If you have sustained injuries in a job-related accident or contracted an illness in the workplace, you need a skilled workers’ compensation lawyer who knows California’s claims process and how the law applies to your situation. An experienced attorney can fight for you if your claim is denied or you have experienced other difficulties during the claims process.

Contact the skilled Solana Beach workers’ compensation lawyers at Gomez Trial Attorneys for a free case evaluation, to discuss your workplace injuries or illness, and to strategize the best course of action for your situation. Our Solana beach personal injury lawyers are available today.

California Workers’ Compensation Benefits

The U. S. Bureau of Labor Statistics (BLS) estimates that more than 450,000 employees in California suffer workplace injuries or occupational illnesses every year. This results in thousands of injured workers who must work with job restrictions and thousands who cannot work at all.

Workers’ compensation is a federal requirement, but each state administers its own program. In California, the Division of Workers’ Compensation (DWC) is within the state’s Department of Industrial Relations.

Unless they choose not to self-insure, all employers with at least one employee are required to purchase workers’ compensation insurance. Even if your employer violates the law by failing to maintain adequate coverage, you are still eligible for benefits. California’s Uninsured Employers Benefits Trust Fund (UEBTF) pays benefits to those who suffer injuries or illnesses covered by workers’ compensation in the event their employers do not have the required coverage.

When you file a workers’ compensation claim after an occupational illness or work injury, you may be eligible for the following benefits: (1) medical treatment benefits (2) temporary or permanent disability benefits (3) supplemental job displacement benefits; and (4) death benefits.

Medical Treatment Benefits

If you file a workers’ compensation claim that is approved, the benefits will cover medically necessary treatment costs. Under California law, workers’ compensation pays for visits to the doctor, hospitalization, specialized treatment, lab testing, X-rays, medication, medical equipment, and travel costs to and from the hospital.

Temporary or Permanent Disability Benefits

Missing work for weeks or months, or never returning to work due to injury or illness, is a common outcome for those who file workers’ compensation claims. Employees who get their claims approved can receive disability payments for two-thirds of their average gross weekly wage, up to the maximum allowed by California law, which changes each year. In 2020, the maximum amount an injured or ill employee could receive for disability benefits is $1,299.43 per week.

The number of weeks that an employee receives disability payments depends on whether his or her disability is partial or total and whether or not the disability is temporary or permanent.

The categories that workers’ compensation will use to determine disability payments include:

• Temporary total disability, which refers to employees who can’t work presently, but eventually fully recover and return to work in their future.
• Temporary partial disability, whichrefers to employees who can’t perform all of their work duties or cannot work as much, but ultimately can return to full duty after recovery.
• Permanent total disability, whichrefers to employees who have catastrophic injuries and cannot return to their jobs or work in the future as a result of their injuries or illnesses.
• Permanent partial disability, whichrefers to employees who can return to work in some capacity, but suffer a permanent disability or condition that prohibits them from doing all of their previous job duties.

Supplemental Job Displacement Benefits

Many states provide further training and development for individuals who suffer permanent disability. California’s supplemental job displacement benefits provide injured workers with a voucher to increase their skills through formal college classes, vocational training, certifications, and more. Vouchers are $6,000 and only offered to employees who do not return to their previous employers.

Recipients must adhere to the following rules when spending their vouchers:

• Recipients can use their vouchers to pay for school-related expenses, such as tuition and books.
• Recipients can use their vouchers to obtain a professional license or certification, as well as associated exams, fees, and exam preparation courses.
• Recipients can spend up to $600 to sign on with a job placement agency, a vocational counselor, or have a professional review and update their resumés.
• Recipients can spend up to $1,000 to purchase necessary computer equipment, such as a laptop.
• Recipients can spend up to $500 on miscellaneous purchases that they do not need to document.

Death Benefits

Unfortunately, an injury in the workplace or an occupational illness sometimes results in the death of a loved one. Surviving spouses and dependents are often eligible for death benefits to compensate them for their losses. California workers’ compensation death benefits provide families with $10,000 for burial expenses, a large initial lump sum payment, and continual monthly benefits until the youngest child reaches age 18. Dependent children are first in line to receive monthly benefit payments. Surviving spouses who make more than $30,000 per year do not qualify.

Our Solana Beach Workers’ Compensation Lawyers Can Help

Not all workers’ compensation injuries require a lawyer to ensure you successfully secure benefits. However, employers and their workers’ compensation insurance providers do not always act in good faith, so it’s good practice to consult with an attorney upon suffering an injury or contracting an illness in the workplace.

Hiring a workers’ compensation attorney can help ensure you get the benefits you deserve. Here are some examples of scenarios where a workers’ compensation lawyer can help:

The Insurance Company Denied Your Claim

The claims administrator associated with your workers’ compensation case might deny your claim for many reasons, including:

• Not reporting your injury to your employer soon enough.
• Not filing your claim within the one-year time limit provided under the law.
• Receiving medical treatment from an out-of-network medical provider.
• Your employer denying that your injury or illness happened in the workplace.

If your claims administrator denies your claim, you have the right to contest the decision and request for a judge to hear your case. At Gomez Trial Attorneys, our Solana Beach workers’ compensation attorneys can help you prepare a strong case that might overturn the denial.

Your Employer Retaliated Against You or Threatened Retaliation

Retaliation against an employee for filing a workers’ compensation claim is both a violation of California and federal law. However, even with legal protections in place, some employers take illegal actions or try to intimidate employees who file workers’ compensation claims.

Some examples of retaliation include, but are not limited to:

• Your employer firing or suspending you.
• Your employer demoting or transferring you.
• Your employer reducing your pay.
• Your employer reducing your scheduled hours.
• Your employer threatening any of the above.

Employers who retaliate against their employees for filing a workers’ compensation are at risk for being sued. If you have been a victim of retaliation, you may file a complaint with the state. An experienced workers’ compensation attorney will be able to help you bring a suit against your employer for their unlawful conduct.

Another Party Might Face Liability for Your Workplace Injury or Illness

The workers’ compensation insurance program protects employers from lawsuits and workers from financially absorbing all the costs associated with a workplace injury or illness. Unless your employer has retaliated or violated some other law, you are unable to sue your employer or obtain damages for pain and suffering—however, you also don’t need to prove fault in workers’ compensation claims making recovery for compensation far easier.

However, some workplace accidents and occupational illnesses occur as a result of third-party negligence. In these situations, you may have recourse against that third party. An attorney will be able to evaluate your case and identify potential third parties who might be liable for damages in a personal injury lawsuit.

Some examples include:

• Sustaining injuries from defective machinery or equipment, potentially opening the manufacturer up to financial liability.
• Suffering a permanent condition or illness due to exposure to hazardous substances or chemicals, potentially opening the manufacturer to liability.
• Working away from your employer’s premises at a job site and suffering injuries, making the landowner, contractor, or another party potentially liable for damages.
• Suffering injuries in a traffic collision, while you were driving a company vehicle, making the other driver potentially liable.
• Suffering injuries in a train accident, plane accident, taxi accident, or rideshare accident while traveling for your job.
• Being intentionally harmed—assault, rape, or another type of violence—while you were working or traveling for your job.

Your Employer Has Not Purchased Mandatory Workers’ Compensation Insurance

Some employers want to avoid the additional cost of workers’ compensation insurance, so they do not comply with the law. Fortunately, injured employees can still receive benefits through California’s Uninsured Employers Benefits Trust Fund (UEBTF). Since their employers failed to comply with the law, they also have the grounds to file a lawsuit.

Employees who file a claim with the UEBTF should simultaneously report their employers as uninsured. A skilled workers’ compensation attorney can protect you from retaliation and help you hold your employer accountable for failure to comply with the law.

You Have Preexisting Injuries in the Area Where You Suffered a Workplace Injury

Pre-existing injuries can potentially complicate your workers’ compensation claim more than anything else. It is possible your claims administrator will deny your claim on the basis that your injury is not current. You may also have medical providers with different opinions on whether your workplace accident aggravated your old injuries. If you have pre-existing injuries, an attorney can build a strong case to show that your workplace injuries did in fact cause you harm.

Your Claims Administrator Denied Needed Medical Treatment

Workers’ compensation insurance providers are particular about who provides medical treatment after a workplace injury or illness. They are also particular about what constitutes necessary medical treatment. Your claims administrator might deny medical treatment that your doctor deems necessary because the carrier’s medical consultants don’t agree with the necessity of that treatment. A Solana Beach workers’ compensation attorney can help you get the medical treatment you need after contracting an illness at work or sustaining on-the-job injuries.

Solana Beach Workers’ Compensation FAQ

If you were recently injured at work or contracted an occupational illness, you may struggle to seek the workers’ compensation benefits to which you are entitled. Employees who sustain an injury or contract an illness in the workplace often have to miss days, weeks, or months of work, and some never return to their jobs. Lost income along with medical expenses financially devastate some households, adding an element of emotional stress on top of the physical pain and discomfort of injury and illness.

Workers’ compensation exists to help employees through these challenging times. Whether you’ve already filed a claim or are ready to file a claim, you might feel uncertain about what you should do next. Not all work injuries or illnesses require legal representation, but it’s a good idea to consult with an attorney as soon as possible after an injury, preferably before you file a claim.

The sooner you have a workers’ compensation lawyer in your corner, the more likely you will succeed in your claim. Until you have the chance to consult with a Solana Beach workers’ compensation lawyer, you can find the answers to many frequently asked questions below.

What benefits may I receive after suffering an injury at work?

If you report your injury to your employer, file a workers’ compensation claim, and get your claim approved, you might receive the following benefits:

• Medical benefits to pay for needed treatment
• Payments for temporary, partial, or total disability (generally, where you have a chance to recover and return to work) to replace lost income
• Payments for permanent partial, or total disability (generally, where doctors don’t believe you will ever recover and return to work) to replace lost income
• Supplemental job displacement benefits
• Death benefits for surviving spouses and dependents

How much are workers’ compensation benefits in California?

Your benefits cover medical expenses related to your illness or injury, with no specific amount attached. Once you have missed work for three days as a result of your illness or injuries, you are eligible for temporary disability benefits to cover a portion of lost income. Your payments will amount to two-thirds of your pre-tax average weekly wages, however, by California law, there is a maximum amount you cannot exceed. While this amount changes annually, it was approximately $1,300 in 2020.

Can I sue my employer for negligence?

Negligence rarely plays a role in workers’ compensation cases.

Workers’ compensation insurance is mandatory in California for employers who have one or more employees. This insurance protects employers from lawsuits and allows workers to get the treatment and benefits they need without needing to prove fault or negligence.

However, some exceptions do exist. You can typically file a lawsuit if your employer hasn’t purchased the mandatory insurance or has retaliated against you for filing an injury claim. You can also sue the workers’ compensation insurer if it refuses to pay a valid claim.

An experienced workers’ compensation attorney will guide you on the right path after a workplace injury or illness.

Can I recover compensation from another person or business for my workplace injury or illness?

Sometimes, workplace injuries and illnesses occur because of a third party’s negligence. In this case, you might have grounds for a personal injury lawsuit against the liable individual or business.

Examples of situations where a third party might hold some or all financial liability for your injuries or illness include the following:

• You suffered a permanent condition or illness from exposure to harmful chemicals or substances.
• You suffered injuries at a job site or customer/client location while working.
• You suffered injuries on a train or in a taxi while traveling for work.
• You suffered injuries in a traffic accident while driving a company vehicle.
• You suffered injuries at work as a result of a defective product, equipment, or machinery.

How long do I have after my injury to file a workers’ compensation claim?

California law requires you to report your workplace injury or illness to your employer within 30 days, and you have one year to file a workers’ compensation claim. If you miss these deadlines, you risk losing your right to workers’ compensation benefits. Under California law, your employer must provide you with a claim form within one day after you report your injury.

If you’ve already reported your injuries or illness, and your employer has not provided you with a claims form, you can download it here. Even though you have one year to file your claim, it’s always in your best interest to file as soon as possible so your claims administrator cannot deny your claim on a technicality.

How long do I have to wait to receive workers’ compensation benefits?

California law requires claims administrators to make the first temporary disability payment within 14 days of reporting the injury to your employer, provided your claim is approved and your medical treatment provider confirms that you cannot work or must have reduced hours and/or job responsibilities.

After you receive your first temporary disability payment, you should receive subsequent payments every two weeks until your eligibility changes. Once you reach your maximum medical improvement, your payments may stop, or you might receive some form of permanent disability payments.

Can I still receive workers’ compensation benefits if my employer is uninsured?

Under California law, all employers with one or more employees must self-insure or purchase workers’ compensation insurance for injuries or illnesses that occur in the workplace. If your employer is uninsured and hasn’t self-insured, then your employer may face criminal misdemeanor charges. It’s not your fault that your employer broke the law.

Fortunately, in California, workers who suffer illness or injury covered under workers’ compensation can apply for benefits from the state’s Uninsured Employers Benefits Trust Fund (UEBTF). The UEBTF pays benefits to injured employees and goes after your employer for reimbursement.

My employer fired me after I filed a workers’ compensation claim. Is that legal?

It depends. It’s illegal for an employer to take any kind of retaliatory measure against an employee for filing a workers’ compensation claim. However, your employer can fire you for another reason. In fact, some employers hide their retaliation and try to fire employees for some dubious reason.

Other forms of retaliation from employers include demotion, pay reduction, forced job transfer, suspension, and threats. If you suspect that you’ve been terminated because you filed a workers’ compensation claim, you should contact a lawyer as soon as possible.

My Solana Beach workers’ compensation claim was denied, now what?

Claims administrators deny workers’ compensation claims for a variety of reasons. Sometimes, employees file late or do not report their injuries to their employers in time. Other times, the employer might dispute that an injury or illness is job-related. If the claims administrator denies your workers’ compensation claim, you have the right to contest the denial. You must take action quickly because there are time limits to challenging your denial.

If your claims administrator denies your workers’ compensation claim, you should first get your case in front of a judge, who will review the claim and make a ruling without a jury. To do this, if you live or work in Solana Beach, you must file for an Application for Adjudication of the Claim in San Diego County. If not, you can submit the document in the county where you live or sustained your work injuries.

Once the county schedules a hearing, you and your claims administrator will go before the judge and present and plead your cases. The ultimate goal is for the judge to help you and the workers’ compensation carrier come to an agreement. If mediation is not possible, the judge will set a trial date in the future for both of you to present your cases in front of another judge.

After the final hearing, the judge will issue a written opinion and send it out by mail between 30 and 60 days after the hearing. If you are unsatisfied with the decision, you have another chance to overturn your denial by petitioning the California Department of Workers’ Compensation (DWC) for reconsideration.

Am I eligible for workers’ compensation if I am an independent contractor?

No. Workers’ compensation insurance is only for employees who receive a salary or hourly wage, have taxes taken out of their payroll, and receive a W-2 form at the end of a year. If you are an independent contractor, you likely receive a 1099 form from the company to report your income at the end of the year. However, you should beware that some California employers intentionally classify employees as independent contracts to avoid the costs of having an employee.

According to the DWC, contractors must have control over their job duties. When employers control the details or manner of work, an individual is an employee regardless of classification. Some other things that differentiate independent contractors from employees include the right to fire an employee, payroll deductions for unemployment insurance and Social Security, provision of necessary materials and tools for employees, and specific work requirements in terms of daily or weekly schedules.

Call us. We can see whether you deserve workers’ compensation benefits or whether you have other options for seeking compensation.

How can a Solana Beach Workers’ Compensation attorney help me with my claim?

Workers’ compensation insurance providers and their claims administrators deny perfectly valid workers’ compensation claims to avoid paying benefits to those who suffer injuries or contract illnesses at work. This leaves deserving employees struggling with medical expenses and loss of income. When you retain a lawyer to assist with the claims process, he or she can guide you and help you with an appeal, if applicable, to ensure that you get the best outcome possible for your situation.

Examples of how a workers’ compensation lawyer can help with your claim include:

• Investigation. Workers’ compensation attorneys typically investigate the events that led to a workplace injury or illness to learn all relevant facts about the case. With evidence, your lawyer can build a strong case to support your workers’ compensation claim. Some examples of evidence that attorneys gather for their clients include medical records, witness statements, police reports, photos, and video footage. To ensure fair reporting of your injuries or illness, attorneys typically have injured workers go see a specific medical provider. Attorneys also investigate the workplace for dangerous conditions and poor safety practices.
• Negotiation. Solana Beach workers’ compensation attorneys understand California law and how to apply it to your claim to protect you from questionable strategies or actions that your employer or its insurance carrier might use to deny your claim or reduce your benefits. Lawyers are experienced negotiators that know how to communicate with insurance providers, giving you the best odds for a positive outcome.
• Representation. If your claim gets denied, you do not need an attorney to request a hearing with a judge. However, you risk dragging out the appeal process, which may still result in denial. Lawyers know how to build cases and present evidence to help injured workers maximize their chances of securing workers’ compensation benefits.
• Litigation. Some workers’ compensation claims require litigation, especially if a third party is partially or fully liable for your injuries or illness. A skilled workers’ compensation attorney can identify potentially liable third parties, help you bring a lawsuit if necessary, and fight your case in the courtroom. Contact Gomez Trial Attorneys today.

Contact Our Solana Beach Workers’ Compensation Attorney Today

If you suffered workplace injuries or an occupational illness, or a loved one has passed as a result of a fatal illness or injury, you are entitled to workers’ compensation benefits. You shouldn’t have to fight to get benefits during this difficult time.

Instead, you should focus on healing and rehabilitation. If your claims administrator denies your claim or places obstacles in your way to receive benefits, we can help you contest the decision or bring a lawsuit against relevant parties.

The award-winning legal team at Gomez Trial Attorneys has the knowledge and resources to help injured workers. Contact us online today or at (619) 237-3490 for a free case evaluation to discuss your workers’ compensation claim, explain your injury or illness and its impact on your life, and determine the best path forward for your case.

Gomez Trial Attorneys
603 N. Highway 101
Solana Beach, CA 92075
Phone: (858) 400-4333