The Laws and Regulations have dramatically changed in workers’ compensation.
The changes that have occurred have made it tough to navigate and handle
a workers’ compensation claim.
When one is injured on the job, it is crucial and necessary to report the
injury to one’s employer, manager, supervisor or person in charge.
A special form must be completed at the time/moment of injury, or the
claim does not technically exist. An attorney can make sure the proper
paperwork is completed and, in addition, not barred by any statute of
The next step is to obtain proper medical attention. Typically, the injured
worker is sent to the employer’s industrial clinic. Most are ill-equipped
to deal with many medical conditions, and this is where an attorney is
necessary to make sure the injured worker is sent to the proper doctor.
Furthermore, almost all treatment goes through a Utilization Review (UR)
by a physician who does not examine the injured worker. If treatment is
denied, certain paperwork must be submitted to appeal and request an Independent
Medical Review (IMR)—which must be submitted in a certain time period
or the treatment will not be authorized. The IMR is a process where another
doctor, who does not examine the injured worker and is anonymous, gets
to decide whether the treatment is allowable. It is important that all
proper paperwork and documentation be submitted timely. Again, if not
done properly and timely the request is denied, and this denial of treatment
is effective for twelve (12) months unless there is a change in circumstances.
Another issue affecting injured workers is whether they are getting paid
at the proper temporary disability (TD) rate while off work undergoing
medical treatment. The average weekly wage upon which the rate is based
should include overtime, concurrent employment, and additional benefits
such as meals, tips, etc. Many times insurance companies fail to consider
the additional sources of income in their compensation rates.
Understanding Your Settlement
One of the most important reasons an attorney may be necessary for a workers’
compensation claim is at the time of settlement. Settlements are based
on permanent disability (PD) ratings, and an attorney can ensure that
all aspects of the claim are considered. Also, there are additional issues
that can be added to the settlement value, such as a settlement for future
medical treatment or assessment of additional benefits, which increase
Lastly, if one is unable to return to their usual and customary vocation
and they are not provided modified or alternative work, they may be entitled
to a voucher authorizing them to undergo retraining for a new occupation.
There is also additional money from the State of California and other
resources that an attorney will seek to make available to their client.
Please consider this, the insurance company or third-party administrator
of a self-insured company is a business, which seeks to conclude each
claim in a cost-effective fashion benefitting their bottom-line.
When selecting an attorney, you should look for one who specializes in
workers’ compensation law, specifically, a Certified Specialist
in Workers’ Compensation. An attorney will usually charge 15% of
the final settlement, which is paid out by the insurance company. Beware
of television and radio ads for attorneys; they typically send non-attorneys
to your home to sign you up and rarely do you speak with an attorney.
It is important to talk with an attorney because there may be additional
issues beyond workers’ compensation that should be identified.
Alan J. Wax is Senior Partner at the Law Offices of Wax & Wax. He is
a Board-Certified Specialist in California Workers' Compensation Law.
He is the founder and first president of the Los Angeles Valley Applicants'
Attorneys Association (LAVAAA). Alan attended UCLA undergraduate and Glendale
Law School and is a recipient of the Los Angeles Professional Excellent
Award. He is an active member of The Board of Governors of the California
Applicants' Attorney Association (CAAA). Alan has been recognized
as a Super Lawyer®, which represents the top 5% of lawyers in an area
practice since 2006.
At The Law Offices of Wax &Wax, we specialize in workers’ compensation
law, and only attorneys conduct initial interviews and make decisions.
Please review our website for our qualifications and achievements, and
contact our office for a free initial consultation with our Glendale workers' compensation lawyer.