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workmans comp | Workers’ Compensation in California Explained

workmans comp

Workers’ Compensation or workmans comp is a state program that pays benefits to employees who have a work-related injury regardless of whose fault the injury is. Part-time workers and undocumented workers are usually covered.

The two big categories of workers who are not covered are federal employees, who have a separate compensation system, and independent contractors. But many employers misclassify workers as independent contractors to avoid paying benefits.

So, if you’re classified as an independent contractor, I encourage you to do some research to confirm that you actually meet the legal requirements for being an independent contractor. Workers’ Compensation covers injuries “arising out of and in the course of” employment.

Generally Speaking, this means you got injured because of your job and while you were doing your job. The word injury is broad. It includes sudden injuries like a broken leg and injuries that develop over time like a bad back. It can also include psychiatric injuries and when your job makes a pre-existing condition worse. There are five main types of benefits injured workers can get through Workers’ Compensation.

The first is your reasonable and necessary medical expenses. The second is temporary disability benefits. You can get temporary total disability if you can’t work at all while you’re recovering from your injury. This is typically two-thirds of your average pay. You can also get temporary partial disability if you’re able to work some, but your pay is now less than what you earned before the injury. Temporary benefits end when you return to work, your doctor says you can return to work, or your condition stabilizes and you become eligible for permanent disability.

There are some exceptions, but you can typically receive temporary benefits For a maximum of one hundred and four weeks paid within five years of your injury. The third type of benefits is permanent disability. This compensates permanently injured people for their reduced ability to earn income in the future. To determine the amount of benefits, your doctor rates your injury from one to one hundred percent based on the nature of your injury, your job, your age, and how much the injury decreases your future earning capacity.

One hundred percent means you have a permanent total disability and cannot work at all. Less than one hundred percent means you have a permanent partial disability. I’ll include a link below to a chart that explains the amount of benefits available for a permanent partial disability. The fourth type of benefits is death benefits paid to a spouse, children, or other dependents who relied on the deceased’s income. And fifth are supplemental job displacement benefits.

If you have a permanent partial disability and your employer doesn’t offer you work that meets certain legal requirements, you may be eligible for a voucher that helps You pay for school or training to enter a different occupation. The amount of the voucher depends on your disability rating. Let’s talk now about the steps of a Workers’ Compensation claim.

There are lots of twists and turns that can happen, but I’m just going to lay out the basic steps. To get benefits, you must tell your employer about the injury within thirty days. The employer must then give you a claim form called the DWC-1 within one working day. This is a simple form for describing who got injured, when the injury happened, and what caused the injury. After you complete the form, you give it to your employer, and they submit it to their insurance company. Within one working day of you completing the claim form, the insurance company must start paying for your medical treatment while it’s investigating whether your claim is valid.

Until it makes a decision, the insurance company is responsible for up to ten thousand dollars in medical bills. If you have to miss work because of the injury, the insurance company should begin paying temporary benefits within Fourteen days of learning about the injury. If the insurance company doesn’t deny your claim within ninety days, the claim is usually considered approved. If the insurance company denies your claim or there is some other disagreement related to your benefits like your benefits being too low, you can file an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board.

This ultimately leads to a hearing with a judge where both sides can present evidence. If the judge rules in favor of the employer, you can appeal by filing a Petition for Reconsideration with the Appeals Board. After that, you can appeal again to state court. Usually, the worker and the insurance company will settle their case before going all the way to a hearing with a judge. There are two different ways to settle a case. The first is called a “Compromise and Release.” This is when you agree to close your case for good in exchange for a lump sum payment. This means Workers’ Compensation won’t pay for any future medical care, and you won’t be able to reopen your case if Your condition gets worse or you need more money later on. Before agreeing to this type of settlement, you want to make sure your condition is stable.

You also want to make sure you don’t need any more medical treatment or that the lump sum payment is enough to cover your future medical treatment. The second type of settlement is called a “Stipulated Findings and Award.” You and the insurance company agree on the extent of your permanent disability and the amount of your benefits. Instead of a lump sum, you receive payments every two weeks, unless you have a real financial need for receiving part or all of the benefits up front. There are two big advantages to this type of settlement. First, the insurance company will pay for your future medical treatment as needed. And second, you may be able to reopen your case if your condition gets worse within five years of the injury. A judge must approve any settlement you agree to. The judge will hold an informal hearing to make sure that you understand the agreement and that the agreement is fair.

Now, when should you Hire a lawyer? You typically don’t need a lawyer if your case is small, straightforward, and the insurance company isn’t fighting your claim. But you should speak to a lawyer if your case gets complicated. For example, your employer denies your claim or doesn’t pay your benefits on time. You have a permanent disability.

These claims are more expensive for insurance companies, so they’re more likely to try and underpay you. You receive or plan on applying for Social Security disability benefits. An attorney will help you minimize the effect of your Workers’ Compensation benefits on your Social Security benefits. Your boss retaliates against you, for example, by demoting you or cutting your hours. You’re unsure of how to continue with your case.

Your employer offers you a settlement and you’re not sure whether to accept it. Or your employer is illegally uninsured. If that’s the case, you can still get benefits, but there’s a special process to go through. If you have any doubts, it’s a good idea to call a lawyer because they’ll give you A free consultation and tell you whether you really need a lawyer for your case. Workers’ Compensation attorneys charge by contingency. This means they get paid by taking a percentage of the benefits they help you get. The percentage is usually between nine and fifteen percent depending on how complicated the case is.

Attorneys cannot charge more than “a reasonable amount,” and a judge must approve the attorney’s fee. This helps prevent the lawyer from overcharging you. Because the attorney’s fee depends on the amount of benefits you get, attorneys usually only represent workers who have a moderate to severe permanent disability. OK, I hope this was helpful. Good luck to you.

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