GENERAL INFORMATION ABOUT WORKERS’ COMPENSATION CLAIMS.

DISCLAIMER:
THE INFORMATION IN THIS WEBSITE IS GENERAL IN NATURE, AND SHOULD NOT BE READ OR UNDERSTOOD AS LEGAL ADVICE. IT SHOULD NOT BE SOLELY RELIED UPON IN MAKING A DECISION THAT MAY AFFECT ANY LEGAL MATTER. ONLY A CONSULTATION WITH AN ATTORNEY REVIEWING THE FACTS AND CIRCUMSTANCES IN YOUR PARTICULAR CASE CAN GIVE YOU THE ADVICE YOU NEED.

REPORT YOUR INJURY!

Once injured, there are time limits to file a claim. If your employer has not formally accepted the claim, and the time limit to file passes without filing, you may lose all rights to any Workers’ Compensation benefits. Therefore, if injured, or you think you have contracted a work related illness or impairment, REPORT YOUR INJURY. This is done using a form called a “DWC-1” and Kim LaValley or your employer can provide it to you upon request. Please review the reasons for contacting an attorney early on in the claims process discussed on the Workers’ Compensation FAQ page.

Maintain Control of Your Medical Treatment.

This means you should immediately, and before any injury, designate your choice of a personal treating physician, chiropractor or acupuncturist to your employer IN WRITING. If you don’t pre-designate your treating physician, and if injured on the job, your treating physician could be chosen by your employer or its insurance company…often NOT a good thing. (You should have been informed of the right to pre-designate your treating physician at the time of hire, or annually thereafter.) To pre-designate your own treating physician, either fill out the forms from the following links, or write your employer about it with the information noted after these links:

  • To see an approved form to pre-designate a Doctor (an M.D. or D.O.). Click here
  • To see an approved form to pre-designate a Chiropractor or Acupuncturist, Click here
  • Or, write a note to your employer. State:

        >“Pursuant to the Labor Code, I designate [name, general address and phone #] as my primary                    health care provider in the event of a job related injury”

        >Date it, sign and print your name

        >Be sure to make copies, and give one to your employer’s Personnel or Human Resource Dept. or             to the owner or manager

        >Make a note of when and where you delivered it on your retained copy


There are restrictions to your right to pre-designate a treating physician. To qualify,

  • your employer must offer group health coverage
  • the doctor must be your regular physician, who shall be either a physician who has limited his or her practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner, and has previously directed your medical treatment, and retains your medical records
  • your “personal physician” may be a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries
  • prior to the injury your doctor agrees to treat you for work injuries or illnesses
  • prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury or illness, and (2) your personal doctor’s name and business address


Pursue Medical Treatment As Needed

The money you may receive for your injury will not make up for the loss of work capacity, earnings, pain and suffering you endure when suffering a significant injury. Your health and your ability to function as fully as possible should be your primary interest. If you have trouble getting your employer’s insurance to pay for treatment, and if you have your own medical insurance, don’t hesitate to demand that your own medical insurance company pays for treatment. Once your employer’s liability for the injury is established, the employer’s workers’ compensation insurance may have to reimburse your own insurance company.

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. Employers may, however, seek to limit treatment based on medical opinions called Utilization Reviews.

There Are Limits To Certain Treatments

You are limited to 24 visits with a chiropractor under the compensation laws, and even then, the chiropractor may not get paid if treating, say, a foot injury, or ancillary health issue not directly caused because of you work related injury. You are also limited to 24 physical therapy visits and 24 occupational therapy visits.

Maximize Your Income While Not Working

There are various programs that may be able to provide you with extra income while you are not working.

If you miss work for ANY reason, including a work related injury that your employer or its insurance company disputes, immediately APPLY FOR STATE DISABILITY INSURANCE (SDI) BENEFITS. This program is funded by money withheld from your wages, so you should apply if you aren’t getting disability payments from your employer! Once employer liability is established, your SDI pool will be reimbursed by the Employer’s insurance. 
Click here for a list of SDI offices.

Prepare Early To Resolve Your Claim

Finally, once your condition has stabilized, your employer will send you a notice discouraging you from contacting an attorney. Insurance companies will often suggest that you don’t need an attorney to get benefits, and remind you, correctly, than 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”.

Check the FAQs page about when you should contact an attorney. Because of the many ways a claim can be minimized by the employer or insurance company, it’s better to call an attorney sooner rather than later AND it costs no more.

EARLY INTERVENTION WORKS

Have A Question? 
Contact Kim LaValley now!

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