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workerscom304   , 27

from Carson




As part of the compromise, employees in most instances lost the right to sue their employers for negligence resulting in injury, illness or disability. In return, employees generally receive payment from workers' compensation without regard to fault as long as the injury, illness or disability was related to work. The question of what is work-related is not always simple. Even horseplay at work may be considered work-related in some instances.

Any time a serious injury occurs while at work, it is advisable to talk to a lawyer. Some workplace accidents may permit the injured party to sue a third party e.g., product manufacturer, land owner or someone other than the employer who contributed to the injury. There are also special laws in California that offer additional protection to certain workers such as workers at a construction site. Consultation with a lawyer is essential any time there is a serious injury. Lawyers who represent injured persons do not charge any consultation fee and do not charge the client a fee for their efforts unless money is recovered.

In California, employers are required to have workers' compensation insurance. The employer is required to pay for the insurance, and employees cannot be required to contribute to the cost of the insurance policy. A workers' compensation insurance company may accept a claim, contest a claim, or contest part of a claim filed by an injured worker. If you are injured while working for a company that does not have workers compensation insurance then you will be protected by a special fund set up in California State to protect such workers, the Uninsured Employers Fund.

The Workers' Compensation Board is the state agency that decides claims filed under the Workers' Compensation Law. The Board has offices throughout California State. The Board functions similar to a court, providing Workers' Compensation Law Judges to decide disputes between injured workers and insurance companies. The Board does this either by holding hearings or by issuing written decisions based on paperwork filed by the injured worker, the treating doctors, the insurance company, and the insurance company's medical consultants. Recently, there has been a trend to issue Administrative Decisions. Often, there are many mistakes in these administrative decisions and they must be objected to within a set time period. For this reason, it is even more crucial to consult with a workers compensation attorney.

Hearings are held at the Workers' Compensation Board before a Workers' Compensation Law Judge. The insurance company will be represented by an attorney or other insurance company lawyer who is trained to appear at hearings. Court reporters are present to take down what is said at the hearing. Many injured workers retain attorneys to represent them in workers' compensation claims. A workers' compensation attorney is not permitted to charge a fee or to take money directly from a workers' compensation claimant. If the claim results in an award of benefits, the attorney will generally request that a fee be approved by the Workers' Compensation Board. The fees vary based upon the jurisdiction and the law judge, but is generally 15% of the monies that the attorney obtains, over and above what is paid voluntarily by the insurance company.

A claim for an accident must be filed by the injured worker with the Workers' Compensation Board within two years of the incident or condition that caused the injury, illness or disability, unless the failure to file is excused for certain limited reasons. Notice must be given to the employer within 30 days of the accident. There are exceptions to the 30 day requirement if the claim is an "occupational" or "repetitive trauma" claim. A person may seek workers' compensation and also bring a lawsuit against other parties who contributed to causing the injury.

What is an "accident" To be covered under the Workers' Compensation Law, an accident must arise in and out of the course of the employment. By way of example, accidents suffered while traveling to and from work are generally not covered, subject to certain exceptions, for example if you do not work at a fixed location, such as a visiting nurse, or salesman. In other words, just because you are sitting at your desk at work and have a heart attack, does not mean you can file for workers compensation--the reason for the heart attack must arise out of the employment. For example, before sitting at the desk you lifted 10 cases of copy paper or you were under unusual work-related stress that day.

What is "notice"?

The law requires the injured worker to give the employer an oral or written report of the accident within 30 days of the accident. This requirement is often excused by the Workers' Compensation Board where it is shown that the employer had knowledge of the accident within the 30-day time period.

What is causal relationship?

In order to establish a case, the injured worker must have a medical report stating that a work-related accident or condition was the cause of the injury, illness or disability. Without a medical report stating this, the Workers' Compensation Board will not consider the case.

An occupational disease is a condition which is caused by the specific type of job over a period of time. For example, a person who works as a typist may, after a period of weeks, months, or years, develop a problem with their hands or wrists. A person who does heavy lifting on a daily basis may develop a back problem over the course of time as opposed to one specific incident or accident. An occupational disease may also result from being exposed to a substance typical to your job over a long period of time. An example of this type of occupational disease would be lung disease as a result of working with asbestos, or hearing loss as a result of loud noise at work.

The notice and claim filing time limitations in occupational disease cases are very technical, and depend on factors including the date of first medical treatment, the date of first lost time from work, and the date that you knew or should have known that your problem was work-related. It is up to the Workers' Compensation Board to decide whether any particular claim for an occupational disease was filed timely.

One is average weekly wage. What your average weekly wage is generally depends on what you earned with your employer in the year before your accident, although adjustments may be made if you were under the age of 25 when injured, if you did not work for a full year for the employer before your accident, or if you had more than one job. The most that an employee can receive in workers' compensation is two-thirds of his/her average weekly wage up to the maximum compensation rate as of the date of accident. It also depends on the date of your accident. In that case, the worker may receive cash benefits from the first work day off the job. Necessary medical care is provided no matter how short or how long the length of the disability.Claimants who are totally or partially disabled and unable workers compensation law here to work for more than seven days receive cash benefits. The amount that a worker receives is based on his/her average weekly wage for the previous year.

The following formula is used to calculate benefits:2/3 x average weekly wage x % of disability = weekly benefit Therefore, a claimant who was earning $400 per week and is totally 100% disabled would receive $266.67 per week. A partially disabled claimant 50% would receive $133.34 per week.While it is not illegal to work at reduced earnings and collect workers' compensation benefits, it is illegal to conceal or fail to report work activity to the workers' compensation insurance company. Only doctors and chiropractors who are coded by the Workers' Compensation Board may treat compensation patients. Doctors and chiropractors are not permitted to bill a compensation patient directly but must send their bills and reports to the insurance company and the Workers' Compensation Board. If there is a dispute regarding a medical bill, the insurance company must file a form with the Compensation Board advising it of the dispute.

The bill will then be addressed at a hearing or sent to arbitration, but while it is pending the health care provider must wait to be paid. A workers' compensation claimant should never pay a health care provider for a medical bill for treatment related to the workers' compensation case.If a doctor or chiropractor requests a test or procedure which will cost less than $500, no advance approval from the insurance company is required. If the test or procedure will cost $500 or more, the insurance company is entitled to obtain an opinion from one of their own medical consultants as to whether the test is necessary. With awards of this type, weekly benefits paid while you are out of work may be deducted from your final compensation award.

Depending on the type of injury, you may only be entitled to compensation for time out of work or lost earnings. In either event, you must work injury lawyer office see a doctor at least once every six weeks in order to prove that you are still disabled.