Work injuries and illnesses can happen to anyone. Traumatic accidents like an equipment malfunction, fall, or trench collapse can lead to sudden, catastrophic injuries. Repetitive motions like bending, twisting, or typing can lead to repetitive stress injuries like carpal tunnel syndrome. Illnesses and diseases such as contact dermatitis and even cancer may also be a result of work environments. If you have suffered a work-related medical concern, you may be thinking of filing a workers’ compensation claim and recovering financial compensation. If so, make sure to avoid the following mistakes.

Common Mistakes When Filing a Workers’ Compensation Claim

Any employer with one or more employees is required to carry workers’ compensation insurance. This insurance is used to compensate an injured worker for medical bills and part of their lost income. Unfortunately, getting an adequate workers’ comp payout is not always easy. The following mistakes can make it even harder to get the compensation you need:

• Not following your company’s policies for reporting an accident or injury - Some injured workers do not realize how badly injured they are until hours or days after the accident. If you are hurt at work, always report the injury right away – even if you think your injuries are minor.

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When you have been injured while on the job, workers’ compensation can help to cover your medical bills, lost wages, and other related expenses. Many work injuries result in temporary or even permanent disability. But what happens when someone who already had a disability is injured on the job? Millions of people who suffer from disabilities are still able to work. Are they also entitled to workers’ compensation benefits? If you or a loved one believes that you have a workers’ compensation claim in California, it’s imperative that you understand your rights.

The good news is that those who had a pre-existing disability prior to their work injury are generally still eligible to receive compensation benefits. However, these benefits come from an alternate source: the Subsequent Injuries Benefits Trust Fund (SIBTF). The SIBTF helps to compensate those workers who already had an impairment or disability at the time of their workplace injury. However, there are some requirements.

During the summer of 2021, California and many other parts of the United States have experienced record-breaking temperatures. This extreme heat has put many people at risk, especially those who work outdoors, around hot equipment, or in buildings without environmental controls. Employers are required to take the necessary measures to prevent heat illnesses for workers, including ensuring that they have sufficient water and access to shade. However, workers in high-risk occupations or others who experience extreme heat may still suffer heat-related injuries or illnesses. Whether this occurred because an employer did not take the proper safety precautions or for other reasons, employees can receive workers’ compensation benefits for any health issues that occurred because of the work they performed.

Common Heat Illnesses in the Workplace

Health issues resulting from extreme heat can vary in severity depending on factors such as the level of heat a person is exposed to and their underlying health conditions. These illnesses may include:

• Heat stroke - If a person is unable to regulate their body’s temperature and cool off properly, they may overheat to temperatures of 106 degrees Fahrenheit or more. This can lead to confusion, slurred speech, seizures, and loss of consciousness. If the proper emergency medical treatment is not provided, this illness can lead to permanent disabilities or death.

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Employees who are injured while working are eligible to receive workers’ comp benefits. Employers in California are required to maintain workers’ compensation insurance, which will provide coverage for the medical expenses related to an employee’s injury, as well as disability benefits that address a temporary or permanent loss of income. However, if an employer does not maintain the required insurance coverage, an injured worker may be unsure about their options for receiving workers’ compensation benefits. In these cases, a person will need to work with an attorney to ensure they follow the correct steps to receive the benefits they deserve.

Workers’ Comp Benefits for Employees of Uninsured Employers

If an employer does not have workers’ compensation insurance, an injured employee can still receive benefits through the Uninsured Employers Benefits Trust Fund (UEBTF). However, these benefits are not provided automatically, and an employee will need to follow certain procedures when making a workers’ compensation claim through the UEBTF. They will need to do the following:

1. File a workers’ compensation claim form (DWC-1, Employee’s Claim for Workers’ Compensation Benefits) with their employer. Three copies of this form must be mailed or hand-delivered to the employer, and the employee should keep a copy for their own records.

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Most employees who are injured while working or who have suffered negative health conditions because of their jobs will qualify for workers’ compensation benefits. These benefits will ensure that a person receives the necessary medical care, and they can also help address a person’s loss of income due to a temporary or permanent disability. In addition to these benefits, union workers may have other options for receiving assistance, including payments made through a union welfare fund.

What Is a Union Welfare Fund?

Unions allow workers to utilize collective bargaining to ensure that they have certain rights and benefits. Collective bargaining agreements may address wages, work schedules, paid leave, and rules that apply to employers and employees. Workers who join a union and receive these benefits will usually be required to pay union dues. These dues may be put toward a union welfare fund that provides different types of benefits for union members.

Many union welfare funds provide health insurance plans, life insurance, and other benefits for workers. These funds may also provide disability benefits for those who have suffered workplace injuries or other health issues that affect their ability to work. An injured union worker may receive a stipend to help them address the loss of income due to an injury, or short-term or long-term disability benefits may be available to be paid on a weekly or monthly basis. In some cases, unemployment benefits may be available for union workers who are unable to return to their previous jobs after being injured, or a person may receive pension benefits if their injury forces them to take an early retirement. A union welfare fund may also provide benefits to the dependents of a worker who was killed in a work-related accident.

A workplace injury can affect a person in many ways. Fortunately, workers’ compensation benefits are available to provide injured workers with financial assistance while they are recovering, and workers’ comp will also pay for all expenses related to medical treatment for an injury. In many cases, a person can receive temporary disability benefits while their injury has limited their ability to work. Once they have fully recovered, they can return to work. However, if a person will be unable to return to their former position, they may be able to receive permanent disability benefits, as well as supplemental job displacement benefits that will allow them to find work that fits their limitations.

SJDB Vouchers and the Return-to-Work Supplement Program

If a work injury has resulted in a permanent partial disability that has caused a person to experience limitations on the types of work they can perform, and they will be unable to return to work for their former employer, they can receive benefits that will allow them to obtain education or training and pursue employment in a new position. 

Supplemental job displacement benefits (SJDB) are available if an employer does not offer regular work equivalent to their former position or modified work in alternative positions that fit limitations that apply to the person due to their disability. A person will qualify for these benefits if they do not receive an offer from their employer of a position that will last for at least 12 months and pays at least 85 percent of the person’s wages before their injury.

When 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. 

There are multiple types of injuries that a person may suffer in the workplace or because of the work they have performed. Back injuries can be very painful, and they can limit a person’s movements and their ability to bend over and lift objects, affecting the work they can perform. Because of this, workers who suffer back injuries will want to determine whether they can receive workers’ compensation.

Common Types of Back Injuries

An injury may affect a person’s backbone and spinal cord, or they may experience injuries to the muscles and ligaments in the back. These injuries may include:

• Strains and sprains - Back muscles and ligaments may be injured because a person attempted to lift an object that was too heavy, because they twisted their back into an unnatural position, or due to ongoing strain to the back muscles. In many cases, these injuries require a person to rest and refrain from strenuous activities for several days. A person may also need to take anti-inflammatory medications.

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People 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.

In California, employees who are injured on the job are entitled to reimbursement for medical expenses and part of their lost income through workers’ compensation. With some exceptions, anyone who is hurt while performing work tasks is eligible for workers’ compensation or “workers’ comp.” However, some workers’ compensation claims are denied. If you or a loved one applied for workers’ compensation and were denied, a workers’ compensation lawyer may be able to help.

When is a Worker Not Entitled to Workers Compensation?

California workers’ compensation is extensive and covers most individuals. However, there are some exceptions to this generality. For example, if you work in exchange for housing or other aid instead of wages, you do not qualify for workers’ compensation. Individuals who are employed by their parent, spouse, or child in a family business may also be excluded from workers’ compensation. You do not qualify for workers’ compensation if the injury was not related to your job or it occurred when you were off the clock.  

Only workers who are classified as employees are entitled to workers’ compensation. So, if you are an independent contractor, you may not receive reimbursement for your medical expenses or lost income. That being said, many workers who are classified as independent contractors should be classified as employees. A workers’ compensation attorney can help you determine if you have been misclassified.

Most people struggle with one or more medical conditions at some point in their lives. Whether you have an old sports injury, a degenerative disease, or hearing or vision problems, managing the condition’s symptoms may be a constant struggle. So what happens when work tasks aggravate an existing medical concern? Is the injured worker entitled to financial compensation through workers’ compensation? Is the worker barred from financial recovery because he or she had the condition before being hired?

California Workers’ Compensation Typically Covers Aggravation of Pre-Existing Conditions

Many people assume that they cannot get workers’ compensation for a medical issue that existed before starting their job. Fortunately, California workers’ compensation does cover situations in which a person’s job worsens a pre-existing medical problem. Unfortunately, it is often difficult to get the compensation you need for a pre-existing condition. To get reimbursement for medical bills and lost wages through your employer’s workers’ compensation insurer, you must prove that:

• Your medical condition was aggravated or worsened by your job duties

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Workers’ 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.

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Our brains control everything from walking to problem-solving. When the brain is damaged in a work accident, the worker may be left with severe symptoms that significantly impact his or her life. Fortunately, most injured workers are entitled to compensation through their employer’s workers’ compensation insurance. Unfortunately, obtaining workers’ compensation is sometimes a difficult process. In situations like these, a workers’ compensation lawyer can be an extremely useful asset.

Symptoms of a Brain Injury Can Be Subtle at First

A traumatic brain injury (TBI) occurs when the brain is directly damaged by an object penetrating the skull or, more commonly, when a force causes the brain to strike the inside of the skull. Falling, being struck by objects, and equipment-related accidents are some of the most common on-the-job causes of TBI. One factor that can make TBI especially dangerous is that many TBI sufferers do not immediately realize how badly they are injured. Some symptoms are delayed by hours, days, or longer. Symptoms of TBI often include:

• Headache
• Dizziness
• Blurred vision
• Vomiting
• Ringing in the ears
• Slurred speech
• Disorientation
• Cognitive and behavioral changes
• Sleeping problems
• Mood swings or depression

TBI Can Lead to Profound Financial Losses

A traumatic brain injury can become a major financial burden. Usually, doctors use a CT scan or MRI to diagnose a brain injury and look for brain bleeds. The sufferer may need to remain in the hospital for several days while he or she recovers. A TBI patient may also need ongoing medical care after leaving the hospital. These medical treatments quickly add up. Fortunately, workers’ compensation may cover medical bills as well as a portion of your lost income after a TBI.

Fortunately, employees who are hurt on the job in California typically have access to reimbursement through workers’ compensation. While the law entitles most injured workers to compensation for medical expenses and a portion of their lost income, successfully obtaining this compensation is not always easy. There are specific steps an injured worker must take to get compensation after a work injury. Additionally, some mistakes can derail the process of obtaining compensation.

Mistakes That Can Impair Your Ability to Get Workers’ Compensation After a Work Injury

Work injuries can occur during a sudden accident such as falling, or slowly over time due to repetitive motions like bending or twisting. Whatever the cause, a work injury can damage your ability to earn a living. These injuries may also lead to steep medical expenses. Ideally, getting the compensation you need for these financial losses would be straightforward. Unfortunately, obtaining workers’ compensation is sometimes quite challenging. To give yourself the best chances of getting adequate compensation after a work injury, avoid these mistakes:

• Incorrectly reporting the injury – If you are hurt at work, tell your supervisor immediately. Fill out the appropriate incident forms or other paperwork. If you wait too long to report the injury or do not have a paper trail to show that you reported the injury, it can be hard to prove the timeline of the injury.
• Not following the doctor’s orders – For many people, going to the doctor is something that they avoid at all costs. However, not getting proper medical care after a work injury can significantly damage your ability to get compensation. The insurance company may claim that neglecting to get appropriate medical care proves that your work injury is not as severe as you claim.
• Accepting an inadequate settlement – Save for very specific exceptions, injured workers have a right to workers’ compensation per California law. Do not accept an unreasonably low payment. Speak with a workers’ compensation lawyer for help if you feel that you are being offered an inadequate workers’ compensation settlement. Your lawyer can help you negotiate the settlement or file an appeal if your workers’ compensation claim is denied.

Contact a Hollister Workers’ Compensation Lawyer

At Cramer & Martinez, LLP, we understand the obstacles that many workers run into when trying to get workers’ compensation. Our team of skilled San Benito County workers’ compensation attorneys can help you with filing a claim, negotiating a settlement, appealing a denied claim, and much more. Call us at 408-848-1113 for a confidential consultation today.

Being a firefighter is one of the most dangerous jobs a person can have. However, traumatic injuries like burns or broken bones are not the only type of medical concern that may afflict a firefighter. Firefighters are also exposed to toxic fumes and carcinogenic substances in the course of their work that can cause cancer. If you are a firefighter who has been diagnosed with cancer, you may be entitled to financial compensation through workers’ compensation.

How Do I Prove My Cancer is a Work-Related Illness?

Workers’ compensation only covers injuries and illnesses that were acquired during the course of employment. Illnesses like cancer can take months, years, or even decades to show up on medical tests. You may wonder how you can prove that your cancer is a work-related illness. Fortunately, firefighters, peace officers, and the Department of Forestry workers are specifically addressed by California workers’ compensation laws.

Per the William Dallas Jones Cancer Presumption Act of 2010, cancer suffered by firefighters and other designated workers is presumed to be work-related. Unless sufficient evidence to the contrary can be shown, cancer is automatically considered a work-related illness for the purposes of workers’ compensation claims. This presumption extends to former firefighters for a period of three months per year of service for a maximum of ten years.

Ideally, workplace accidents would never happen. Unfortunately, even the safest workplaces experience employee injuries. If you were hurt in a workplace accident, you may have questions about your ability to get reimbursement for medical bills and lost income through workers’ compensation. You may wonder, “Can I get compensation if I caused my injury?” Typically, workers’ compensation coverage is “no-fault” meaning that an employee is covered even if he or she was at fault for the accident or injury. However, there are exceptions to this rule.

Criteria for Workers’ Compensation Coverage in California

To know if you can get financial reimbursement through workers’ compensation, you must first determine if you qualify for workers’ compensation coverage. Employers with one or more employees are required to have workers’ compensation insurance per California law. Full-time, part-time, and seasonal employees are covered by workers’ compensation. If you are an independent contractor, you most likely do not qualify for reimbursement through workers’ compensation.

Circumstances of the Injury

Another factor that determines whether you get compensation through workers’ comp is the circumstances of the injury. Normally, fault does not influence an employee’s eligibility for workers’ compensation. If your own mistake caused the accident or injury, you are most likely still covered. However, the injury must have taken place while you were performing work duties.

California 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:

While some professions are more dangerous than others, a workplace injury can happen to anyone. Some work injuries are the result of a one-time incident such as a slip and fall or equipment-related accident. Other injuries are caused by months or years of repetitive stress on certain body parts. Whatever the cause, work-related accidents can incur a significant financial burden on injured workers and their families. Workers’ compensation is intended to relieve this financial burden, however, workers’ compensation is not available to all workers. Supporters of Senate Bill 216 say that the legislation is one step toward making workers’ compensation available to a greater number of California workers.

Supporters of SB-216 Say That Many Contractors Lie About Having Employees

California law requires employers to carry workers’ compensation insurance. However, contractors who do not have employees are exempt from this requirement. Of the nearly quarter-million contractors in California, over half report no employees. However, some believe that many of these contractors are lying. The author of SB-216, California State Senator Bill Dodd, has stated that contractors who falsely claim exemption increase the cost of workers’ compensation for others. This gives the contractors an unwarranted financial advantage over other contractors. Moreover, these falsifications leave injured workers without the protection they deserve. The costs associated with ambulance transportation, hospitalization, and ongoing medical needs resulting from a work injury can quickly add up to staggering amounts. When combined with lost wages from missed work, a serious work injury can nearly bankrupt an injured worker.

Legislation Aims to Provide Immediate Coverage to Workers in Construction, HVAC, and Related Fields

The proposed legislation would immediately require contractors in the heating, air conditioning, concrete, and tree service industries to obtain workers’ compensation insurance. The rest of the licensed contractors in California would need to get coverage by 2025. This would ensure that workers who are hurt on the job have access to the financial compensation they need. Contractors who violate the proposed legislation would be subject to license suspension and even misdemeanor criminal charges.

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:

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: