Workers’ Compensation

In California, nearly 420,000 people are injured on the job in private industry every year. At 3.6 workers for every 100, it’s higher than the national average. Some industries, like construction, manufacturing, transportation, and utilities, have more on-the-job injuries than others.

Whatever your occupation, you have the right to expect that your workplace is safe. Employers are required to ensure a safe workplace whether it’s an office, retail store, or construction site. Creating a safe workplace environment is crucial in preventing workplace accidents caused by slips, trips, falls, overexertion, contact with objects and equipment, transportation accidents, and violence.

When an accident happens, Worker’s Compensation insurance is available to help you get medical care and financial support after an accident while you recover. Because it’s a no-fault system, you won’t have to prove fault for a work-related accident as in a personal injury lawsuit.

As a rule, workers who file for and receive Workers’ Compensation cannot file a lawsuit against their employer, but there are exceptions.

What Is Workers’ Compensation Coverage?

It’s an insurance policy that all businesses in California that have employees are required to carry to protect workers who are hurt on the job. The companies purchase a policy either from a private insurance carrier or from the State Compensation Insurance Fund or be legally self-insured. Some larger businesses choose self-insurance and do not have a policy.

Workers’ Compensation insurance provides medical care and disability payments to an employee after they are injured or become ill in a work-related accident. The goal is to help workers recover and heal for their eventual return to work.

Unlike a personal injury claim, it’s not necessary to prove fault to get benefits. In a work-related accident, your medical care is covered, and you’ll receive a portion of your wages or salary while you recover, based on your earnings. If you are permanently injured and cannot return to work, those disability payments can become permanent.

In some cases, someone is injured or became ill and cannot work in their previous profession, but may be able to work in a different vocation.  Workers’ Compensation also covers supplemental job displacement vouchers that pay for retraining for an employee to move into a different line of work. For instance, a construction worker who is injured and can no longer work in construction may be able to train for another vocation that’s suited to their post-injury abilities, such as IT or project management.

There are also death benefits for families and survivors of a worker who dies from a work-related injury or illness.

Who Qualifies

California requires businesses with one full-time or part-time employee to have Workers’ Compensation. An “employee” is a person employed with a company, and their employment arrangement is:

• Oral or written
• Expressed or implied
• With lawful or unlawful employment

There are exemptions to this requirement:

• Self-employed sole proprietors who can opt to have coverage for themselves
• Independent contractors
• Members of an LLC who don’t work in the business
• Executive officers and directors if they own the business entirely

One exception is roofing, since is one of the most dangerous professions. California requires roofers to have Workers’ Compensation coverage even though they are self-employed to ensure that they can access medical care if needed.

Workplace Accidents

Any type of accident can lead to a variety of injuries and disabilities. The most common are:

1. Construction Site Injuries
2. Electrical Accidents
3. Machinery Accidents, including being struck by and caught in heavy machinery
4. Slip, Trip, and Fall Accidents from slick or dangerous floors with broken flooring, torn carpeting, and other hazards in footpaths and walkways.
5. Falls from heights
6. Fires and explosions
7. Toxic exposures to smoke, chemicals, and other hazardous materials
8. Transportation accidents, from delivery drivers to vans and large trucks, heavy equipment, and public transit
9. Workplace violence and animal attacks, especially between coworkers, or working on a job site outdoors

These are just some of the ways workers can be injured on the job.

Common Work-Related Injuries

Anyone in any industry can experience a work-related injury no matter what their workplace or occupation. Construction, manufacturing, and even healthcare workers can sustain more serious injuries because of the nature of their vocations. The most common are:

1. Musculoskeletal injuries, including strains, sprains, and fractures resulting from slips, trips, falls, or overexertion. For example, a worker may strain their back while lifting heavy objects or suffer a sprained ankle from slipping on a wet floor. This can also include repetitive motion or repetitive strain injuries, such as Carpal Tunnel Syndrome.
2. Cuts and lacerations from sharp objects or machinery while working, such as knives, saws, or broken glass.
3. Burns from exposure to hot surfaces, flames, chemicals, or electrical sources in the workplace.
4. Bruises and contusions from contact with objects or equipment.
5. Traumatic brain injuries (TBIs) result from severe blows to the head, falls from heights, or being struck by falling objects. These can range from mild concussions to more severe, debilitating brain damage.
6. Electrocution, where workers in industries involving electrical equipment can suffer shocks or electrocution if safety protocols are not followed or with malfunctioning equipment.
7. Respiratory injuries: Exposure to hazardous substances or poor air quality in the workplace can lead to respiratory problems, such as asthma, lung irritation, or chemical pneumonitis.
8. Repetitive strain injuries (RSIs): These injuries develop over time due to repeated motions or overuse of certain muscles or joints, such as carpal tunnel syndrome or tendonitis.
9. Crush injuries: Workers may sustain crush injuries if they become trapped or pinned by heavy machinery or objects.
10. Psychological injuries: Workplace accidents can also have psychological effects, such as post-traumatic stress disorder (PTSD), anxiety, or depression, especially if the accident results in serious injuries or fatalities. Note that Workers’ Compensation does cover psychological injuries.

Depending on the type of injury, your employer may also find “light duty” work for your continued employment. Workplace accidents can also lead to fatal injuries.

Do You Need An Attorney For A Workers’ Compensation Case?

Every case is different. Some cases are easily resolved between a worker and a claims administrator with no issues. Others may be more complex and take longer to resolve.

A Workers’ Compensation claim is a long process with lots of paperwork and red tape. One mistake can lead to delays, getting less than you’re entitled to, and even having your claim denied. Your employer may fail to file your claim or make it difficult to obtain benefits. An insurer may stall your claim, request additional proof they don’t need, delay paying you, or not want to pay you at all.

In these cases, an attorney can advise you on your case, and offer information beyond what your employer or Information & Assistance officer may give to you. They can also help ensure that the paperwork is done correctly to avoid these obstacles.

You are entitled to have an attorney for a Workers’ Compensation case. Some reasons to contact an attorney for your Workers’ Compensation claim:

Even if you do not need any help, speaking with a Workers’ Compensation attorney can answer your questions and tell you what you need to know. Most people do not deal with work-related injury claims every day, but an attorney does. He or she can tell you what you need to know before you file your claim and help you understand the process.

For instance, you may not know that you are not required to accept an offer from a claims administrator. You have the right to negotiate for your settlement. If you cannot reach an agreement with the claims administrator, you also have the right to have your claim heard by a Workers’ Compensation judge in a Findings and Award hearing. You’ll receive the judge’s decision in writing later.

Having your attorney means someone is working on your behalf, not your employer or the insurance company. If you’re wondering what it will cost to get help from an attorney—their fees are a portion of your Workers’ Compensation benefits. You do not pay their fees outright as you would for another type of case.

What To Do After An Accident At Work

You need to see a doctor right away. Even if you don’t believe you’re injured, a doctor will check for anything not visible, like a concussion or internal bleeding from injuries that can lead to more serious problems later.

California requires an employer to supply an injured employee with a DWC-1 claim form and a notice of eligibility within one day of the reported injury by an employee. But employees also have responsibilities following a workplace accident:

1. Get medical treatment immediately. If the injury is a life-threatening emergency, head to the emergency room and notify the medical staff that it is job-related. When you are able, contact your employer about the accident and for further instructions. If the injury is not an emergency, get first aid and then see your doctor immediately if needed. Medical treatment is a record that also documents your injuries for your claim.
2. Notify your employer of your injury or illness within 30 days. If the condition develops gradually and over time, report it as soon as you are diagnosed and discover that it is work-related. This is vital to your claim and shows that the injury is work-related. If you fail to report the injury within 30 days, you could lose your right to benefits under Workers’ Compensation.
3. Complete and submit a DWC-1 form. This form is used to file a Workers’ Compensation claim with the California Department of Industrial Relations (DIR). Your employer should provide you with a copy, or you can obtain one
4. Start your file of accident-related information and records. Document the time, place, circumstances, and description of the accident, as well as your injuries.
5. Make sure to keep all medical bills, receipts, and other related documentation in the file. This is for evidence for your claim as well as legal compliance and representation throughout the process. If you need to contact an attorney for your claim or a third-party action, this will make things easier.
6. Consider speaking with a California Workers’ Compensation attorney. Many people have successful Workers’ Compensation claims. Some claims may be more complex and need additional help. If you have questions about the process, an attorney can answer them for you and advise you of your rights in case you have a problem.

A workplace accident can be both painful and stressful. In addition to dealing with your injuries, you have administrative tasks to handle for your Workers’ Compensation claim. Getting the help you need after the accident can make all the difference for your claim and your recovery.

Your Employee Rights Under California Workers’ Compensation

Employees also have legal rights under Workers’ Compensation laws, including:

• The right to file a claim: following an injury, you have the right to file a Worker’s Compensation claim.
• Medical care: for work-related injuries, irrespective of who is at fault for the accident.
• Lost wages: you can receive a portion of your lost wages while you’re unable to work after a work-related illness or injury
• Vocational rehabilitation: if your injury prevents you from returning to your previous job, you may be able to start vocational rehabilitation to train for a different one that you can do.

You have 30 days to report your injury to your employer, who is then required to report the injury to California Occupational Safety and Health Regulations (CAL/OSHA). Employers also have specific rules they must follow when reporting injuries.

Your employer cannot prevent you from filing your claim for Workers’ Compensation. If this happens, you need to speak with our Workers’ Compensation attorneys immediately.

What is a QME (Qualified Medical Evaluator) and why do I need one for my Workers’ Compensation claim?

A QME is a medical professional who specializes in evaluating and determining the extent of a worker’s job-related injury or illness. They have a vital role in determining how valid a workers’ compensation claim is, and the appropriate compensation to be awarded to the injured worker.

What if my claim is denied?

Many claims are denied outright, by either an employer or an insurance carrier, even if they are valid. But it doesn’t mean your claim is invalid, or that you won’t get anything. You’ll need to appeal the decision.

Make sure you continue your medical treatment for your injury under Workers’ Compensation, and keep all bills, receipts, and medical records. Make your report of the accident that led to your injury or illness. Documenting your injury also helps to preserve evidence of your work-related injury, and gives your attorney more evidence to work with for your appeal.

A Workers’ Compensation attorney can help you with the claim, and the appeal, as well as help have your claim accepted by either your employer or the insurance company. Alternatively, we can show the California Workers’ Compensation Board that your claim is work-related and should be paid.

You have rights as an employee, so contact us immediately if you are denied, or need help with your claim.

Can I Sue My Employer?

In some cases, you can. Workers’ Compensation is intended to aid injured workers after an accident as well as prevent lawsuits against employers. If the company does not have Workers’ Compensation, you may be able to get these benefits directly from the company itself.

If you choose to file for and accept Workers’ Compensation, you forfeit the right to sue. But there are limited instances where you may be able to file a lawsuit against your employer:

• The injury doesn’t fall under the Workers’ Compensation rules, such as working offsite or caused by a related or unrelated third party.
• Willful misconduct, in which the employer disregarded the employee’s safety, acting intentionally or with reckless disregard.
• Fraudulent concealment is when the employer knows about a workplace hazard or dangerous condition and intentionally hides this from the employee.
• A defective product that the company manufactured caused your injuries.

If one of these situations applies, or if the company does not have Workers’ Compensation, you may be able to sue your employer. A Workers’ Compensation attorney can advise you on your rights to collect.

Third-Party Claims

What if your work-related injuries were not because of negligence by your employer, but by another party at the job site?

Even if you are awarded Workers’ Compensation, you may also be able to sue another entity for damages related to your injury. This action is separate and can lead to compensation above and beyond what you receive in your claim. You may be able to collect compensation above and beyond what Workers’ Compensation covers.

A third party can be:

• An equipment manufacturer that produced and/or sold equipment
• A subcontractor, such as a security company hired to provide security at a facility or construction site, or a cleaning company hired to clean office areas after hours.
• Other employees, whether for the same company or a subcontractor, at a multi-employee workplace, such as an industrial or construction site.
• A driver (of a vehicle or equipment) that causes an accident while an employee is working
• A negligent property owner responsible for a slip-and-fall or other injury-causing accident

Because a third-party claim is a separate claim for personal injury, the rules are the same as they would be in any personal injury action. As the plaintiff, you’ll have to prove that the injuries occurred in a work-related accident and that the defendant owed you a duty of care. You’ll also have to prove that the defendant breached that duty of care, leading to the accident, and that you suffered financial losses (damages) resulting from the injury.

Be aware that if you pursue a third-party claim and receive a settlement, you will be required to repay your benefits under California Workers’ Compensation laws.

Mistakes that could compromise your Workers’ Compensation claim

It’s important to act quickly after an accident at work to ensure your claim. Document all the details of the accident. Include what you were doing before the accident, how the injury occurred, and what you did immediately after the accident.