Workers' Compensation Overview
The law firm Amos, Dittrich & Ushana devotes a majority of its practice to assisting Central and Northern California employees in workers' compensation claims. If you have been hurt on the job, or suffer from a work-related disability or illness, please contact our offices in Salinas and San Jose for a free initial consultation. Se habla español.
Understanding Workers' Compensation Benefits
Employers are required by California law to pay for workers' compensation benefits when employees get hurt or sick because of work. Workers' compensation is a no-fault system, which means that you do not need to prove that your injury was caused by another person in order to receive benefits. This also means that you may be compensated even if you were at fault in the incident that led to your injuries. Six basic benefits are provided by an employer's workers' compensation insurance:
- Medical care - Medical care must be paid for by your employer to help you recover from an injury or illness caused by work. Doctor visits, hospital services, physical therapy, lab tests, x-rays, and MRIs are some of the many medical services that may be provided. Services should be necessary to treat or cure your injury.
- Temporary disability benefits - Your employer will provide payments if you lose wages because your injury prevents you from working. The amount you get is up to two-thirds of your pre-injury wages. You will be paid every two weeks, if you are eligible, for a maximum of 104 weeks within five days of the date of your injury. Temporary disability stops when you either return to work, when the doctor releases you to work, or the doctor says you have reached maximum recovery. If benefits are delayed, denied, or ended, you may file a claim with the Economic Development Department and receive State Disability.
- Permanent disability benefits - If you are permanently and totally disabled from all types of employment, and not merely the position that you held before your injury, you may be eligible for permanent total disability benefits, as well as Social Security disability benefits. If you are able to return to work but have a permanent disability, you may be entitled to a settlement or payment for your permanent partial disability.
- Supplemental job displacement benefits - If your injury occurred in 2004 or later, these vouchers help pay for retraining or skill enhancement if an employee does not completely recover and does not return to work for his or her employer.
- Vocational rehabilitation - If your injury occurred before 2004, vocational rehabilitation benefits cover job placement counseling and possibly retraining if an employee is unable to return to his or her previous job and the employer does not offer other work.
- Death benefits - If you die, your employer may make payments to your spouse, children, or other dependants. The amount of your payment is based on the number of dependants. Temporary Disability benefit is paid every two weeks. In addition, workers compensation provides a burial allowance.
Types of Work-related Injuries
A work-related injury or illness may be the result of a single incident, such as a fall or equipment malfunction, or repeated exposures at work, such as constant loud noise and repetitive motions. For example, a delivery driver may be hurt in a car accident, while an office worker may develop eyestrain and carpal tunnel syndrome resulting from computer use and typing. Please see our industry-specific pages for more information about different types of injuries:
- Construction Workers
- Agricultural Workers
- Office Workers/Repetitive Injuries
- Health Care Workers
- Third-Party Injury Claims
Reporting an Injury
If you have sustained an on-the-job injury, been involved in a workplace accident, or discovered that an illness or ailment stems from a work-related task or workplace environment, you must report your injury to your employer or supervisor as soon as possible. Prompt reporting helps avoid problems and delays in receiving benefits, and is often the first step to building a successful benefits claim. If you fail to report your injury or ailment within 30 days of the incident or discovery, you may jeopardize your ability to receive maximum workers' compensation benefits.
Please see our workers' compensation help center page for more information about reporting an injury.
Filing a Claim
After being informed of your injury, your employer must give or mail you a Workers' Compensation Claim Form within one working day after you report your injury or illness. It is important to read all of the information that comes with the claim form, and then fill out and sign the "employee" portion of the form, being sure to fully describe your injury and include every part of your body affected by the injury. When you give the completed form to your employer, you have officially "filed" your claim.
Even at the onset of preparing a workers' compensation claim, the process can be slow and confusing if you do not know exactly what documentation and reporting is necessary to support your claim. Furthermore, if information is missing or inaccurate, it is more likely that your claim will be delayed, denied, or questioned.
At Amos, Dittrich & Ushana, our attorneys possess an in-depth knowledge of the claim process in Monterey and Santa Clara County. We will work tirelessly to protect your rights, gather information to support your claim, plan a strategy for your case, keep track of deadlines, and effectively represent you in workers' compensation hearings.
Receiving Medical Care
In cases of medical emergencies, your employer must ensure that you have access to emergency treatment right away. For non-emergency care, the claims administrator is required to authorize treatment within one working day after you file your claim form. While investigating your claim, your employer must authorize necessary treatment up to $10,000. If your employer's claims administrator does not authorize such treatment, speak to your supervisor, or other management, or the claims administrator. If immediate treatment is still not authorized, use your own health insurance to get medical care, or go to a doctor, clinic, or hospital that will treat you without immediate payment. The healthcare provider will seek reimbursement from your employer's claims administer.
Seek Experienced, Caring Representation
The goal of the workers' compensation system is to avoid lawsuits and to ensure that employees receive prompt and effective treatment for on-the-job injuries; however, sometimes disputes arise over issues such as the actual cause of the injury or the amount of benefits available. We counsel clients through every stage of the claims process, always working to ensure that injured workers and their families receive the full amount of benefits to which they are entitled under the law. If you have suffered a work-related injury, do not hesitate to contact Amos, Dittrich & Ushana and set up a free initial consultation. Se habla español.