

15. Death Benefits
A. Who May Receive Death Benefits
B. Death Benefit Amount
C. Additional Payments for Dependent Minor Children
D. Burial Expense for Deceased Worker
E. Unpaid Temporary or Permanent Disability Payments
F. How Death Benefits Are Distributed

16. Extraordinary Workers' Compensation Benefits and Remedies
A. Subsequent Injuries Benefits Trust Fund
B. The Uninsured Employers Benefits Trust Fund
C. Discrimination Benefits (Labor Code § 132(a))
D. Employer's Serious and Willful Misconduct

17. Benefits and Remedies Outside the Workers' Compensation System
A. State Disability (SDI)
B. Social Security Benefits
C. Claims or Lawsuits for Personal Injuries
D. Claims or Lawsuits Based on Discrimination

Part IV: Settling Your Case
18. Rating Your Permanent Disability
A. Obtaining a Rating
B. What Is Involved in the Rating Process?
C. How to Rate a Disability Using the New Rating Schedule
D. Other Considerations in Rating a Permanent Disability
E. How to Rate a Disability Using the Old Rating Schedule
F. How to Use the Pre-1997 Rating Manual

19. Figure Out a Starting Settlement Amount
A. What You May Receive in a Settlement
B. Two Kinds of Settlements
C. Determine the Value of Your Claim Using the Settlement Worksheet
D. What to Do Next

20. Negotiating a Settlement
A. Deciding Whether to Negotiate Your Own Settlement
B. The Concept of Compromising
C. How to Negotiate a Settlement
D. Review and Sign Settlement Documents
E. Attend an Adequacy Hearing

Part V: The Workers' Compensation Appeals Board
21. Preparing Your Case
A. Identify Possible Issues in Dispute
B. How to Prove (or Disprove) Disputed Issues
C. Depositions
D. Subpoenaing Witnesses and Documents
E. Preparing for a Pre-Trial Hearing
F. Preparing for a Trial

22. Arranging for a Hearing or Trial
A. Kinds of Hearings
B. Trial on Preliminary Issues
C. Trial on Entire Case (the Case-in-Chief)
D. File a Declaration of Readiness to Proceed to Set Your Case for Hearing
E. Copy, Serve, and File Documents
F. Receiving Notice of a Hearing

23. How to File and Serve Documents
A. What Is Service of Documents?
B. How to Serve Documents by Mail
C. How to Serve Documents Personally
D. How to Serve Documents by Fax
E. How to File Documents With the Workers' Compensation Appeals Board

24. Going to a Hearing or Trial
A. Finding Your Way Around the Appeals Board
B. Pre-Trial Conferences
C. Trial
D. Findings and Award

25. Appealing a Workers' Compensation Decision
A. The Three-Step Appeal Process
B. Petition for Reconsideration
C. Writ of Review With the Appellate Court
D. Writ of Appeal to the California Supreme Court

Part VI: Beyond This Book
26. Lawyers and Other Sources of Assistance
A. Information and Assistance Officers
B. Hiring a Lawyer

27. Legal Research
A. Find a Law Library
B. The Basics of Legal Research

28. Case Law Review

A1: Workers' Compensation Offices
A2: Temporary Disability Benefits Compensation Chart
A3: Permanent Disability Indemnity Chart
A4: Maximum Life Pension Weekly Payments for Injuries Between 7/1/96 and
A5: Workers' Compensation Forms
Forms to File With the Division of Workers' Compensation
DWC-1: Workers' Compensation Claim Form
Application for Adjudication of Claim
Declaration in Compliance With Labor Code Section 4906(G)
Declaration of Readiness to Proceed
Declaration of Readiness to Proceed to Expedited Hearing Trial
Pre-Trial Conference Statement
Notice of Change of Address
Proof of Service
Cover Letter to Workers' Compensation Appeals Board
Record-Keeping Forms and Worksheets
Record of Income and Benefits Received
Record of Time Off Work
Record of Medical Expenses and Request for Reimbursement
Record of Mileage Transportation and Request for Reimbursement
Settlement Worksheets and Documents
Settlement Worksheet: Value of Workers' Compensation Claim
Stipulations with Request for Award
Compromise and Release
Forms to File With Your Employer
Employee's Designation of Personal Physician
Letter to Employer Requesting Copies of Documents and Evidence
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