Workers’ Compensation Information
A Little Background
A work injury may be the result of a single incident or the result of repetitive work activities over a period of time called a cumulative trauma injury (CT injury). For example, a person whose job requires lifting heavy objects may develop back or neck pain due to repetitive trauma on the job. Another example would be a person whose job requires repetitive motion of the hands or wrists such as assembly work or typing at a computer. This worker might develop carpal tunnel syndrome or repetitive use syndrome of the hands or wrists, and this would also be a work injury entitling a person to the same benefits as if it had been a specific injury.
An incident or activity on the job which aggravates a previous injury or condition is also considered a work injury. An example of this would be an employee who has had prior back problems and then re-injures the back while lifting on the job. That person is entitled to work injury benefits for the reinjury.
Death benefits payable by the insurance carrier are payments to a spouse, children or other dependents if an employee suffers a fatal work-related injury or illness. Death benefits include reasonable burial expenses as well as payment of death benefits depending on the number of total and/or partial dependents.
The Workers’ Compensation Appeals Board is the court, which handles workers’ compensation cases. Workers’ compensation judges determine if settlements are fair and decide the contested issues which are presented to them at hearings. The process can be long, confusing and frustrating for the injured worker. The following is brief summary of the process.
The work injury must be reported to the employer. If you are injured on the job, you must fill out a claim form which the employer must provide to you within 24 hours of reporting your injury. By accepting the claim form, the employer is not admitting the injury.
Under California workers’ compensation law, the employer has 90 days to accept or deny the claim. The employer can take up to 90 days to investigate a work injury claim and during that time, the employer may be allowed to take the injured worker’s statement or have the injured worker examined by a doctor and obtain your medical records. For injuries after January 1, 2005, the employer must pay for medical care up to $10,000 during the first 90 days. If an injured worker is unable to work during the 90 day discovery period and has been certified temporarily disabled by a medical doctor, you may be entitled to receive state disability benefits through the Employment Development Department. The EDD office will file a lien in your workers’ compensation case to recover reimbursement of the benefits they paid.
If the claim is accepted, the injured worker can select a treating doctor from the employer’s medical provider network (MPN) and be provided with temporary disability benefits. Once the injured workers’ condition reaches permanent and stationary (P & S) or maximum medical improvement (MMI), they will be evaluated to determine the level of partial or total permanent disability.
The evaluation of partial permanent disability (PPD) is done by a Qualified Medical Examiner (QME). The evaluation is done pursuant to the AMA Guides used in California and many other states. The selection of a QME doctor from a three-panel list is very important because that is the doctor whose opinion will be used to determine the extent of permanent disability and the date the injury plateaus or reaches P&S/MMI (when the temporary disability ends). Call Fowler & Ball for a free consultation before selecting a QME doctor from a three-panel list.
If there are issues of injury, entitlement to temporary disability, compensation rate, the extent of PPD, or any other dispute, the contested issue will be submitted to a workers’ compensation judge who will evaluate the evidence presented and issue a decision.
After the judge issues a decision, either side may appeal to the Workers’ Compensation Appeals Board, which is a state-appointed court made up of seven appointees (appointed by the Governor) established for the purpose of reviewing the decisions of workers’ compensation judges. After this process, in some instances, the cases may be appealed further either to the Court of Appeal or the California Supreme Court.