If you've suffered an injury in a workplace accident, a workers compensation attorney in San Diego can guide you through the claims process. Remember that you're not alone in this situation - workers comp attorneys in San Diego are here to help make sure your case gets the attention it deserves. In all of the confusion of workers compensation benefits, an attorney will fight for your rights.
To help simplify the process, it's best to inform yourself on how the workers comp process works in California. This guide will go over all the important information about workers comp in San Diego that you should be aware of.
Unfortunately, workplace accidents are common. However, that also means that you aren't the only person going through this situation. Workers comp and a workers compensation attorney in San Diego are here to support you.
When you're injured at work, you're entitled to benefits that help you recover and continue to pay bills even if you can't perform your usual work duties. The most recent data shows that nearly $62 billion per year is paid out in workers comp claims across the country. That's more than $1 billion per week! Roughly half goes toward medical costs and half goes toward wage replacement.
It's important to note that these costs don’t account for the lost productivity that workplace accidents incur. For example, in 2019, out of 2.8 million recorded cases, nearly 900,000 people nationwide missed at least one day of work due to non-fatal workplace injuries.
In 2019, the state of California received 483,000 total workers comp cases, of which almost 285,000 resulted in a loss of at least one workday. The main culprit for these cases was lifting, which caused nearly 58,000 people to suffer an injury.
In San Diego, 16% of total employment is in either manufacturing or construction, industries where lifting heavy objects is common. This raises the overall risk in the region for a lifting injury. Data shows that the area of the body that these injuries affect the most is the lower back. The most common manifestation of an injury is a strain or tear, covering a massive 29% of all workplace injuries.
You, like many other California residents, are facing a complicated situation. What should you do if you're injured at work? How does workers compensation in California work? What are workers compensation benefits? A workers compensation attorney in San Diego can help you answer those questions.
The workers comp program, like all other programs, has certain requirements people must meet to be eligible. Here's what you need to know to determine your standing:
1. You must be an employee of the company to receive workers compensation benefits in the event of an injury. This means that contract workers, volunteers or outside consultants aren't eligible. Some companies purposely miscategorize workers to avoid workers comp obligations. A workers compensation attorney in San Diego can help you determine if your position is defined correctly based on your duties.
2. The company must carry workers comp insurance. California law states that every company must carry workers comp insurance. Unfortunately, not all employers follow this law. If your company doesn't have workers comp insurance, a local workers compensation lawyer in San Diego can still help you pursue damages.
3. Undocumented workers are eligible for workers comp benefits and shouldn't allow an employer to use their residency status as a reason to deter them from filing a claim. If you're facing this sort of discrimination, look to a San Diego workers compensation lawyer to defend your rights.
In any situation where you're injured, the first step is to seek medical attention. The priority is your health and wellbeing, so even if you think your injury is minor, see a doctor anyway. They can check to make sure you don't have any hidden problems that could become serious issues later.
Obviously, if your injury is major enough to require first aid, your employer is aware that you've suffered a workplace injury. If, however, you're working remotely or you just have a minor injury, there may be no witnesses or clear proof that your injury was indeed work-related.
That's why you should seek medical help right away. Tell your doctor your injury was from work, and they'll fill out a Doctor’s First Report of Occupational Illness or Injury form within five days of your exam. This report will help you prove that the injury happened at work.
As soon as practical after immediate medical care, you need to inform your employer that you suffered an injury while on the clock. If you don't report the injury within 30 days, it may endanger your workers compensation benefits. Contact a workers compensation attorney in San Diego for help with filing a proper report.
Within one day of your report, your employer must give or mail you Form DWC-1, which is the workers compensation form for the state of California. If they don't do this, you can also download the form from the forms page of the California Department of Worker Compensation website. Fill out the employee section of the form and return it to your employer in person or through certified/registered mail.
Be sure to keep a copy of this form for your own records. Your employer will fill out their section of the form and forward it to their insurance company. The insurance company has 14 days to contact you about the status of your claim. You should also receive a copy of the completed Form DWC-1 from your employer for your own records.
While the insurance is evaluating your claim, you're entitled to immediate payment for medical treatment. You can receive up to $10,000 in medical treatment before the official claim acceptance. As long as the claim isn't rejected within 90 days, it's considered to be covered. If you have questions about your status, you can contact the San Diego DWC District Office at 619-767-2083, or email them at SDO@dir.ca.gov.
To visit in person, you can find them at:
7575 Metropolitan Drive, Suite 202
San Diego, CA 92108-4424
If you're unable to work due to your injury, you're legally entitled to temporary disability benefits within 14 days. If the insurance company fails to do so, they're liable for a late fee of 10% on top of the benefits. Contact a workers compensation attorney in San Diego for more guidance on these deadlines and processes.
Your temporary total disability benefits are 2/3 of your average weekly wages prior to the injury, within the bounds of upper and lower limits. For 2020, you couldn't make less than $194.91 or make more than $1299.43. If you can work, but at a reduced capacity (at a different position or part-time), you'll receive temporary partial disability payments equivalent to 2/3 of your lost earnings. These workers compensation benefits will continue until:
Also, you may have noticed the word "disability" to describe the wage replacement payments. To explain why, it comes down to legal definitions. In the state of California, the DWC recognizes four types of injuries. They are temporary partial disability, temporary total disability, permanent partial disability and permanent total disability. What category you fall in depends on the type of injury you have and how it interferes with your ability to work.
To contact the San Diego Disability Evaluation Unit with questions about your injury classification, call at 619-767-2081.
There are also cases where injuries are severe enough to become an impairment, meaning that no amount of treatment will return them to pre-accident status. These injuries are classified as permanent and entitle a worker to a percentage of their lost earnings based on a medical evaluation. This evaluation determines on a scale of 1 to 100 how much the impairment affects an employee's work capacity. When impairments are severe enough, an individual may receive 2/3 of their weekly wages for the rest of their life.
Classifying injuries is a nuanced process. If you believe that your medical evaluation was in error or if you faced excessive wait times or discrimination, please contact the DWC Medical Unit's Qualified Medical Examiner Investigation and Enforcement Section. You can contact them through email at QMEInvestigations@dir.ca.gov or through regular mail at:
DWC Medical Unit
QME Investigations and Enforcement Section
P.O. Box 71010
Oakland, CA 94612
A workers compensation attorney in San Diego can also work with the appropriate departments and forms to help you pursue claims.
A relatively new addition to workers comp rules in California is a result of Governor Gavin Newsom's executive order. Any employee who contracts COVID-19 can file for workers comp regardless of where or when they may have contracted it. The estimated total increase in premiums is around $1.2 billion, at a time when businesses are already struggling with shutdowns and reduced staffing.
While well-intentioned, the method of proof associated with this order is a “rebuttable presumption.” Essentially, by allowing an employee to claim they got COVID-19 at work, it's then up to the employer to prove differently. Qualifying criteria for employers with 5-100 employees is four individuals testing positive within 14 days. For employers with more than 100 employees, 4% of the staff have to test positive within the same interval.
Since tests cannot show the specific time of infection, this opens up a door for all sorts of problems related to disputes and fraud, which can end up affecting workers with legitimate claims for workers compensation benefits.
Unfortunately, there are employers who will ignore or downplay previous injuries, coercing employees to do things that they shouldn't be doing in their current state.
In one real example of terrible employer behavior, a man was injured after slipping on ice while unloading goods. A doctor cleared him to return to work but with certain restrictions, including no heavy lifting or standing for long periods.
His employer didn't follow these restrictions and gave him the same tasks as before his injury. As a result, his injury worsened and his doctor ordered him to take a month off for therapy. It was during this period that the company informed him that they were going to eliminate his position. This is where the specific language becomes important.
His position was going to be eliminated, but he himself was not terminated yet. He was given 30 days to find a new position within the company or face complete termination. When he couldn't find one, the company fired him. The man consulted a workers comp attorney, sued the company and won a settlement of $4.3 million. The company claims that they created a position for him that would have met the requirements of his doctor's orders, but they never officially told the employee about the position.
Don't let your employer pull stunts like these with your injury. If you feel that your employer is violating your rights, you can contact the San Diego DWC to file a complaint. Employers aren't allowed to retaliate against an employee for filing a claim. If this happens to you, report it and seek the help of a workers compensation attorney in San Diego.
A workplace injury is a hard, confusing experience to endure. It can affect your life in so many ways that even simple activities can become ordeals. Navigating through the difficult workers comp process adds to the challenge. To ensure that you're not taken advantage of and that you can pursue all applicable benefits, a workers compensation attorney in San Diego can help. Accident.com can connect you with a local San Diego workers comp lawyer today.
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