A workers’ compensation attorney can help if you have a job-related injury or illness. If so, your employer’s insurance company should pay for the expenses. But without legal representation, you may be left paying medical and other costs out-of-pocket. Many people are unfairly denied benefits or get less than they deserve. Our workers’ compensation lawyers work on your behalf to protect your rights and navigate the claims process.
From filing a claim to handling disputes and appeals, your workers’ comp lawyer serves as a guide, representative, and negotiator. They can handle communications with your employer and their insurance company. If your claim is denied, they know the right paperwork to file, procedures to follow, and evidence needed to prove your injury is work-related.
But just when do you need a workers’ comp attorney? The following situations warrant calling The Law Offices of Jacob Emrani for help:
- Your Employer Won’t Pay
- Your Employer Fails to Report the Incident
- You Were Terminated After Being Injured at Work
- You Didn’t Receive the Benefits You’re Entitled To
- You’re Required to Pay Back Workers’ Comp Benefits
- You Are Denied Benefits
- It’s Taking Too Long to Receive Benefits
- Your Employer’s Doctor Doesn’t Communicate
- The Insurer Offers a Lump Sum Settlement
- Your Employer Doesn’t Provide Alternative Work or Modifications
1. Your Employer Won’t Pay
Depending on your injury, payments for medical care, temporary or permanent disability benefits, or supplemental job displacement benefits may be available. Spouses, children, and other dependents may be eligible for death benefits if an employee dies from a job-related injury or illness.
If you’ve been injured at work, report it as soon as possible and fill out the workers’ compensation (WC) claim form your employer provides. If it does not take the proper steps or is uninsured, you can:
- File a civil lawsuit against the company (aside from your workers’ comp claim)
- Report an uninsured employer to the Division of Labor Standards Enforcement
- Pursue benefits from the Uninsured Employers’ Benefit Trust Fund
2. Your Employer Fails to Report the Incident
In California, employers are legally required to report workplace injuries within a specified period. To protect your rights, inform a supervisor or the HR department and keep a written copy of your report. Information such as the date, time, nature of the injury, and who you reported it to is crucial in filing your workers’ comp claim (and for your attorney too). Also, seek immediate medical attention and notify your health insurance company.
If your employer isn’t fully cooperative, you can file a claim independently with a workers’ compensation attorney. They can explain the benefits you’re eligible for and provide advice on settlement options. The more diligent you are and the more evidence you have, the greater the chances your claim will be successful.
3. You Were Terminated After Being Injured at Work
Getting fired due to a workplace injury is not only frustrating but illegal. California law prohibits employers from firing or discriminating against an employee for filing a workers’ compensation claim. A workers’ compensation lawyer can file a wrongful termination lawsuit. It can result in recovering back wages or reinstating your employment.
An at-will employee can still be terminated for legitimate reasons, even if they’re injured. However, retaliation is considered a misdemeanor under state law. If you feel your employer has retaliated against you, a workers’ comp lawyer can help file a 132a claim (there’s a one-year deadline to do so) and gather evidence to link your initial claim and the termination. Aside from your reinstatement and compensation, your employer may face costly penalties.
4. You Didn’t Receive the Benefits You’re Entitled To
If you qualify for benefits, have submitted your application in time, and your benefits have been calculated per the State Disability Insurance (SDI) guidelines, and you’re not paid, you can file a dispute. Your workers’ compensation lawyer can help navigate a dispute on a claim decision or if benefits are delayed. If SDI benefits are issued while your claim is pending, your attorney can help with a lien, so benefits are recovered when the case settles.
It can be difficult to determine if you receive all the benefits you’re entitled to. The workers’ compensation system is complex. Your lawyer can help calculate benefits and break them down by the type of coverage you’re eligible for.
Disability Insurance (DI) claims can be even tougher to navigate. Your lawyer can help file a DI claim and ensure you receive the difference in your weekly benefits if the workers’ compensation amount is less than you’re getting from DI. They’ll also ensure benefits are properly recovered, as both WC and DI shouldn’t be issued simultaneously.
5. You’re Required to Pay Back Workers’ Comp Benefits
In rare cases, injured employees are asked to pay back workers’ compensation benefits. This can be frustrating, especially if your claim wasn’t fraudulent. However, your attorney can help address the situation. Seek legal consultation if your employer asks you to pay back some or all of your benefits. But if a third party, such as a driver, is at fault for your injury, your employer may be entitled to reimbursement from a portion of the settlement it paid you. Again, an experienced lawyer can navigate this process and protect your rights.
6. You Are Denied Benefits
Hire a workers’ compensation attorney if you’re injured at work and denied benefits. One option is to file a DI claim. Your lawyer can also set you up with a physician who can determine if the cause of your injury is work-related. The practitioner must then submit the medical report to your employer’s insurer.
You can appeal a denial of workers’ comp benefits within 30 days of the notice. Your attorney can provide invaluable help in addressing legal matters. They can also forward the dispute to the Department of Industrial Relations, Division of Workers’ Compensation while fighting for your best interests and much-needed benefits.
Conflicts can arise even after you start receiving benefits. Consult with your attorney if your employer tries to stop, reduce, or otherwise modify your benefits at any point.
7. It’s Taking Too Long to Receive Benefits
Delayed benefits can leave employees in financial distress. This is one of the reasons that employers have a legal responsibility to pay workers’ compensation benefits in a reasonable amount of time. Insurance companies are required to resolve claims within 90 days. If the company causes any delays in payments, it can face the following penalties:
- A 10% penalty for late payments
- An up to 25% penalty for unreasonable delays
- Presumption of liability if the insurer or employer doesn’t respond to the claim
An employer can delay or deny coverage in many ways. It may conduct investigations intended to protect an insurer’s interests. An employer or insurer can also face penalties for claiming insufficient evidence, saying a pre-existing condition caused a worker’s ailment, or issuing a medical referral that led to an inaccurate diagnosis.
8. Your Employer’s Doctor Doesn’t Communicate
Working with your employer’s doctor is an important part of managing your claim. If the physician doesn’t communicate promptly, your eligibility for benefits can be affected, especially if crucial deadlines are missed. The doctor must also protect the confidentiality of your information and follow all requirements for authorizing its disclosure.
You have a right to complain if:
- Your refusal to sign an authorization results in discrimination.
- A workplace safety concern or health hazard led to your injury/illness.
- The doctor violated HIPAA privacy rules.
- Your employer refused to provide paid leave due to a disability.
- The doctor says you’re ready to return to work when you’re not.
Disputes regarding medical evaluations can be handled by requesting an independent evaluation by a Qualified Medical Examiner. If you have a worker’s compensation lawyer, you and your employer must consent to an Agreed Medical Examiner. You can file an appeal if your workers’ comp claim is denied based on a physician’s assessment (or a “vocational expert” determines you can return to work before you’re ready). If your employer contests an AME’s formal evaluation, they can be liable for your attorney’s fees.
9. The Insurer Offers a Lump Sum Settlement
Workers’ compensation and disability benefits are typically paid weekly or biweekly. A lump sum settlement is a one-time payment. You can accept it and have immediate access to money. It also ends any legal proceedings and no further medical evaluations are required.
However, if additional funds may be needed later, your condition might worsen, or the settlement is underestimated, consult with a workers’ compensation attorney. They may weigh other settlement options, dispute a disability rating, or fight for a higher settlement amount.
10. Your Employer Doesn’t Provide Alternative Work or Modifications
Being medically cleared to return to work may feel rewarding. However, it doesn’t mean you don’t have medical restrictions. If so, your employer must make modifications to your original job or find alternative work in a different role. The position offered should last at least 12 months. Termination or other discriminatory actions due to a job-related injury or disability are forbidden.
An employer also has the following legal obligations once you return to work:
- Continue disability payments if modified or alternative work can’t be found.
- Provide reasonable accommodations to protect you against further injury.
- Allow access to ongoing medical care for your workplace injury.
How Do I Ensure My Worker’s Compensation Claim Is Successful?
California’s workers’ compensation system is complex. A claim must be filed within one year of your injury and there are other deadlines to follow. There’s lots of paperwork and other formalities. Dealing with so many complexities can be challenging, especially if you’re injured. A workers’ compensation lawyer can navigate all the laws, regulations, and procedures so you don’t miss out on benefits you’re eligible for.
What Does a Worker’s Compensation Attorney Do to Help Me Get Benefits?
Your attorney is your legal advocate. Hiring one from the beginning ensures no details are missed. Your lawyer will help file the claim, send it to your employer, and submit it to their insurance company. Following an investigation, the claim can be accepted or denied. Your attorney will provide updates along the way. They help with access to and preauthorization of treatments; once you’ve reached “maximum medical improvement”, settlement negotiations can begin.
If your claim is denied, you can object to the denial. To do so, your lawyer will prepare an Application for Adjudication of Claim with a Division of Workers’ Compensation office. The office must be located in the county where you live or were injured. An experienced lawyer knows the procedural rules and paperwork required. They will also appear with you before an arbitration judge at a court hearing, and be at your side should your case go to trial.
Call Jacob: Our Worker’s Compensation Lawyers Are Ready to Help
If you’ve been injured on the job, our construction site accident and other workers’ compensation attorneys can help with your claim. Our team has helped people with work-related back, neck, head, and other injuries win fair settlements. Jacob Emrani, our lead attorney, has recovered tens of millions of dollars to compensate injured clients. To schedule a free consultation with our highly rated Los Angeles personal injury law firm, call (888) 952-2952 today.