1. HOW TO FILE A CLAIM
Question: If I am injured at work do I have to file a claim?
Answer: Yes. If you do not inform your employer and file a claim,
you may be time barred from doing so in the future. If your employer
knows that you have been injured at work, they should file a claim for
you. However, they might simply give you a claim form and ask you to
fill it out and return it to them.
Question: How do I report a work injury and file a claim?
Answer: You should inform your immediate supervisor. Generally, your
supervisor will either file the claim for you or inform those higher up
in the company to do so. If nothing happens, you should report your
injury to your company's Human Resources Department or your manager.
Question: After I file a claim, do I have to go to my employer’s
doctor?
Answer: Usually, yes. In some cases, you can pre-designate a treating
doctor. Pre-designation must be done before you are injured. In most
cases your employer controls your medical treatment for the first 30
days, which means you have to go to the doctor you are assigned for the
first 30 days. After the first 30 days you can change doctors. However,
in most cases, you must choose a doctor that is within your employer’s
Medical Provider Network (“MPN”).
Question: What does my employer do after I file a claim?
Answer:
Your employer contacts its insurance carrier and reports the claim to
them. That insurance carrier will send you letters, including a medical
release, and may contact you to take your statement. The medical
release, if you sign it and send it back, allows the insurance carrier
to obtain your medical records from your doctors. It is generally best
to speak to an attorney before you sign a medical release or give a
statement.
Question: Once I file a claim, how long before my employer
provides me benefits?
Answer: That depends on many factors. First, your employer has 90 days
to accept or deny your claim. Your employer does not have to pay you
anything, including temporary disability, until it accepts your claim.
However, during the first 90 days after you file a claim, until your
employer denies your claim, it must pay for reasonable medical treatment
for your injury, up to $10,000. If your employer denies your claim, it
will not pay any benefits. You should always consult an attorney if your
claim is denied.
Question: Can I be terminated from my job if I have filed a workers’ compensation claim?
Answer: Yes. However, the reason for your termination cannot be related
to your injury or because you filed or requested to file a workers’
compensation claim. You can be laid off while you have a workers’
compensation claim, but you cannot be laid off because you are injured
or have been injured, or because you are on modified duty or light work.
If you are terminated after filing a claim, you should consult at
attorney.
2. MEDICAL TREATMENT AND BENEFITS
MEDICAL
Question: After I file a claim, do I have to go to my employer’s doctor?
Answer: Usually, yes. In some cases, you can pre-designate a treating
doctor. Pre-designation must be done before you are injured. In most
cases your employer controls your medical treatment for the first 30
days, which means you have to go to the doctor you are assigned for the
first 30 days. After the first 30 days you can change doctors. However,
in most cases, you must choose a doctor that is within your employer’s
Medical Provider Network (“MPN”).
Question: How long after I file a claim can I get medical treatment?
Answer: In most case you should see a doctor the same day. If your
employer does not refer you to a doctor, you can go to one and bill your
employer. However, if your employer does refer you to a doctor you
cannot bill your employer for seeing your own doctor. If your claim is
accepted, you have to go to the doctor that your employer sends you to
for 30 days. After 30 days you can change doctors. However, in most
cases, while you can choose your own doctor after 30 days, you have to
choose a doctor that is within your employers Medical Provider Network
(“MPN”). If your claim is neither accepted nor denied, you can get up to
$10,000 in medical treatment, paid for by the employer. After 90 days,
if your employer has not denied your claim, it is deemed accepted by
law.
Question: How do I pick my own doctor within the MPN?
Answer: If you are represented by an attorney, your attorney can
find a doctor for you. If you are not represented, you can contact your
claims adjuster and ask him or her to send you a list of doctors that
are in the MPN. You can then choose one of those doctors. However, not
every doctor listed in the employer’s MPN will be seeing new patients or
new workers’ compensation cases. You need to call the doctor and make
sure that they will treat you before contacting the carrier again and
informing them of the change of doctor.
Question: If I have an injury before 2004 and I have a doctor,
but my employer is trying to force me to choose a new doctor in their
MPN, do I have to?
Answer: No, not always. However, you must very closely review the
notices sent to you to make sure they are right. You should consult an
attorney. The rules regarding MPNs are very technical and, generally,
you will need an attorney to fight this. In some cases, your doctor can
write a letter to the employer, stating that you have a chronic
condition. If accepted by your employer, you may be able to stay with
your existing doctor for up to one year. Again, you should speak to a
lawyer about trying to keep your doctor. Otherwise, your employer can
force you to select a new doctor that is within their MPN.
Question: Can I get medical treatment for a work injury even if I have a prior injury to the same body part?
Answer: Yes. If medical treatment is needed because you have an
on-the-job injury, you can obtain that medical treatment and your
employer has to pay for it. Even if you previously injured the same body
part in an accident at home or away from work or in a work injury for
another employer.
Question: Why can my doctor say I need treatment, but my employer will not authorize it?
Answer: In 2004, the California Legislature passed a law that
allows your employer or its insurance carrier to deny medical treatment
that it does not think is necessary. The system created is called
“Utilization Review” or UR. This system allows your employer to deny
treatment that your doctor recommends. Even if your employer sent you to
a doctor, it can deny treatment recommended by that doctor.
Question: If my employer denies medical treatment that my doctor is
recommending, how can I fight back?
Answer: If you are represented by an attorney, your attorney can object
to the denial and request that you be examined by another doctor to
determine if the treatment is reasonable. If you are not represented by
an attorney, you can object to the denial and request a “panel QME.”
Upon your request, your employer or its insurance carrier will obtain a
panel QME list of three doctors. You can choose one of the three doctors
to examine you and determine if your doctor’s treatment recommendations
are reasonable.
TEMPORARY DISABILITY
Question: What is temporary disability?
Answer: There are two types of temporary disability. One is total
temporary disability (“TTD”) and the other is total partial disability
(“TPD”). TTD is paid when you are unable to work for a temporary period,
due to your injury. TPD is paid when you can work part-time, but not
full-time, due to your injury.
Question: If I am injured at work, how do I get TTD or TPD?
Answer: You must first report your injury to your employer and
then see a doctor. If that doctor takes you off work, you are entitled
to TTD if you cannot work at all or TPD if you can only work part-time.
However, your claim must be accepted by your employer before you will
get either TTD or TPD. Your employer may take up to 90 days to decide
whether to accept or deny your claim. During this 90-day period, you
will not receive either TTD or TPD. Your employer may accept your claim
before the 90 days are up, at which time, you can get TTD or TPD as long
as your doctor says that you should.
Question: When does temporary disability end?
Answer: Either when you are released to return to work or when you are
found to have reached maximum medical improvement (“MMI”), which means
you have healed up about as much as you are going to. At that point, you
may be entitled to permanent disability if you are not 100% better
after you have reached MMI.
PERMANENT DISABILITY
Question: What is permanent disability?
Answer: As with temporary disability, there are two types of
permanent disability. One is permanent total disability (“PTD”). This is
very rare and is paid to injured workers that can never compete for any
job in the future. This person is determined to be totally unable to
work. The other is permanent partial disability (“PPD”. This is paid to
injured workers that can work, but still have some residual effects from
their injury.
Question: How is permanent disability determined?
Answer: First, a doctor evaluates you and determines if you have
completely healed from your injury. If you have not completely healed,
your doctor will state what physical impairment you have and phrase that
as a percentage, between 0 and 100% whole person impairment (“WPI”).
Then, a schedule that is issued the State of California is used to
determine a permanent disability rating. This rating is again, phrased
as a percentage, between 0 and 100%. One the number is determined,
another chart is used to tell you how much money you will receive for
the residual effects of your injury.
Question: Can I work and receive permanent disability checks?
Answer: Yes. Permanent disability checks are very different from
temporary disability checks. You can be working, full-time and still
receive permanent disability checks. These checks are not to supplement
lost pay. They are to pay you because of the residual effects of your
work injury. Even if you return to work, doing the same job with the
same employer, you may be entitled to receive permanent disability
checks.
Question: How is permanent disability paid?
Answer: Generally, it is paid in checks sent to you every two weeks. If
you are injured in 2005 and your permanent disability is 15%, you will
receive approximately $11,110, paid out at a rate of $220 per week or
$440 every two weeks, until your award of $11,110 is fully paid out. You
can work full-time during this period and you will still get this
money. If you completely settle your case, including your right to get
medical treatment paid for by your employer to the injured body parts,
you can have your permanent disability award paid to you in a lump sum.
3. GENERAL QUESTIONS
Question: If I file a claim for a work injury will I get fired?
Answer: No. It is very rare that an injured worker is fired because he
or she filed a claim. If you are fired because you filed a claim, you
can take action in the workers’ compensation court system to obtain back
pay, benefits, and penalties against your employer. However, you must
file a petition in the workers’ compensation court system within one
year of your employer’s bad conduct, or your claim will be barred.
Question: Am I suing my employer when I file a workers’ compensation claim?
Answer: No. Filing a workers’ compensation claim is not a
lawsuit. Your employer is insured against work injuries. The claim you
are making is against that insurance. Even if your employer is a public
entity or is self-insured, your claim is against the workers’
compensation insurance, not your employer.
Settlements
Workers' Compensation Lawyers in Los Angeles, San Francisco, and Fresno California
We help people reach settlements with insurance companies in workers' compensation cases. There are two types of settlements which we will briefly outline.Contact us today to speak with an experienced workers' compensation attorneys.
Stipulated Finding and Award
We help injured workers recover compensation through settlements with insurance providers. One form of settlement is a "stipulated finding and award" in which a specific amount of disability is paid over a period of time. While the weekly compensation is based on the extent of disability, the compensation for medical care is ongoing, and often paid for entirely under this plan.The medical and legal issues in a stipulated finding and award are ongoing and could require legal assistance years and even decades in the future. Our attorneys will be here for you when you need us — today, tomorrow or 20 years down the road. Many firms shun this type of work, but it is one of many services we are glad to offer injured workers in California.
No comments:
Post a Comment