INJURED WORKER’S HAVE RIGHTS

Frequently Asked Questions FAQ


                                       

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Workers' Comp
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Law Offices of Cleveland & Metz  
9330 Baseline Road, Suite 100  
Rancho Cucamonga,  CA  91701  
ccattorney@aol.com  
909-980-9703  
Call: 800-397-7708  
Fax: 909-980-2013  

 



INJURED WORKER’S HAVE RIGHTS

 1 - 800 - HURT NOW

What is Workers’ Compensation?
Workers’ compensation is a system of laws designed to provide injured workers with specific benefits and a legal forum in which disputes can be resolved between injured workers, employers and in which disputes can be resolved between injured workers, employers and insurance companies. A workers’ compensation claim is not a lawsuit against your employer; it is simply a request for insurance benefits.

What Happens If You've Been Hurt On The Job?ladyjustice.gif
All physical injuries and diseases that result from your job duties or work environment are covered by workers' compensation except for self-inflicted injuries, injuries from attacks by others for reasons not related to employment, or injuries resulting from self-intoxication.

In order to receive workers’ compensation benefits under California’s Workers' Compensation Laws, you must report your job-related health problem to your employer as soon as possible after it occurs. Your employer must then file a claim with the company's insurance carrier so that your compensation will be paid. There's no need to prove that your employer is at fault for your injuries in order to receive your work comp benefits.

However, a number of other obstacles may stand in the way of collecting benefits in your workers' compensation case. Your company and its insurer might say that your health problem isn't job-related, or may disagree on the seriousness of your injury - and therefore refuse to pay all or part of your claim. An employer may try to prevent you from filing your claim, or try to retaliate when you collect benefits. And as if these weren't enough, our state's Work Comp Laws present a complicated maze of rules and procedures in which an injured worker could become hopelessly lost.
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What are the Benefits?

There are four basic benefits:
1. MEDICAL TREATMENT:
You have the right to select your treating doctor and receive all medical treatment reasonably necessary to cure all relieve that effects your injury, potentially for life.

2.TEMPORARY DISABILITY:
Payment of two-thirds of your average weekly gross pay, with certain maximum and minimum limits; it is paid every two weeks while you ate off work and undergoing active medical treatment.

3. PERMANENT DISABILITY:
If you don’t complete recover from the effects of your injury, you may be entitled to a monetary award. The amount of the award (and the weekly rate at which it is paid) depends mainly on how your injury limits your activities; it is also affected by your age, your occupation, and your earnings at the time of your injury. After your condition has been declared permanent and stationary, PD checks compensate you for your permanent inability to compete in the open labor market or whole person impairment for the 2005 schedule.

4. VOCATIONAL REHABILITATION:
If you are no longer able to do your old job, and your employer does no offer you another, you may be entitled to vocational rehabilitation, which is designed to help injured workers return to work. If you qualify, a plan to return to work will usually be developed by a vocational counselor or with the supervision of your attorney. Generally, you are only entitled to one plan, which must take place within California and must not exceed 52 weeks and $16,000.00. If you do not accept vocational rehabilitation, you can trade this benefit for cash. If you accept it, you may be entitled to certain services and benefits. 2004 injuries do not get vocational rehabilitation, they get a Supplemental Job Displacement Voucher that ranges from $4,000.00 to $10,000.00 depending on level of disability. In some cases the Voucher may have a cash value. Vocational Rehabilitation has abolished by your Legislature for 2005 or later injuries. Sorry, thanks for playing.


REMEMBER: Your employer and the insurance company have attorneys advising them about your case. You are entitled to do the same.

ClevelandMetzLaw@aol.com

Fact sheets for injured workers

These fact sheets provide injured workers with answers to frequently asked questions about issues affecting their benefits.

Fact sheet A
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Answers to your questions about utilization review

Fact sheet B
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Glossary of workers' compensation terms for injured workers

Fact sheet C
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Answers to your questions about temporary disability benefits

Fact sheet D
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Answers to your questions about permanent disability benefits

Fact sheet E
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Answers to your questions about qualified medical evaluators and agreed medical evaluators

Fact sheet F
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Answers to your questions about the state's Uninsured Employers Fund

Hojas de información en español



HOW DO I BEGIN MY CLAIM FOR BENEFITS

1. REPORT THE INJURY
You must report your injury to your employer. If possible, do so in writing and keep a copy of the report.
2. COMPLETE A CLAIM FORM As soon as your employer learns from your injury (from any source), the employer must give you a CLAIM FORM. Complete it, listing all body parts that were or may have been injured and return it to your employer right away, Keeping a copy for your records. Your employer must then immediately identify, and notify, its worker’s compensation insurance carrier and send you to a doctor.

Who decides what medical treatment I receive?
You have the right to choose the doctor you want to treat you 30 days after your injury, although in some cases you may be able to choose doctor earlier. The insurance company must authorize all reasonable and necessary” treatment recommended by the your doctor. What is “reasonable and necessary” treatment depends, mostly, on what your doctor (not the insurance company) decides you need. If the insurance company unreasonably delays or denies your medical treatment, the insurance company is required to pay your penalty.

How will my Permanent Disability Award be decided?
Your award will be determined by the doctor’s description of your permanent condition. Factors include current symptoms and limitations you have because of your injury. This is true even if you have returned to the job you were doing when you were injured.

Who describes these factors of disability?
Initially, your treating doctor must describe your disability. Either you or the insurance company may disagree with this description. How this disagreement is resolved depends whether an attorney represents you. If you are represented, you and you’re an attorney may select a doctor to provide an opinion about your disability. Attorneys are experienced in choosing the best doctor for your claim.
If you are not represented by an attorney, you will receive a list of three doctors from which you pick one to give an opinion about your permanent disability list. This is a very important decision. If you pick one of the three doctors from the list and you are dissatisfied with the doctor’s opinion you will not be able to obtain another medical opinion, even if you later decide to hire an attorney.

What happens after the medical evaluation?
The medical description of your disability will be ‘rated” to determine the monetary amount of your permanent disability award. The rating process is very complicated, depends on many factors, and may vary greatly depending on the interpretation of the medical description of your disability.

You have the right to challenge the rating. A worker’s compensation judge will decide disputes about your disability, your rating, and/or your award.

What if may employer fires or discriminates against me for filing a claim or requesting benefits?
This is illegal. If you can prove it, you will receive additional benefits.

What happens if my claim is denied and I am receiving no benefits?
You have the right to challenge this decision and to have a hearing before a worker’s compensation judge.

How can an attorney help?
There are many questions, issues, and disputes that may arise regarding each of the above benefits, such as:
  Is the insurance company paying you the amount of money?
  Are you receiving all the medical treatment you need?
  How can you make the insurance company approve your medical treatment?
  Who are the best medical specialists in your area?
  How do change doctors?
  What can you do about delays in your benefits?
  Is your permanent disability rating correct?
  Are you entitled to vocational rehabilitation?
  How much is your case worth?
  Should you settle your right to future medical treatment?
  Are there any other benefits available to you other than worker’s compensation?
  Did the insurance company follow the correct procedure in sanding you to an Evaluating doctor?
  Has your employer treated you improperly because you field a case?
  Did your employer cause your injury through some serious and willful misconduct?
  Did someone other than your employer negligently or intentionally cause your injury?

How Much Does It Cost To Hire A Workers' Comp Attorney?
You pay nothing up front to hire a workers' comp attorney. Here's how it works:
Workers' compensation cases are taken on a contingency fee basis. That means that the costs of preparing a case (including filing fees, investigation, expert witnesses, attorney fees, etc.) are not collected until the case is completed, and then, only if we win the case. If we lose the case, we absorb all expenses - including attorney fees - in all but the rarest of circumstances. California law sets fees for services provided by a workers’ compensation attorney. Attorney fees are calculated at 12 to 15 percent of the benefits received by the client. By accepting the up-front financial burden that comes with the contingency fee arrangement, we can help people who otherwise would not have the resources necessary to take on big corporations, insurance companies and their law firms.

ClevelandMetzLaw@aol.com

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Making a false or fraudulent workers' compensation claim is a felony subject up to 5 years in prison or a fine of up to $5,000 or double the value of the fraud, whichever is greater or by both imprisonment and fine.



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