While the cost of living keeps going up, benefits for workers’ compensation in California and elsewhere keep going down. Overall, benefits have declined by over 15 percent since 2015. Cash benefits have gone down even more. Lack of insurance company funds isn’t a problem. The reason for the decline is quite simple. The fewer claims they pay, the more money insurance companies earn, including workers’ comp insurance companies.
Workers’ compensation benefits usually include medical bill payments and lost wage replacement. In these areas, the Golden State has very subjective rules. Medical bill payment is a good example. Insurance companies must only pay “reasonably necessary” medical bills. However, the term "reasonably" is somewhat subjective. What’s reasonable to a job injury victim is usually unreasonable to an insurance company adjuster.
Frankly, insurance companies will cheat injured workers if they have a chance. These companies employ a small army of lawyers whose only job is to find coverage loopholes. An attorney for workers’ compensation in California levels the playing field. Our lawyer partners get many questions about workers’ comp, so we collected the top five and answered them in this post.
Many people assume the answer to this question is “yes.” Like most other states, the Golden State is an at-will employment state. Employers can fire employees for a good reason, a wrong reason, or no reason. Likewise, workers can usually quit for a good cause, a bad reason, or no reason at all.
However, employers cannot fire workers for an illegal reason. Illegal reasons usually include discriminatory reasons, such as sexual orientation, gender, and ethnicity. It’s also unfair to fire employees who file workers’ compensation claims, and it’s unlawful to refuse to hire a person who previously filed a lawsuit.
This law sometimes affects the decision to file a claim. For example, if repetitive stress causes Sarah to hurt her knee, her injury might not be work-related. Because of the anti-discrimination law, Sarah can file a claim with confidence. She can always withdraw it later if she wants.
Not exactly. Workers’ comp doesn’t suspend the at-will employment rule. However, bosses can only fire injured workers in limited situations. Our attorneys for workers’ compensation in California see the most common scenario as workers who refuse to accept light-duty assignments or have a poor attitude about the reassignment.
Assume Sarah is a computer programmer. She enjoys the challenging nature of her job. However, while she recovers from her knee injury, her boss orders her to watch the parking lot. As a result, she now sits in a shack all day. The workers’ comp insurance company must probably pay her two-thirds of the difference between her old and new salaries, so money may not be an issue. But Sarah might not take too kindly to her new role. In that case, her boss could use her poor attitude to fire her.
No. Workers’ comp covers workplace accidents. But it doesn’t cover other kinds of job injuries. Lawyers call these claims nonsubscriber claims.
Some bosses recklessly, or even intentionally, send workers on dangerous assignments. For example, a construction company might send Ben to demolish an old building, which probably contains asbestos, without providing proper protective gear. Suppose Ben proves negligence, a lack of care, and lost wage and medical bill benefits. Then he could be entitled to money for his pain and suffering or other non-economic losses.
Defective product injuries are another example. Usually, these manufacturers can’t hide behind workers’ comp laws and avoid paying damages. Generally, product makers are strictly liable for the injuries their defective products cause. In legal terms, strict liability is much like a no-fault liability — more on that below.
Uninsured employers make up the third major category of nonsubscriber cases. For example, some bosses ignore the law and don’t buy insurance, seeing workers’ comp as an unnecessary cost. Other employers lie on the application and other forms. When insurance companies discover these lies, they usually deny payment.
These injured workers must go to court and prove negligence. Negligence is easier to prove in these nonsubscriber cases. State law prohibits these employers from using certain “silver bullet” defenses, like the assumption of the risk and comparative fault.
This question is actually two questions. First, the waiting period for filing workers' compensation in California is three days. So, if Geraldo falls at work, he must wait 72 hours before filing a claim.
The benefits waiting period is often much longer. Usually, claims adjusters deny workers’ comp claims, at least in part. The initial review is typically a paper review with no lawyer present. Attorneys can introduce additional evidence and make legal arguments at a later administrative hearing. So, victims have a much better chance of winning. Usually, the benefits awarded are retroactive to the filing date.
Yes. No-fault insurance was part of the Grand Bargain between workers and management. If management provided a no-fault insurance system, workers gave up their right to sue in court, except in the nonsubscriber cases described above. No-fault means that legal cause doesn’t matter. Injured workers are entitled to full benefits even if they were mostly or wholly at fault for the accident. They must only prove the injury was work-related.
Defective product claims work the same way. The only effective defenses in these claims are lack of causation and the unforeseeable misuse defense. The cause usually is straightforward because the burden of proof is low. As for unforeseeable misuse, this obscure doctrine only applies in a few cases.
If you have gotten hurt, contact the professionals at Accident.com. Let them can help you find a local attorney to guide you through the system and help you obtain the benefits you deserve.
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