WORKERS’ COMPENSATION

Sacramento California Workers Compensation Attorneys

Mehlhop & Vogt Help Injured Workers in California

A workers compensation injury is defined in California’s Labor Code Section 3208 as any injury or disease arising out of employment. It can be physical or mental (non physical) harm. To be compensable the injury must produce disability or medical treatment more than first aid.

Workers compensation benefits are usually the exclusive remedy available to the injured worker. The system is designed to compensate injured workers for disabilities that occur on the job and to provide medical treatment that is reasonable and necessary to cure or relieve the effects of an injury.

An injured worker does not have to prove anyone was at fault for causing the injury. The trade-off for the employer is there are limited damages payments that are set forth by statute. No compensation is paid for pain and suffering and other general damages like those in personal injury lawsuits. However, wages are paid while the injured worker is off work, and in some instances, additional permanent compensation or job retraining are available.

California Worker compensation Law

The Law passed by the state Legislature more than 85 years ago, guarantees prompt, automatic benefits to workers injured on the job. Before workers’ compensation, injured workers had to sue their employers to recover medical costs and lost wages. Lawsuits took months and sometimes years. Juries and judges had to decide who was at fault and how much, if anything, would be paid. Too often, the injured worker got nothing. It was costly, time consuming and unfair.

Today, workers’ compensation is faster and fairer. If you cannot work because of a job injury, workers’ compensation pays your medical bills and provides money to help replace your lost income until you can return to work.

• California Workers Compensation
• Workers Compensation Benefits
• Temporary & Permanent Disability
• Medical Treatment
• Vocational Rehabilitation
• Medical/Legal Evaluations
• Settlement
• Hearing, Conferences and Trial
• After Settlement

SB 899 (for injuries occurring after 4/19/04)
Frequently Asked Questions

Sacramento Workers Compensation Attorneys

SB 899 (for injuries occurring after 4/19/04)

Senate Bill 899 was enacted into law on April 19, 2004. The following is a summary of some of the important changes in the law resulting from this bill.

• Pre-Designation of Physician – Any employee who is covered by a group health plan is allowed to pre-designate a treating physician (MD only) of his or her choice. The doctor must have previously been the worker’s primary care physician, and must agree to be pre-designated. A worker can begin treatment immediately after the injury with a pre-designated doctor. This section of the law expires in three years. The maximum number of employees who may pre-designate a treating physician at any one time in the state is 7 percent.
• Claim Form/Immediate Medical Treatment – Employers must authorize medical treatment within 24 hours after an employee files a claim form, until the claim is accepted or rejected, up to a maximum of $10,000.
• Medical Treatment if no Pre-Designation MPN – As of Jan. 1, 2005, the law provides for indefinite control of treatment by an employer when it has set up an approved network of medical providers. There will be no free choice of doctor because an injured worker may only select an alternative doctor from within the network. If there is no approved network of medical providers, then the law provides for a 30-day period of treatment control by the employer.
• Medical Disputes in Network – Employee may seek the opinion of two additional physicians within the network, if treatment is denied by the first physician. If disputes still exist, the employee may request an Independent Medical Review (IMR) from the Administrative Director (AD).
• Repeal of Treating Physician’ Presumption of Correctness – The “presumption of correctness” for a treating physician was totally repealed for all cases regardless of the date of injury.
• Treatment: “Cure and Relieve” – The definition of “cure and relieve” has been amended to mean treatment consistent with utilization guidelines adopted by the legislature last year. This will result in an increase in delays and denials of recommended medical treatment. The law now specifically limits the number of physical therapy, chiropractic care and acupuncture visits to a maximum of 24 each, for any injury that occurs after January 1, 2004.
• Permanent Disability, Injury AOE-COE, and other Medical-Legal Disputes – Employees go through a revised medical dispute resolution process (AME/QME process). The process differs if an attorney represents the worker. If represented by an attorney, then the employee and the employer can agree to an Agreed Medical Examiner to resolve disputes. If the employer and employee cannot agree on an AME, then the Administrative Director will provide a panel of three Qualified Medical Examiners. Each side may strike one panelist, and the remaining doctor will make the determination. Employees not represented by an attorney must pick from a random panel of three physicians. Watch out! If an employee does not choose a doctor from the panel within 10 days, then the employer picks the doctor. No other doctor’s report can be obtained, even if an attorney is hired later, limiting an injured worker’s’ right to obtain benefits.
• Cap on Temporary Disability (TD) Benefits –
  The law now places a 2-year cap on TD benefits from the first date of payment, from most injuries on or after April 19, 2004. There are a few exceptions to this rule in the rare circumstances that a worker has one of a few specified injuries, such as an amputation or a severe burn. In those cases, temporary disability benefits will be limited to a total of 240 weeks, and even then are only payable within the first five years after the injury date.
• Permanent Disability (PD) Schedule – The existing schedule for injuries after Jan. 1, 2005, or for injuries before April 30, 2004, without a report indicating the existence of permanent disability before 2005, has been revised. The new schedule incorporates the 5th Edition of the American Medical Association (AMA) Guidelines and empirical wage loss data from the RAND Institute study. The language pertaining to an employee’s “decreased ability to compete on an open labor market” has been eliminated and replaced with “diminished future earning capacity.” This new schedule will be released near the end of 2004.
• Apportionment of Permanent Disability – Doctors are now required to apportion to causation of permanent disability and injured employees must now disclose previous disabilities upon request. Employers are liable only for the portion of PD caused by the workplace injury. A prior compensable injury is now presumed to exist at the time of a subsequent injury, but that presumption is one that only affects the burden of proof. Total awards may not exceed 100% for any one region of the body.
• Vocational Rehabilitation – Vocational rehabilitation is available (until January 2009) for injuries before Jan. 1, 2004. Vocational rehabilitation is abolished for injuries after Jan. 1, 2004, except for limited educational vouchers, significantly reducing return to work assistance through workers’ compensation.
• Alternative Dispute Resolutions – Alternative Dispute Resolutions (ADRs) are allowed for all employees covered by a collective bargaining agreement. Attorneys are allowed at all stages of the proceeding.
• Labor Code 5814 Penalties – These fines are imposed on employers and insurers that unreasonably delay or deny benefits. The existing penalty structure is substantially amended: Penalties are up to 25% with a $10,000 cap. (This penalty is based on the actual amount unreasonably delayed or denied, rather than the entire class of benefits. For example, the penalty would be imposed on the one late TD payment, rather than all TD benefits.) Late payments to a medical provider would constitute a 5814 penalty if they result in serious harm to the worker (such as not receiving necessary treatment). Employers can “self-correct” errors they discover by making the corrected payment – plus 10% – provided they act before a 5814 complaint was filed. 5814 penalties are now subject to a 2-year statute of limitations, and are presumed resolved when cases are resolved unless specifically noted. In most cases, penalties are greatly reduced.
• Retroactivity – SB 899 takes effect immediately. Unless otherwise indicated in the statute, it applies prospectively from the date of enactment – April 19, 2004 – regardless of the date of injury.

Workers Compensation Lawyers Sacramento CA

Frequently Asked Questions

1) What is the amount of attorney fees in a workers’ compensation claim?

There is no charge for the initial consultation in a workers’ compensation claim. Attorney fees are payable on a “contingency basis.” This means that if there is no recovery there is no fee. The attorney receives a percentage of the settlement or award at the end of the case. If a person chooses to be represented by an attorney, the attorney fees will be deducted from the settlement at the end. Attorney fees are normally 15% of the benefits awarded.

2) Am I entitled to other benefits?

If you have an injury or illness serious enough to prevent you from returning to work, you may be eligible for Social Security disability if you have been off work for 5 months or more. To qualify, you must have paid into the Social Security system in 20 of the last 40 quarters, and are likely to be off work one full year or longer. If you feel this applies to you, contact an attorney for more information.

Public employees who have retirement programs other than Social Security, may be eligible for disability benefits under the Public Employee Retirement System (PERS), State Teachers’ Retirement System (STRS) or county, city or other retirement systems. Under certain situations you may also be eligible for State Disability Insurance, Unemployment Insurance, Long Term Disability etc.

3) The insurance company is providing all benefits, should I wait to hire an attorney?

Unfortunately, many injured workers wait until it is too late, or a crisis has occurred, before they consider hiring a workers compensation lawyer in Sacramento CA. The injured worker should consider the following facts:

• The insurance company’s interests are not the same as those of the injured worker.
• The workers’ compensation system is highly complex, with many procedural requirements and time limitations.
• The insurance company has attorneys who represent their interests regarding the extent of your workers’ compensation benefits.

If an injured worker retains an attorney, there is no charge for the interview or for any services along the way. The attorney fee is 15% on all cases.

Injured workers usually consider retaining an attorney if they feel they are at a disadvantage in dealing with the insurance company, or any time that benefits are being denied. An injured worker should also consider having an attorney when they are going to have a need for continuing or lifetime medical care, or if they are going to end up with a permanent disability.

If a worker has a permanent disability but does not have an attorney, they are required to select a doctor off of a three doctor panel. The claim will be resolved based upon that doctor’s report. Unfortunately, if the worker does not agree with this doctor’s opinion, they do not then have the right to get a second medical opinion. Essentially, the injured worker is stuck with that doctor’s opinion. However, if the injured worker is represented by an attorney, the attorney can refer the worker to any qualified medical examiner. The attorney can select a doctor who will listen to all of the symptoms of the injured worker and prepare a report for the injured worker, not the company.

If the injury was caused by the negligence of someone other than the employer or a co-employee, an injured worker should consult with an attorney as soon as possible following an injury. In that case, an injured worker may have the right to bring a personal injury action in addition to a workers’ compensation claim. There are strict time guidelines in which a claim would have to be brought. Merely because a person is continuing to receive workers’ compensation benefits does not mean that the statute of limitations against the negligent party does not run. As a result, it is extremely important that an attorney be consulted in those types of cases.

4) What Is the Statute of Limitations?

If you are injured at work, you must file for Workers’ Compensation within the Statue of Limitations, which are strict time limits set by law. Although there are many exceptions, the Statute of Limitations generally is one year from the date of injury. If you delay, or fail to report a work-related injury or illness, no matter what kind or how severe, your benefits may be delayed or denied. Because changes in the law have become effective different times, there may be different time limits depending on the date of injury.

During your case, you will receive notices from your employer. You must respond to these notices before the deadline, or benefits may be severely affected. There are many exceptions to the Statues of Limitations in Workers’ Compensation. If in doubt, consult an attorney.

Contact Sacramento Workers Compensation Attorney for Help

Have you suffered a serious work injury? Contact our Sacramento workers compensation attorney for FREE consultation about your California workers compensation claim benefits. We’ve been helping injured workers since 1987 and are certified by the State Bar of California.

Give us a call at (916) 930-9675 to speak to a work comp attorney in Sacramento now.