Employees who are injured or become ill while working are entitled to workers’ compensation benefits in California. These translate into wages, medical insurance, life insurance, vacations and pensions, among others.
Compensation includes the monetary compensation the worker receives when he suffers an injury on the job or dies. Those responsible for the compensation payment may be: the employer, the insurance company or third parties.
If you need help in a workers’ compensation matter, our Los Angeles personal injury lawyers can help you with everything. Whatever your compensation needs may be, we can offer you legal advice and representation in Los Angeles and California.
What does workers’ compensation mean in the state of California?
The United States workers’ compensation system comprises a series of federal and state laws. The term refers to the right that protects all workers. It is obtained through private insurance that covers the worker if he is injured or dies.
California’s workers ‘compensation law requires employers to have workers’ compensation insurance. Even companies that have only one employee are required to contract this insurance policy as well. Even if you may qualify for self-insurance.
California workers compensation attorneys
Los Angeles workers’ compensation lawyers at Lluis Law have represented hundreds of injured workers. For over 40 years, we have managed to obtain an impressive record of won cases of workers who were injured or died.
The injured worker can file a claim with his employer or the insurance company to request compensation benefits. If these benefits are denied, seek advice from a workers’ compensation attorney and file a lawsuit.
Obtaining fair workers’ compensation for your medical treatment may depend on this. That is, the payment of medicines, coverage of rehabilitation costs and compensation for lost wages. In extreme cases, if the worker dies, the worker’s family can obtain death compensation.
Under California’s labor laws, workers’ compensation rights are not limited to legal workers. The law also protects undocumented workers from receiving workers’ compensation benefits in California.
What does workers’ compensation cover in 2023?
The insurance covers all medical expenses from the most common workplace accidents and injuries. Also, the worker’s permanent disability payments, depending on the type of work-related injury. These expenses must be authorized by the employer.
One of the peculiarities of these workers’ compensation benefits is that they are not taxable.
How much does workers’ compensation pay?
Workers’ compensation payments are determined based on the employee’s average weekly salary. Likewise, according to the type of injury and the medical evaluation related to the disability.
How does workers’ compensation work?
It is basically compulsory health insurance. All employers are required to purchase it in order to provide health care and benefits to the worker when needed.
The workers’ compensation insurance policy covers all workers in any situation. That is, regardless of whether or not the worker was at fault in the workplace accident that caused the injury.
This is because California is governed by the no-fault workers’ compensation system. The worker has the right to claim compensation benefits, regardless of who was responsible for the workplace accident.
In exchange for receiving these benefits, workers generally do not have the right to sue the employer. The only exception is when the employer violates labor laws or is shown that the accident was deliberate.
Who pays for workers’ compensation insurance?
Worker’s compensation insurance premiums must be paid entirely by the employer. Under no circumstances can this cost be partially or totally charged to the worker. When an employer asks the employee for help paying compensation premiums, he makes a serious mistake.
What does the compensation insurance policy cover?
Compensation insurance policies, in general, provide benefits for the payment of medical bills. Includes medical fees, medicines, hospitalization, medical examinations, surgeries and more. Likewise, the treatment and rehabilitation of the patient and the payment of benefits for temporary or permanent disability.
Depending on the type of injury and the circumstances, it can also cover job loss. If the worker dies, his surviving family members have the right to claim death benefits.
What is workers’ compensation self-insurance?
This is another viable option when employers do not want to purchase an insurance policy with an insurance company. It is generally employed by large companies to cover and comply with California’s workers’ compensation law.
Self-insurance requires prior government approval. As a requirement, the company must have a net worth of not less than $ 5,000,000. And annual net income of at least $ 500,000, in addition to leaving a security deposit.
Currently, groups of small companies in certain areas are making use of this option, through group self-insurance. To do this, several employers agree to contract common health care services and compensation benefits for their employees.
The California Office of Self-Insurance Plans offers employers information on how to self-insure. The self-insurance system has been gaining popularity for the collective benefits it offers to small businesses.
Under this system, the employer has the option to manage workers’ compensation claims himself. You can also hire the services of an external or third party administrator (TPA).
What should I do if my employer does not have WC insurance?
California law requires that all employers comply with the requirements set forth in the Workers’ Compensation Act. However, there are employers who do not have any type of workers’ compensation insurance for their staff.
When the worker is injured and does not have an insurance policy that covers him, his health is put at risk. In such a situation, the worker may have to resort to his own private insurance due to the emergency.
You may also agree to alternate medical treatment with a healthcare provider. Workers’ compensation attorneys help with these administrative procedures so that the worker receives the appropriate treatment.
Lluis Law’s employment attorneys are always available to help. Call now and request a free, no obligation consultation.
What are the penalties for uninsured employers?
In California, not having workers’ compensation coverage is considered a minor criminal offense. The penalty is set by a fine of up to $ 10,000 and imprisonment in a county jail. Similarly, the government imposes fines against uninsured employers of up to $ 100,000.
If the employer does not have insurance, the worker can additionally file a civil action against his employer. In addition to the workers’ compensation claim.
California worker rights
California labor law protects all workers in the event of injury or occupational disease. All workers, without exception, whether legal or illegal, are entitled to receive workers’ compensation benefits.
When employers violate this legal provision, they are exposed to penalties including imprisonment and very high monetary fines. Violation of the California Labor Code (Section 3700.5) is punishable by a fine of up to $ 10,000 or imprisonment for up to one year.
Sometimes both penalties can be applied to the same employer. This type of law violation is also considered a punishable misdemeanor in California. Consequently, the government may apply additional penalties of up to $ 100,000, against uninsured employers (Labor Code, § 3722 (a / b).
Other labor and legal benefits for workers in California
In addition to the compensation system, there are other legal instruments that protect the rights of the worker.
Employment Law: In addition to California’s workers’ compensation system, there is an employment law that protects a worker from illegal or improper action and from violations of employee labor rights by employers.
Personal Injury Law: Protects the worker when he is injured due to the negligence of another person or company. This legal instrument provides accident victims with the right to collect monetary compensation for damages.
Can my employer fire me if I was injured?
The employer cannot fire an injured worker to avoid paying compensation benefits. Doing so flagrantly violates the law and is exposed to civil penalties and lawsuits. Nor does the law allow the dismissal of a worker, even when he was responsible for the workplace accident.
If this happens, the worker should immediately seek legal help with experienced wrongful termination attorneys. The lawyer, after studying the case, will determine the most appropriate type of claim and the benefits available to the worker.
Workers’ compensation benefits
These serve those who are injured in the workplace. Compensation provides medical treatment and compensates the worker who is absent from work due to an injury or illness.
In addition to coverage for medical and rehabilitation expenses, the worker receives compensation for lost wages. Unfortunately, sometimes disputes do arise and insurance companies won’t accept the claim or suspend compensation payments.
California workers’ compensation benefits are grouped into five broad categories:
- Medical and hospital benefits.
- Lost wages and temporary disability.
- Permanent disability benefits.
- Supplemental benefits.
- Death benefits and compensation.
The benefits the worker receives are based on certain criteria, which include:
- Medical evaluation of the injury.
- Ability to perform a modified job, according to the type of work performed by the employee, his occupation and age.
- Type of disability determined by the insurance company on a scale of 0 to 100%. This comprises the percentage of the employee’s ability to work to compete in the labor market.
When the worker’s requested disability benefits are denied or a limited payment is offered, the worker may appeal such decision. For these cases, you may need workplace accident or slip and fall lawyers from Los Angeles.
Types of compensation
The worker has the right to claim various types of compensation benefits, depending on the type of injury. Benefits under California labor laws can be:
1. Medical and hospital expenses
Includes all bills of expenses related to the medical treatment of the injury for the necessary time. For example, medical fees, clinical expenses, special exams, medicines, prosthetics, and surgeries. In some cases it includes the expenses of nurses to care for the patient at home.
These compensatory benefits include health consultations, a wheelchair, or a new bed. Also, transportation to attend consultations or to buy medicines and even go to the supermarket. The workers’ compensation attorney must ensure that the insurance company correctly meets its obligations.
2. Temporary disability and lost wages
The worker is paid a percentage of the wages lost during the time of his recovery. This benefit is obtained from the moment of the injury until the worker fully recovers. The percentage is calculated by the government to ensure that the worker covers his living expenses.
These benefits are of two types:
- Temporary Total Disability (TTD). When the worker cannot work in any way during the recovery period.
- Temporary Partial Disability (TPD). It is also called ‘loss of wages TD’. This payment is made when the worker authorized by the doctor can return to work, although only for certain hours.
The employee receives a lower salary for performing some tasks on a limited basis. This option is available if the employer does not offer the possibility of returning to full-time work. If the employer allows it, the workday must be adjusted to medical restrictions.
Temporary disability benefits include paying two thirds of the worker’s lost wages. California law states that the worker can only receive a maximum weekly payment of $ 1,251.38 for lost wages.
While the weekly minimum payment is $ 290 weekly. This amount usually varies every year, depending on the state’s average salary.
3. Permanent disability
This qualification must be granted by a duly authorized doctor in order to have legal force. It is used to determine the type of payment the employee will receive as part of workers’ compensation benefits.
Permanent disability can be physical or mental. A person is considered to be permanently disabled when the injury suffered is irreversible. Therefore, their work capacity decreases markedly, due to the physical or mental deterioration that the worker presents.
Because it is not very well defined in the compensation law, controversies often arise with its use.
Here is where labor lawyers must use the statutes in the most bold and effective way possible to achieve the compensation benefits that the worker is seeking.
Permanent disability benefits
The types of permanent disability benefits in California can be for:
- Loss of future earning capacity as a result of injuries sustained.
- Regular payment (usually every two weeks) of the agreed amount of the compensation pension.
- Eligibility for continued but limited medical treatment after you start receiving the lifetime pension.
- Permanent partial disability.
Permanent disability can also be of several types:
- Permanent Partial Disability (PPD). When the worker is partially disabled, he receives a disability rating of less than 100%. You can receive weekly payments for a fixed amount. As the disability rating increases, the greater the number of weeks paid and the amount the worker will receive.
- Total Permanent Disability (TPD). If the worker has a permanent total disability, when he receives a 100% disability rating. You are entitled to weekly payments for the rest of your life, but prorated at your temporary disability rate.
- Lifetime Pension. When the disability rating ranges from 70% to 99%, the worker is entitled to be compensated with a lifetime pension. After receiving the total pay weeks for his disability, the employee gets an extra award. This payment is for the rest of his life and compensates for a higher level of disability.
4. Supplementary benefits for commuting
They are used in cases where:
- The injured worker qualifies for a permanent disability;
- The employer decides not to hire the worker anymore or does not offer an alternative or modified job; or
- The worker does not return to the same company.
These types of benefits come in the form of a coupon. That is why they are called the Supplementary Displacement Coupon and the Return to Work Fund. It consists of a non-transferable voucher that is awarded to the worker when he suffers an injury with permanent partial disability.
The supplemental coupon equals $ 6,000 total, regardless of the level of permanent disability. For more information you can check the following link of the Department of Industrial Relations.
Supplemental benefits can be used to pay for education or training expenses for other types of employment. This includes worker retraining and rehabilitation expenses for the development of new skills. As well as the costs of teaching material and obtaining professional licenses.
5. Death and dependency benefits
If the worker dies as a result of the work injury, surviving family members are entitled to compensation. Death benefits include:
- Funeral and burial expenses.
- A weekly income for the spouse, underage or dependent children.
The claim must be filed by family members or their attorney to the employer’s insurance company. If the company refuses to recognize death benefits, the case can be brought to court.
In the same way, when the employer considers that he has no obligation whatsoever towards the worker or his family. This often occurs with independent construction contractors. Either way, you should consider seeking the help of a workers’ compensation attorney as soon as possible.
How long can a worker’s compensation case last for?
After one week away from work, the worker is entitled to receive partial disability benefits. These benefits begin to be collected on the eighth day after the injury occurred during the work accident.
If recovery lasts more than two weeks, the worker is entitled to collect the first seven days of disability. The injured worker must exhibit the medical evidence that shows that he suffers during the time he receives these benefits.
As long as the worker is prevented from working, he may collect compensation benefits. The payment to be received is generally 2/3 of the average weekly salary.
When injury-related disputes arise, the claim and benefits may take a little longer. New workers’ compensation laws in California for 2023 establish a series of additional benefits.
Now the state division of occupational safety and health, Cal / OSHA, will have five years to issue citations to employers, instead of just six months. Particularly, when they do not record with due precision the injuries or deaths of their employees.
What is DWC Form 1?
To receive benefits, the first thing a worker must do is submit a DWC 1 claim form to their employer. This form collects the worker’s declaration with the details of the work injury or illness that he has suffered.
Through this form, the employee requests authorization from his employer to receive medical treatment and other benefits. The form must be supplied to the employee by his employer. Filling it out is actually a very simple process.
Among the data to include we find:
- Worker’s name, date and address.
- Date and place of injury.
- Brief description of the injury.
- List of injured body parts if there is more than one injury.
- Social Security number.
Medical care if the claim has been denied
You should immediately contact an experienced and capable workers’ compensation attorney. The attorney will help you obtain the medical treatment you require and fair compensation for the injury or illness.
The attorney can challenge the denial of the claim with the California State Division of Workers’ Compensation. If admitted, the case will be heard by a workers’ compensation judge.
The doctor or clinic that cares for the injured worker will not be able to charge him directly when it is an accident at work. What the medical provider can do is ask you to sign a lien form.
This form specifies the type of treatment you are receiving and its cost. The medical provider agrees with the lawyer to wait for the worker to receive the compensation to receive the respective payment.
Denial of claims in Los Angeles
When the worker’s claim is denied, they have the right to receive medical care outside of the medical provider network. Treatment in these cases is limited to a total of 24 physical therapy sessions. Another 24 from chiropractors and 24 occupational therapy visits for each claim.
If the injury requires surgery, the insurance company may authorize additional therapy, although it is not required.
What type of medical treatment does workers compensation cover?
Medical treatment consists of: medical consultations, emergency medical care, and hospitalization. In addition, medicines, exams and other expenses related to the injury or illness that involves the recovery of the patient. To obtain medical attention, it only needs to be shown that the injury occurred on the job.
In Los Angeles, all workers, whether immigrants or citizens, are entitled to receive workers compensation. If the employer purchased insurance for the injured worker, your attorney will tell you how to obtain medical treatment. The employer will then have to pay these costs along with a fine.
Compensation of medical expenses to injured workers
When the worker pays out-of-pocket for emergency medical expenses, they can later recover these expenses. Depending on the severity of the injury, you may need the help of a California workers’ compensation attorney. You should also keep receipts, invoices, copies of checks and any other evidence that serves to demonstrate the expenses incurred.
How to submit a refund claim?
To file a claim for reimbursement, you must write a letter to the insurance company. Be sure to attach all of the expense vouchers you have accumulated so far. The letter must be accompanied by the claim form that lists those medical expenses.
You should provide your attorney with a copy of all expenses incurred. This is essential proof for requesting reimbursement of medical expenses. Without the necessary facts, no insurance company will want to compensate the worker.
When should you file a lawsuit in court?
When an agreement is not reached with the employer on the value of the compensation, it is necessary to go to trial. The most frequent cases are when serious injuries occur that lead to permanent disability of the worker.
The workplace accident attorney prepares the case and files a personal injury labor lawsuit. If the case goes to trial, the labor judge will hear the allegations based on the medical reports and other records.
The magistrate will then be the one to decide on the worker’s level of disability and the compensation requested.
Why is the help of a workers’ compensation attorney important in these cases?
When a claim is rejected, the worker will not be able to receive any compensation until a ruling is issued in his favor. In other words, you will not receive a refund until then.
There are statutory deadlines for the insurance company to make reimbursement payments upon request. The payment time limit for the insurance company is of 45 days.
With the help of an experienced workers’ compensation attorney, these payments may take less time. A good lawyer knows how to negotiate payment terms for his client. Among other things, because his own payment will also depend on it.
The benefits of hiring a workers’ compensation attorney include contingency fees. This means that they do not charge fees in advance. So you don’t have to pay out of pocket to have your representation. In short, no win no fee.
Dealing alone with insurance company adjusters or in court is a difficult and delicate matter. Instead, if the worker is represented by an expert attorney, insurance companies will try to reach an agreement.
Otherwise, they can delay the resolution of the claim. In this way they make the worker get tired and sign an agreement in the worst terms for him.
In conclusion, the benefits of being represented by a trained workplace accident attorney are many. Lluis Law attorneys with over 40 years of experience are effective in solving cases.