Maximize the medical care and benefits you’re entitled to!
From industrial injuries to carpal tunnel syndrome, more than a million Californians a year suffer job-related injuries or illness. For many, receiving compensation can be a nightmare.
California Workers' Comp shows you how to handle a California workers' compensation claim from start to finish. Find out how to:
-file a claim
-protect your legal rights
-receive the medical care you need
-get the benefits you're entitled to
-deal with uncooperative employers, doctors and insurance agencies
-negotiate a settlement
-present your case before a judge
The 6th edition is completely updated with the latest regulations, and explains how the new AMA Guides affect your permanent-disability award.
Chapter 2 Overview of a Workers' Compensation Claim - Introduction...
If you've been injured on the job, your workers' compensation claim will stumble and saunter its way through the workers' compensation system. It will seem that all you do is wait for something to happen. When you request medical treatment, you may wait weeks for a response. You may wait for a doctor's appointment, then wait for the medical report. And if you file for a hearing before the Workers' Compensation Appeals Board, you may wait months for your hearing date.
And so it will go. At every turn, it is likely to take months before anything is accomplished. Unfortunately, it probably won't make you feel much better to realize you are not alone. An average workers' compensation case takes two to three years to be resolved. And many cases take much, much longer.
It probably won't come as a surprise that the workers' compensation system is bureaucratic: Lots of forms, reports, and other documents are shuffled through what sometimes seems like an endless maze. Above all, the workers' compensation system is confusing. It's fraught with rules and regulations -- and it sorely lacks understandable information for the injured worker.
This chapter helps take the mystery out of the workers' compensation system by clearly outlining the steps involved in a "typical" workers' compensation case. Inevitably, there will be some variations depending on your particular situation and whether or not you're represented by an attorney. But the basic steps are usually similar in workers' compensation cases.
Death Claims. If you were totally or partially dependent upon someone who died due to an industrial injury, you may have a workers' compensation claim for death benefits. Skip ahead to Chapter 15.
STEP 1. Notify Your Employer of the Injury
If you sustain a work injury, immediately notify your supervisor or boss of the injury at your first opportunity. If your injury developed over a period of time, as with a repetitive stress, or cumulative trauma, injury, notify your employer as soon as you have symptoms and realize you've been injured as a result of your job.
Although you may initially orally tell your supervisor of the injury, it is important that you also give your employer written notice of the injury within 30 days of the injury. This will prevent any misunderstanding about whether or not you reported the injury and will protect your right to workers' compensation benefits.
If you have a union representative, contact that person right away; you may need help obtaining additional benefits that are secured by a union contract. (Your union representative may be instrumental in protecting your legal rights should your employer attempt to terminate you because you can't return to work for a while. Also, some employers may have salary continuation agreements for union members injured at work.)
Make certain that you complete any required in-house accident reports. Also, review any accident reports prepared by your supervisor or employer for accuracy, and obtain a copy for your records. If you disagree with the report, write your employer a letter explaining your position. (Chapter 5 takes you through all the rules and procedures involved with reporting your injury and filing a claim.)
STEP 2. Get Medical Treatment If Needed
It is important to promptly seek medical treatment if needed. Not only will prompt medical treatment protect your health, but it will establish a medical record of your work injury.
If you gave your employer the name of your own doctor before your injury ("predesignated your treating physician," in workers' compensation jargon), you may go to that doctor under certain conditions (see Chapter 9, Section B1).
Synopsis
Maximize the medical care and benefits you’re entitled to!
Table of Contents
Part I: All About Workers' Compensation
1. Introduction to Workers' Comp
2. Overview of a Workers' Compensation Claim
3. Is Your Injury Covered by Workers' Compensation?
4. Cumulative Trauma Disorders
Part II: Protecting Your Rights
5. What to Do If You're Injured
6. Keep Good Records to Protect Your Claim
7. The Insurance Company's Role
8. Dealing With Your Employer
9. Taking Charge of Your Medical Case
10. Medical-Legal Evaluations
Part III: Workers' Compensation Benefits
11. Medical Benefits
12. Temporary Disability Benefits
13. Permanent Disability (and Life Pension)
14. Vocational Rehabilitation/Supplemental Job Displacement Benefit
15. Death Benefits
A. Who May Receive Death Benefits
B. Death Benefit Amount
C. Additional Payments for Dependent Minor Children
D. Burial Expense for Deceased Worker
E. Unpaid Temporary or Permanent Disability Payments
F. How Death Benefits Are Distributed
16. Extraordinary Workers' Compensation Benefits and Remedies
17. Benefits and Remedies Outside the Workers' Compensation System
Part IV: Settling Your Case
18. Rating Your Permanent Disability
19. Figure Out a Starting Settlement Amount
20. Negotiating a Settlement
Part V: The Workers' Compensation Appeals Board
21. Preparing Your Case
22. Arranging for a Hearing or Trial
23. How to File and Serve Documents
24. Going to a Hearing or Trial
25. Appealing a Workers' Compensation Decision
Part VI: Beyond This Book
26. Lawyers and Other Sources of Assistance
27. Legal Research
28. Case Law Review
CHAPTER 3-IS YOUR INJURY COVERED BY WORKERS' COMPENSATION?
CHAPTER 5-WHAT TO DO IF YOU'RE INJURED
CHAPTER 9-TAKING CHARGE OF YOUR MEDICAL CASE
CHAPTER 10-MEDICAL-LEGAL EVALUATIONS
CHAPTER 11-MEDICAL BENEFITS
CHAPTER 12-TEMPORARY DISABILITY BENEFITS
CHAPTER 13-PERMANENT DISABILITY (AND LIFE PENSION)
CHAPTER 14-VOCATIONAL REHABILITATION/SUPPLEMENTAL JOB DISPLACEMENT BENEFIT
CHAPTER 15-DEATH BENEFITS
CHAPTER 16-EXTRAORDINARY WORKERS' COMPENSATION BENEFITS AND REMEDIES
CHAPTER 18-RATING YOUR PERMANENT DISABILITY
CHAPTER 19-FIGURE OUT A STARTING SETTLEMENT AMOUNT
CHAPTER 20-NEGOTIATING A SETTLEMENT
CHAPTER 21-PREPARING YOUR CASE
CHAPTER 22-ARRANGING FOR A HEARING OR TRIAL
CHAPTER 24-GOING TO A HEARING OR TRIAL
Appendixes
A1: Workers' Compensation Offices
A2: Temporary Disability Benefits Compensation Chart
A3: Permanent Disability Indemnity Chart
A4: Maximum Life Pension Weekly Payments for Injuries Between 7/1/96 and 12/31/02
A5: Workers' Compensation Forms
Forms to File With the Division of Workers' Compensation
DWC-1: Workers' Compensation Claim Form
Application for Adjudication of Claim
Declaration in Compliance With Labor Code Section 4906(G)
Declaration of Readiness to Proceed
Declaration of Readiness to Proceed to Expedited Hearing Trial
Pre-Trial Conference Statement
Notice of Change of Address
Proof of Service
Cover Letter to Workers' Compensation Appeals Board
Record-Keeping Forms and Worksheets
Record of Income and Benefits Received
Record of Time Off Work
Record of Medical Expenses and Request for Reimbursement
Record of Mileage & Transportation and Request for Reimbursement
Settlement Worksheets and Documents
Settlement Worksheet: Value of Workers' Compensation Claim
Stipulations with Request for Award
Compromise and Release
Forms to File With Your Employer
Employee's Designation of Personal Physician
Letter to Employer Requesting Copies of Documents and Evidence
Reviews
Orange County Register...
"A great hands-on guide for dealing with workers’ compensation cases."
Orange County Register
About the Author
Attorney Christopher A. Ball is the author of California Workers' Comp: How to Take Charge When You Are Injured on the Job, now in its fifth edition. Since 1991, Mr. Ball has practiced workers' compensation law exclusively. He is certified as a Worker's Compensation Specialist with the State Bar of California. Mr. Ball received his bachelor's degree in Business Administration from Long Beach State in 1972 and graduated law school from Western State School of Law in 1975.