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b2ap3_thumbnail_shutterstock_195100124.jpgWorkplace accidents can occur for a variety of reasons, and when these accidents result in injuries, a person will usually be eligible to receive workers’ compensation benefits. Brain and head injuries can be especially harmful, and those who experience these types of injuries will want to be sure they take the correct steps to receive the proper medical treatment. They will also want to determine how they can receive benefits that address the ways an injury has affected their ability to work in the future.

Benefits for Workplace Brain Injuries

There are a variety of situations where workplace accidents may cause a person to experience a blow to the head that results in a traumatic brain injury (TBI). Fall accidents, including those involving a slip and fall due to a wet floor or a fall from a defective ladder or scaffolding, may cause a person to strike their head on the floor or other objects. Brain injuries may also occur if a person is struck on the head by falling objects at a construction site or in a car accident that occurs while a person is working.

Workers’ compensation will pay for the costs of all medical treatment for a work-related brain injury. This includes any emergency treatment that is necessary, such as transportation in an ambulance, treatment at an emergency room, hospitalization, or surgery. A person may also need ongoing treatment, such as medications, physical or rehabilitative therapy, or psychological treatment to address mood disorders or post-traumatic stress disorder (PTSD), and these should be fully covered by workers’ comp.

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b2ap3_thumbnail_shutterstock_1190997985.jpgFollowing a work-related injury, an employee will usually qualify for workers’ compensation benefits. These include medical benefits that will pay for all treatment that is needed, including emergency care, doctor visits, medications, surgery, and long-term or ongoing services such as physical therapy or psychological treatment. The California Division of Workers’ Compensation requires reviews to be performed to ensure that the medical treatment a person receives is necessary to treat their injuries or illnesses. This type of review is known as a utilization review, and workers will need to understand how a review will affect the benefits they receive.

Different Types of Utilization Reviews

All forms of medical treatment that are covered by workers’ compensation are subject to review. A physician or provider will submit a request for authorization (RFA), and this request may be reviewed by a claims adjuster, physician reviewer, or non-physician reviewer. Requests may be fully authorized, partially authorized, or denied. Reviews will generally fall into one of the following categories:

  • Prospective review - In many cases, requests will be sent before medical treatment is provided. After an RFA is submitted, a decision must be made within five business days, and the provider must be notified of the decision by phone or fax within 24 hours. If additional information is needed, the provider must be notified within five business days, and a decision must be made within 14 calendar days after the RFA was originally submitted. If the provider is not notified of the decision or a request for additional information within five business days, they will be allowed to proceed with the requested treatment. In some cases, companies may create utilization review plans that provide prior authorization for certain types of treatment, and in these cases, a provider will not be required to submit an RFA.

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b2ap3_thumbnail_shutterstock_2002074008.jpgFor people who are injured in the workplace, workers’ compensation can provide crucial benefits that will allow them to receive the proper medical care and support themselves while they are recovering. In many cases, injured workers will suffer from temporary setbacks, and they will be able to return to their previous positions after they have fully recovered. However, there are some situations where a person may suffer from permanent impairments that make it difficult or impossible to continue doing the work they had done in the past. While permanent disability benefits may provide assistance in these cases, a person will likely be looking to find work in the future that will fit within their limitations. However, doing so can be difficult, especially if a person has limited experience outside of their previous position or if they do not have the skills to pursue other types of work. Fortunately, certain workers may qualify for vocational rehabilitation that will allow them to receive training and pursue employment in new fields.

Receiving Supplemental Job Displacement Benefits

When a work injury results in a permanent partial disability, a person may qualify for supplemental job displacement benefits (SJDB). In these cases, a person will receive a voucher for $6,000 that may be spent on job training and other forms of vocational rehabilitation. Up to $1,000 may be put toward the purchase of computer equipment that may be used during job training and job searches. $600 may be spent on vocational counseling, and $500 may be used to pay for miscellaneous expenses. The remainder of the voucher may be used to pay for training programs from one or more state-approved providers or for expenses related to obtaining a professional license, including exam fees, license application fees, and licensing exam preparation courses.

A person can only qualify for SJDB if they have not received an applicable job offer from their former employer. In some cases, an employer may offer a position with modified work that fits within a person’s limitations. If this offer is for a position that will last at least one year and will pay at least 85 percent of the wages the person earned before being injured, the person will not qualify for SJDB. If a qualifying job offer is not made within 60 days after a claims administrator receives a return-to-work report from the person’s doctor, the person will be able to receive an SJDB voucher.

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b2ap3_thumbnail_shutterstock_1492492898.jpgIn many cases, people who are injured while on the job will qualify for workers’ compensation benefits that will address their medical expenses and ensure that they receive a certain percentage of their income while they are recovering from their injuries. While workers’ comp laws apply to all employees, people in high-risk occupations may be able to receive some additional benefits and protections to ensure that they will have the financial resources they need as they address work-related injuries. Police officers will want to understand the laws that apply to them in these situations, and they can take steps to ensure that they receive the full benefits they deserve following an injury or work-related health condition.

Full Disability Benefits for California Police Officers

For most workers, temporary or permanent disability benefits provide compensation for a percentage of the income that a person is unable to earn while recovering from their injuries. However, California law states that police officers are entitled to receive their full salary when taking a temporary leave of absence to recover from an injury or illness that arose out of their duties. This leave of absence can last for up to one year, and after that period, an officer may continue to receive workers’ compensation disability benefits.

The following types of officers are eligible for full disability benefits:

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gilroy workers comp lawyerEmployees who experience work-related injuries are entitled to workers’ compensation benefits. These benefits, including coverage for medical treatment and partial compensation for income lost due to a temporary or permanent disability, are available regardless of who was at fault for an injury. If a person can show that they were injured in a workplace accident or otherwise suffered injuries or health issues that arose out of the work they performed, they will qualify for workers’ comp benefits. However, workers should also be aware of the potential for workers’ compensation fraud, including situations where employees or employers may be accused of committing fraud.

What Is Workers’ Compensation Fraud?

There are a variety of fraudulent activities related to workers’ compensation that may be committed by employers or employees. An employee may be accused of making a false workers’ comp claim in order to receive benefits. For example, if a person suffered a back injury after falling down while at home, they may contact their employer and falsely state that the injury occurred while lifting heavy objects at work. By doing so, they may hope to receive coverage for medical treatment, and they may plan to take time off work while recovering and receive temporary disability benefits.

Employers may commit multiple types of workers’ compensation fraud. In some cases, fraud will involve misclassifying workers as independent contractors rather than employees to avoid paying workers’ compensation benefits. Employers may also commit fraud by discouraging employees from making workers’ comp claims. For example, they may state that a particular type of work-related injury is not covered or that an employee does not qualify for benefits because they were at fault for a workplace accident.

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