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 limitations.
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 the value.
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.