Workers’ compensation is a process by which a person who is injured due to or in the scope of their employment can receive prompt medical treatment and, if necessary, disability benefits to help them get through the injury and get back to work as quickly as possible. The purpose is to make the injured worker whole both financially and physically or mentally. 

 The California workers’ compensation system and its rules and regulations can be very difficult to understand and navigate. The intricacies of the laws can also be very confusing, so having a professional who can provide guidance and sound advice can be beneficial in securing a favorable result in defending your claim. Having a lawyer can bring peace of mind in knowing that your claim will be handled competently and correctly.

A lawyer is not required to settle a workers’ compensation claim. However, it is ideal to have an expert who is well-trained and well-versed in this area of law when negotiating settlement. There are many factors that go in to evaluating settlement and you want to make sure you have an experienced lawyer who can secure a reasonable settlement in your favor.

Typically, the average settlement range is anywhere from $5,000 to $50,000. This seems like a wide range, but it is important to keep in mind that there are many factors that go into how much an employee gets in a workers’ compensation settlement. Every case is different and has its own unique set of circumstances. There are also a wide variety of injuries and they do not all equate to the same value to cover all the considerations within a settlement.

 An unsafe workplace is a work environment where an employee is unable to perform his or her regular duties as a result of physical conditions of the workplace that are deemed too dangerous. These conditions are hazards that can lead to potential injury or death to an employee. Such hazards include erroneous safety procedures, exposed wiring, broken equipment, hazardous materials, or failure to utilize safety equipment or gear. However, California’s workers’ compensation system is a “no-fault” system. Thus, even if a workplace is completely safe, an injury can still occur and the injured employee could still be entitled to workers’ compensation benefits.

Workers’ compensation is typically paid for by an insurance carrier who has agreed, for a fee, to cover losses incurred by an employer when an employee suffers an injury. Workers’ compensation insurance is typically required by law. If an employer is uninsured and an employee is injured, the employer will have to pay the expenses out of pocket. The employer will also be subject to potential penalties and even liens against property if they fail to abide by the Labor Code. 

An employer may dispute a workers’ compensation claim whether they are insured or not. The process of disputing the claim varies from claim to claim as the legal defenses available are circumstantial. Among other reasons, an employer can dispute an injury by denying employment, denying that an injury occurred at work or that it was caused by the work or even by claiming that the employee was intoxicated at the time of the alleged injury. Because the defenses that may or may not be available are so dependent on the circumstances, the best option for an employer questioning the validity of a claim is to request a no cost, no obligation consultation. The time to dispute a claim is limited to 90 days or even as few as 30 days from the date of knowledge of the claimed injury. 

Certain employers or municipalities can be exempted from workers’ compensation insurance. However, this must be approved by the state. The entity seeking exemption must meet certain requirements to be a permissibly uninsured entity. Most employers will not qualify for this. If you don’t know if you qualify for an exemption, you probably do not.

Workers comp protects employers by providing a system that should be followed when an employee is injured at work.  This makes it more difficult for an employee to later claim that they were injured at work, if they do not report the injury at the time, or follow the procedures that are in place.  Furthermore, this works to protect the employer by keeping a record of everything as it is happening.  Finally, through the MPN system, an employer can maintain some control over the medical treatment of the employee. 

The Workers Compensation system is set up to protect the employer from fraudulent claims and also to ensure that legitimate claims have a process that is followed.  The UR/IMR process ensures that all conservative treatment is exhausted before more invasive and costly procedures. The Medical Legal process is set up to ensure there are checks and balances of the treatment provided by Primary Treating Physicians. 

When an injury limits a worker from working, they are entitled to receive temporary disability benefits.  These payments are designed to replace an injured worker’s wages while they are not receiving full wages and are recovering from the injury or illness.  California Labor Code section 4653 calculates temporary total disability as “two-thirds of the average weekly earnings during the period of such disability, consideration being given to the ability of the injured employee to compete in an open labor market.”  This amount comes close to making up the total wages lost because those benefits are not generally subject to income tax.

There are five elements that all must be met to qualify for temporary disability benefits.

1. The employee has a medical disability that precludes them working.
2. The disability is temporary, rather than permanent.
3. The disability is a result of a compensable work injury.
4. The employee lost wages.
5. The wage loss was from the work-related disability.