If you are injured at your place of work in California, you have the right to apply for workers’ compensation benefits. How complicated is the application process?
What benefits are available through workers’ comp? Will you need an attorney’s help?
One key fact to remember is that, in the state of California, you have the right to consult an experienced Fresno workers’ compensation attorney at any time.
If your injuries are catastrophic or permanently disabling – or if you have any problem obtaining workers’ compensation benefits after a job-related injury – a workers’ comp lawyer can take action to ensure that you receive every benefit that is rightfully yours.
The following frequently-asked questions and their answers offer a basic introduction to the workers’ compensation process in this state. It’s what every working person in California needs to know.
Of course, because every case is different, do not hesitate to consult a Fresno workers’ compensation attorney for detailed, personal advice regarding your individual circumstances and your eligibility for workers’ compensation benefits.
Q: IF YOU’RE INJURED AT WORK, CAN YOU SUE YOUR EMPLOYER?
A: In California, you cannot sue your employer over a work-related injury.
Employers in this state are obligated only to carry workers’ compensation insurance and to make certain that their employees are covered.
However, if a workplace injury was caused by a third party – someone other than your employer or a co-worker – you may be able to file a personal injury lawsuit against that third party.
Your workers’ comp attorney can explain your specific rights and options after reviewing the details of your workplace accident and injury.
If you have the right to any damages apart from workers’ comp benefits, your workers’ comp attorney will recommend the best way to move forward legally.
Q: AFTER A WORKPLACE INJURY, WHAT BENEFITS CAN YOU EXPECT?
A: Workers’ compensation in the state of California provides four kinds of benefits to workers who have been injured on the job: medical benefits, temporary disability benefits, permanent partial disability benefits, and assistance with vocational retraining.
1. Temporary disability benefits are paid at the rate of two-thirds of the injured employee’s average weekly wage, up to a maximum amount established each year by law.
Temporary disability benefits are paid only after a doctor verifies that an employee cannot work because of a job-related injury.
Temporary disability benefits are paid until the worker is cleared by a doctor to return to work or until the worker’s condition has reached “maximum medical improvement,” meaning the worker’s condition is stable and is no longer expected to either decline or improve.
Reaching the maximum medical improvement level, however, does not necessarily mean that the worker no longer needs medical care.
2. In California, injured employees are entitled by law to all necessary and reasonable medical treatment for a work-related injury.
Workers’ compensation covers that treatment.
Many California employers and insurance companies have medical provider networks (MPNs) for dealing with employment-related injuries.
If your own California employer works with an MPN, a job-related injury must be treated through that network of doctors.
In California, a medical provider network is a group or association of healthcare providers, established by an insurance company or by a self-insured employer and approved by the California Division of Workers’ Compensation, to provide medical treatment to employees who sustain job-related injuries.
3. Permanent partial disability benefits may be paid after a worker has reached the maximum medical improvement level, when a doctor concludes that the job-related injury is the cause for a permanent disability or a permanent impairment.
Under the workers’ comp guidelines, a permanent disability is “rated” from zero to one-hundred percent.
A one-hundred percent disability rating means it is impossible for the worker to continue to work in any capacity at all.
4. Workers who cannot return to their previous employment after a job-related injury may qualify under workers’ compensation for vocational retraining vouchers.
Q: CAN I CHOOSE MY OWN DOCTOR?
A: As mentioned previously, if your California employer works with an MPN, most job-related injuries must be treated through that network of doctors.
To be treated by a doctor outside of the network, you must “pre-designate” that doctor prior to any work-related injury. You may only pre-designate a doctor if:
- You’ve seen the doctor previously, and he or she has your medicals records.
- Your employer offers group health insurance coverage.
- Prior to any work-related injury, the doctor agrees to treat you for work-related injuries or illnesses.
- Prior to any work-related injury, you inform your employer that you are pre-designating the doctor, and you complete the necessary paperwork.
If no doctor is pre-designated, you will be treated for a work-related injury by a physician in the insurance company’s MPN.
If you choose, you may switch doctors within the network after your first office visit.
Each network must offer doctors who are specialists in employment-related injuries as well as doctors who are general practitioners.
MPNs must adhere to the treatment guidelines established by the by the California Division of Workers’ Compensation.
MPNs also must offer patients a chance for a second and even a third opinion if the patient disputes the first diagnosis.
If a dispute remains after a second or third opinion, the patient may ask for an independent medical examination.
Q: DO YOU NEED A WORKERS’ COMPENSATION ATTORNEY?
Determining the specific workers’ compensation benefits that an injured employee may be entitled to is seldom easy.
Many workers who are injured on the job in California are not certain whether they qualify for workers’ compensation, and many don’t know how to apply for their benefits.
In the greater Fresno area or from anywhere in the state, your best option is to seek the advice of a skilled Fresno workers’ compensation attorney.
California workers’ compensation lawyers regularly deal with the most complicated workers’ comp cases, so they understand exactly what it takes to win the benefits you need and deserve.
The workers’ compensation process in California can be extremely confusing and complicated, so if you are recuperating from an on-the-job injury, you’ll want a workers’ compensation attorney – someone who knows the system well – to represent you and your interests. Your health – and your future – are simply too important to consider any other option.