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Famous for its cafes, farmers’ market, and art galleries in the Cedros Design District, Solana Beach is full of interesting and creative places to work. With these unique jobs comes unique on-the-job risks. While unfortunate, workplace injuries and illnesses regularly take place in Solana Beach.
Sustaining injuries or contracting illnesses at work takes a toll on employees and their families. Injured workers must cope with physical discomfort and pain, in addition to the economic struggles that often accompany a serious injury. To make matters worse, the entire situation often causes emotional distress for injured workers and their families.
Fortunately, injured workers can usually rely on workers’ compensation insurance to cover their medical expenses and fill in gaps of lost income. Many injured or ill workers file claims, get approved, and begin receiving benefits until they recover and return to work. This, however, is not the story for all workers. Workers’ compensation insurance providers and employers frequently deny claims, reduce benefits, and create challenges for employees to collect their benefits.
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.
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.
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.
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:
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:
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.
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 claims administrator associated with your workers’ compensation case might deny your claim for many reasons, including:
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.
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:
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.
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:
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.
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.
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.
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.
If you report your injury to your employer, file a workers’ compensation claim, and get your claim approved, you might receive the following benefits:
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.
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.
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:
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.
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.
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.
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.
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.
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.
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:
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.
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