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morgan hill workers compensation lawyerWhen people suffer work-related injuries, they are generally eligible for workers’ compensation benefits. Medical costs related to a work injury, disease or illness contracted while working, or a health condition that was caused by the work a person performed should be fully covered. However, there are a variety of requirements that must be met during treatment, and some limitations may apply. Injured workers will want to make sure to understand their rights and the procedures that will be followed as they receive treatment, and they may need to work with an attorney to make sure they receive the medical benefits they deserve.

Medical Care Covered by Workers’ Compensation

When doctors or other medical professionals provide treatment covered by workers’ comp, this treatment must be evidence-based. It must be scientifically proven to be an effective treatment for the injuries that a person experienced while working or due to their work. The California Department of Workers’ Compensation (DWC) maintains a set of regulations known as a medical treatment utilization schedule (MTUS). This schedule provides guidelines for appropriate treatments for different parts of the body, including those related to post-surgery pain treatment and therapy, as well as acupuncture.

A DWC claims administrator must authorize all forms of medical treatment, and they will perform a utilization review (UR) to ensure that a planned course of treatment is medically necessary. The UR will determine whether treatment recommended by a doctor falls within the guidelines of the MTUS. If the recommended treatment is not included in the MTUS or goes beyond the guidelines, the doctor must provide evidence to the claims administrator showing why this treatment will be necessary and demonstrating its effectiveness. 

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morgan hill workers compensation lawyerPeople who suffer work-related injuries are eligible for workers’ compensation benefits. These benefits cover the costs of medical care, and if an injured worker is required to miss work or suffers a loss of income, they may also receive disability benefits. While temporary disability benefits will apply in situations where a person cannot work or can only work at a reduced capacity for a short period of time, permanent disability benefits may be available for those who have suffered permanent impairments to their ability to earn an income. However, the process of determining the amount an injured worker can receive in permanent disability benefits can be complicated, and it involves the calculation of a PD rating.

How Is a PD Rating Determined?

Before a person can qualify for permanent disability (PD) benefits, a doctor will need to determine that they have reached the point in their treatment where their medical condition is permanent and stationary (P&S). This is also known as maximum medical improvement (MMI). At this point, the doctor will send a report to the Department of Workers’ Compensation (DWC) that specifies the person’s level of impairment using an “impairment number” while also noting whether there were any non-work-related factors that contributed to the impairment.

The DWC’s Disability Evaluation Unit (DEU) will review the doctor’s report and use the impairment number to calculate the person’s percentage of disability. This will indicate the amount of loss of their bodily or mental functions that would affect their ability to return to working in the position they held before being injured. This percentage may then be reduced based on the amount of the disability that was the result of any issues unrelated to the work a person performed. The resulting amount is known as the PD rating, which will be used to determine the total amount of benefits the person will receive for their permanent disability.

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santa clara county workers' compensation lawyerWorkers’ compensation is typically associated with traumatic workplace incidents such as falls or equipment-related accidents. However, California workers’ compensation may also cover illnesses and diseases that a person acquires at work. If you have fallen ill and the condition is work-related, you may be entitled to compensation for medical bills and part of your lost income. Unfortunately, workers’ compensation claims involving illnesses are often harder to prove than other types of worker’s compensation claims.  

What Types of Illnesses May Be Covered by Workers’ Compensation?

California covers injuries and illnesses resulting from the work environment and/or completing work tasks. So, if your illness or disease can be linked to job duties or the workplace, you may qualify for compensation. Some illnesses that often lead to workers’ compensation claims include:

  • COVID-19 – If you contracted COVID-19 at work, it is possible that your medical bills and lost income will be recoverable through a workers’ compensation claim. Respiratory illnesses like coronavirus were already typically covered by California workers’ compensation. However, Senate Bill 1159 and other legislation have further established workers’ right to compensation.

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Santa Clara County workers compensation attorney

When most people think of workers’ compensation claims, they picture a worker suffering from a broken leg or a back injury. While physical injuries do make up the majority of workers’ compensation claims in California, many workers also suffer from psychiatric injuries caused by traumatizing work incidents. Firefighters, police officers, and other first responders are at an especially high risk of psychological injuries. These workers are often witness to extremely upsetting situations involving gruesome injuries, death, and other tragedies. However, psychological injuries can occur to workers in any profession.

California Workers’ Compensation Law Regarding Emotional or Psychological Harm

Employers in California are required to carry workers’ compensation insurance. Employees who suffer an on-the-job injury are typically entitled to compensation for medical bills and a portion of their lost income. California workers’ compensation covers physical injuries as well as certain work-related emotional and psychological injuries.

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Morgan Hill workers' compensation lawyerCalifornia law requires employers to carry workers’ compensation insurance. This insurance is designed to cover medical bills and partial lost wages for workers who are hurt on the job. California law also prohibits employers from retaliating against employees who have filed a workers’ compensation claim. Employers cannot fire or otherwise discriminate against a worker simply because he or she filed for workers’ compensation. Victims of workers’ compensation discrimination may be entitled to job reinstatement, additional financial compensation, and reimbursement for lost wages.

What Actions Are Considered Discriminatory?

Some employers are irritated by an employee filing a workers’ compensation claim – even when the employee has a legitimate work injury and is rightfully entitled to workers’ compensation benefits. The employer may take out this frustration on the employee by treating him or her differently than the other employees. Not only is this practice unethical, it is also unlawful. Employers who discriminate against an employee because of a workers’ compensation claim, settlement, or award are guilty of a misdemeanor criminal offense.

Examples of actions that may constitute workers’ compensation discrimination or retaliation include:

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Santa Clara County workers compensation attorney

It is hard to believe, but spring is just around the corner in Santa Clara. While many welcome the warmer weather, it is important to consider the effect that the heat can have on workers. Heatstroke, heat exhaustion, heat syncope, and heat cramps can affect both outdoor workers and indoor workers in high-risk occupations. According to the Centers for Disease Control and Prevention (CDC), approximately 700 heat-related deaths occur in the United States each year. Heat illness also leads to thousands of non-fatal injuries including injuries sustained because of fainting. Those who are hurt may be able to recover damages through a workers compensation or personal injury claim depending on the details of their case.

OSHA Guidelines for Safe Work Environments

California is known for its warm, sunny weather. Unfortunately, working in hot environments can lead to serious and even fatal injuries. The Occupational Safety & Health Administration (OSHA) states that 50 – 70 percent of heat-related fatalities occur during the initial days of working in warm conditions when the body has not yet acclimatized to the hot environment. OSHA has established guidelines for employers with workers in outdoor or indoor environments that involve hot environments, heavy physical activity, or heavy clothing. Workers in certain industries are often at particularly high risk of heat-related illnesses and injuries, including those who work in:

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San Benito County workers compensation attorney

This year has been unprecedented, to say the least, especially when it comes to safety in the workplace. As COVID-19 hit the United States, most businesses went fully remote, and almost one year later, many are still working from home. Those considered essential workers, however, were not given this option. Essential workers have been placed at a much higher risk of contracting COVID-19 than those who have been granted the benefit of keeping their job while also working remotely. The state of California recognized this and granted additional protective measures to those on the frontlines. With the vaccine now being administered, many workplaces are requiring their employees to get the vaccine before returning to work. Getting the vaccine may protect against COVID-19, but it has also left many with serious side effects and wondering if workers’ compensation is an option.

Senate Bill 1159

California legislature released Senate Bill 1159 back in September 2020, which states that COVID-19 may be considered a work-related illness, making employees eligible for workers’ comp, if the following conditions are met:

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Santa Clara County workers compensation attorney

Those who are injured at their workplace have certain rights outlined by the state of California, regardless of the nature of their position. There are a number of misconceptions about California’s workers’ compensation policy, including the assumption that this financial assistance is solely reserved for those in especially dangerous fields such as construction. It is important to have an understanding of your rights as you join the California workforce since a single injury can leave you in physical and financial disarray. 

1. What Should I Do If I Have a Work Injury?

After any type of injury, it is common to “wait it out” to see if reporting the injury or seeking medical treatment is truly necessary. Perhaps you slipped on wet floors or have a gash on your arm from improperly stowed tools and believe that your injuries are fairly minor. Regardless of the nature of your injury, you should immediately report the injury to your employer and seek medical treatment. This report will ensure that the nature of your injuries is recorded from the onset and prevent you from problems and delays in receiving benefits.

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Santa Clara County workers compensation attorney

Construction sites are some of the most dangerous work environments that exist. Workers must often work with hazardous materials, atop scaffolds and rooftops, and among heavy machinery and dangerous equipment. It is for these reasons that construction workers suffer catastrophic injuries and fatalities at much higher rates than workers in other professions. If you or a loved one were injured while working at a construction site in California, it is essential to know your rights. You may be entitled to compensation by filing a workers’ compensation claim as well as through a third-party claim.

Workers’ Compensation for Construction Accidents

The Occupational Safety & Health Administration (OSHA) lists falling, being struck by objects, electrocution, and caught-between accidents as the top four causes of fatal construction site accidents. Traumatic events often lead to severe injuries on construction sites; however, repetitive stress injuries that develop over time are also commonly suffered by construction workers. Back and spine injuries are typically caused by repetitively lifting objects, working in awkward positions, or uneven weight distribution on tool belts. California workers’ compensation covers traumatic injuries in addition to repetitive motion injuries.

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Santa Clara County workers compensation attorney repetitive stress injury

When people think about workers’ compensation injuries, they often imagine sudden injuries that occur in a fall or other traumatic accident. However, accident-related injuries are not the only types of injuries covered by California workers’ compensation. Individuals suffering from repetitive stress injuries or repetitive motion injuries may also be entitled to compensation. Office workers are often vulnerable to injuries caused by typing and other office work. However, it is sometimes difficult for injured office workers to receive the compensation they deserve.

Carpal Tunnel Syndrome and Other Repetitive Motion Injuries

The most common office-related repetitive stress injury is carpal tunnel syndrome. Typing on a computer keyboard, filing, and other office tasks require repetitive hand and wrist motions. This can put too much pressure on the median nerve and can cause painful symptoms including numbness, tingling, weakness, and pain. Medical conditions such as diabetes, rheumatoid arthritis, and thyroid disorders increase a worker’s chances of developing carpal tunnel syndrome. According to the Bureau of Labor Statistics, the median number of workdays missed due to carpal tunnel is 27. Cervical radiculopathy, ganglion cyst, tendonitis, De Quervain's Disease, and bursitis are other repetitive stress injuries that may be caused by office work.

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Hollister workers compensation attorney

Unlike in many other states, workers' compensation is mandatory for all employers in California. It does not matter if an employer has hundreds of employees or only one. It also does not matter if the injured employee was working full-time or part-time. Typically, self-employed individuals are not covered by the hiring entity’s workers’ compensation insurance. However, workers who have been misclassified as independent contractors may actually fall under the category of employee, which means that they would be entitled to coverage through workers’ compensation.

Individuals Who Are Not Covered by Workers Compensation in California

California has wider-reaching workers’ compensation coverage than many other states. However, there are still some individuals who are not covered by workers’ compensation, including:

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Santa Clara County workers compensation attorney death benefits

Losing a relative in an unexpected work accident is a devastating experience to go through. If your spouse has recently passed away due to injuries he or she sustained on the job, you may still be figuring out what to do next. In the midst of your grief, you may also be trying to determine how you will make ends meet without your loved one’s financial support. In California, if a worker is injured in an on-the-job accident, the worker is typically entitled to financial compensation through workers’ compensation. If an employee is killed in a work accident, the worker’s dependents are usually entitled to compensation called death benefits. However, obtaining the compensation you need and deserve after losing a loved one in a work accident is often more complicated than many expect.

Workers’ Compensation Death Benefits in California

The compensation available can be for family members who were totally or partially financially dependent on the deceased worker. Some individuals are considered total dependents of the deceased worker. Minor children, disabled adult children, and surviving spouses with an annual income under $30,000 are automatically considered totally dependent on the worker. Stepchildren, spouses who make above the income threshold, grandchildren, parents, siblings, and other family members may qualify for death benefits. However, they will need to provide evidence that shows that they were partially or totally dependent on the deceased worker.

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California workers' compensation lawyersWorkers’ compensation benefits can help an injured worker pay for medical expenses and other costs related to a work injury. However, filing a workers’ compensation claim and successfully recovering benefits is often more difficult than many workers expect. If your workers’ compensation claim was denied, you may be worried about how you will pay your bills and receive the medical care you need. Fortunately, you may be able to appeal a workers’ compensation denial.

Determining the Reason for Workers’ Compensation Denial

If you or your loved one was denied workers’ compensation after a work accident, you may be confused and unsure as to why the claim was denied. Workers’ compensation claims are denied for many reasons. In some cases, the insurer or employer may simply not have received enough information about the injury to make a proper assessment about workers’ compensation benefits. Mistakes made on the part of the injured worker or the insurer/employer may also lead to delays or denials. Workers’ compensation benefits are contingent on the injured worker meeting specific filing requirements and deadlines. The insurer or employer may also deny you if the way you were injured makes you ineligible for benefits. Injuries that occur while a worker is under the influence of drugs or alcohol, self-inflicted injuries, injuries caused by a preexisting condition, or injuries that are unrelated to work are not typically covered by workers’ compensation. Employers or insurance companies sometimes wrongfully deny workers’ compensation claims.

Appealing the Decision

If you were denied coverage under California workers’ compensation laws, you have the option of appealing the decision. To do so, you must file a form called a “Declaration of Readiness to Proceed.” You may then attend a hearing with the Worker’ Compensation Appeals Board (WCAB) and argue your case in front of a judge. A workers compensation lawyer can help you fight for the benefits you need. Your lawyer will help you use medical records and other evidence to demonstrate your eligibility for workers’ compensation and represent you during the hearing. If a settlement cannot be achieved, your attorney can also represent you during trial.

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