When Are Your Injuries Covered?

You are entitled to compensation while NOT even at your worksite, or not even actively engaged in your work at the time of injury!!!  If you are truly an independent contractor, you may not have Workers’ Compensation coverage, but you may be found to be an employee, even if you think you are not.  Otherwise, if you are providing a benefit or service to someone else, and you are receiving money for it, chances are good you are entitled to Workers’ Compensation benefits if injured or killed during the activity.  (Indeed, there are many “volunteer” activities that are covered, too!)

Call for a free consultation to find out if you are covered by the Workers’ Compensation laws.  In the unfortunate event of death, a dependent should seek a consultation to determine whether the death was job related, entitling certain dependents to benefits.  Many people are surprised to find out that, under certain circumstances, injuries or even death is compensable while waiting at or near a jobsite, while commuting, or even off work but living in company-provided housing while away from home.

What Kinds Of Injuries Are Covered By Workers’ Compensation?

  • A specific injury or series of smaller injuries that require medical care other than minor first aid.
  • An injury that developed over time, such as repetitive use or jarring of a limb, joint or your spine.
  • An injury resulting from exposure to harmful or toxic substances, or sometimes, substances to which you have an allergic reaction.
  • An injury caused while on-the-job but caused by an unrelated 3d party, for example, a vehicle accident caused by a stranger.

What Kinds Of Claims Can Be Filed Together With A Workers’ Compensation Claim?

There are several types of claims that can be filed in connection with a work related injury. Depending on what type of claim it is, these “ancillary” claims may be prosecuted against an employer, its insurance company, or a “third party,” that is, a party other than the employer.

These claims can provide significant benefits to the injured worker beyond and in addition to benefits provided through the regular Workers’ Compensation benefit package. Sometimes, they can also provide protection to injured workers from adverse action, harassment or discrimination that may be taken against them by an employer. We believe that the presence of an attorney will often give the employer or insurance company an extra reason to follow the dictates of the law.

These “ancillary” claims can include the following:

  • A claim against a third party who caused or contributed to the injury, or who by operation of law had a special duty owed to you that “set up” the injury to occur, whether by negligence, or willful action
  • A claim that the employer or its insurance company unreasonably denied or delayed the provision of benefits to an injured worker
  • A claim that the employer discriminated or took adverse action, or harassed an injured worker because of the injury, for pursuing a claim, or because of a disability
  • A claim that the employer’s serious and willful action caused the injury



How Are Attorney’s Fees Paid?

YOUR INITIAL CONSULTATION IS FREE!!! And Kim’s fee will be paid only after a resolution of your case, and then it is deducted as a percentage (generally 15%) of the settlement or amount of Partial Permanent Disability benefits payable to you! You need not advance any funds for fees or costs to prosecute your claim. All attorney’s fee requests must be reviewed by a judge, found to be reasonable, and approved. Regardless of when an attorney is retained, there is neither an increase nor reduction in total fees.

Insurance companies will often suggest that you don’t need an attorney to get benefits, and remind you, correctly, that an attorney’s fees are deducted from your award. The interest of any insurance company is to minimize any award to be paid to you.  They may try to dissuade you from obtaining legal counsel because an attorney will often produce more in benefits than their charged fee. The fee is deducted from the last payment to be made to you.  The attorney’s fee is deducted from your award, and you need not pay for any fees or costs “up front.”

What Benefits Are Payable Under A Workers’ Compensation Claim?

This section deals only with standard injury claims, without reference to the “ancillary” claim types noted above. While the benefit packages are limited, you are still entitled to benefits even if the injury was your fault. And as of February, 2009, the benefit package could be more than in the past because of new and significant WCAB decisions—case decisions the insurance companies will not recognize until your attorney forces the issue.

A standard injury claim will entitle you to the following benefits:

  • Medical care to cure or relieve you from the effects of the injury, now and indefinitely into the future, and whether or not you keep your job
  • ALL Mileage and Travel Expenses incurred in connection with treatment, obtaining prescriptions, traveling to a deposition or to medical evaluations
  • If you can’t work at your usual job, and your employer can’t or won’t offer you a lighter duty job modified in line with your doctor’s orders, you should receive weekly Temporary Disability payments calculated on the basis of all earnings from all sources. Payment of Temporary Disability is limited to 104 weeks
  • Once your condition has stabilized, and if there are going to be permanent or long term medical restrictions, a limited earning capacity or other medical problems restricting your strength or ability to move, you should receive a“Partial Permanent Disability” award paid weekly. If you are totally or almost totally disabled from the labor market, you may be eligible for a very large “Total Permanent Disability” award. (You may also qualify for Social Security Disability! (This benefit is available to anyone who has an injury, condition or disability, or a combination of these that has severely impacted your ability to work.)
  • If you cannot return to your old job because of the long term effects of the injury, you may receive assistance in retraining or further education to help you back into the job market
  • AND, the cost of needed expert opinions to obtain medical evaluations and services to support your case should be paid for by your employer
  • Under the worst circumstances, if death results or is hastened because of a work related injury or condition, your family and dependents could receive a significant death benefit award

All these benefits must be provided by your employer or its insurer when an employee has suffered a work related injury, and if they unreasonably withhold providing you with any of them, substantial penalties can be assessed and paid to you.

When Should I Call An Attorney?

Work related injuries often can involve some of the “ancillary” actions noted above that can provide extra protection and extra benefits to injured workers.  There are several reasons to call an attorney soon after an injury, and no real reason to NOT call one early on after suffering an injury.  Obtaining legal representation early gives you the benefit of legal advice and representation throughout the process, AND COSTS NO MORE than waiting to contact an attorney when the flow of benefits is interrupted or after treatment is concluded.  Early representation will help insure your benefits flow smoothly to you, as opposed to seeking advice only when your benefits or rights have been threatened or denied.

If you have a work related injury, the odds are very high that you will benefit by using an attorney.  The rules and regulations of the Workers’ Compensation system are very complicated.  Employers and insurance companies spend much time and money to minimize their own expenses (at your expense) when they are dealing with a work related injury.   Choosing an evaluating physician is a crucial step in the process, and familiarity with the evaluators is essential in obtaining a fair or even favorable evaluation.  Legal time limits go by very quickly at this stage of a claim, and choosing the wrong evaluator can permanently prejudice your interests. The insurance companies and employer’s claims administrators are trained and experienced in this regard, and they are NOT looking out for your best interests.   Kim LaValley WILL protect your interests to maximize your benefits.

Often, the insurance company’s attorneys will want to take your sworn deposition before a court reporter to provide your statement to investigators, the employer, or to health care providers.  The assistance of an attorney at this stage is crucial.  You should never submit to questioning without an attorney’s assistance.  The impact on your claim can be quite large.

Additionally, there are time limits to filing an Application For Benefits before the Workers’ Compensation Appeals Board that must be met.  “Ancillary” claims must also be filed in a timely manner.

Once benefits to which you are entitled have been disrupted, even a little, it often takes extra time, additional inconvenience and frustration before benefits are restored.  Ongoing legal representation can help insure everything stays “on track” and will allow for a much faster resolution of problems if and when they arise.

Additionally, the determination of the value of your benefits involves complicated calculations which are necessary to insure you receive everything you should receive.  Aspects of your benefit package can be increased, sometimes dramatically, when reviewed and presented properly.  For information about how attorney’s fees are billed and collected, see the FAQ below.



Have A Question? 
Contact Kim LaValley now!

(530) 362-7188
(877) 233-8399