Preparing For The Workers’ Compensation Claim Process In The State of California

A workers’ compensation claim is distinct from other legal claims. Unlike civil claims, such as those for personal injury or breach of contract, a workers’ compensation claim is administrative in nature. This is because when a claim is brought, it is a claim through the employer’s insurance company rather than a claim against the employer. Because of this, a workers’ compensation claim is a claim for benefits rather than a claim for damages. Damage awards in the civil context include financial losses, pain and suffering, punitive damages, and other things needed to make a plaintiff whole. Workers’ compensation benefits, on the other hand, include medical treatment, temporary disability, permanent disability, and, if needed, lifetime future medical care for any industrially injured body parts. Workers’ compensation, then, is akin to a benefits delivery system flowing from an employer’s insurance company to the injured employee.

Total temporary disability benefits may include up to two-thirds of an employee’s salary for 2 years during a 5-year period. These benefits may only be awarded when a doctor has diagnosed an employee with a total temporary disability rendering him or her unable to work.

Workers Compensation Claims Process

Workers Compensation Claims Process

Establishment of a Permanent Disability

After an employee has received medical treatment, but has not fully recovered despite the passage of ample time, medical evidence may be presented to establish the existence of a permanent disability. This plateau is referred to as “maximum medical improvement” or “permanent and stationary” status. Presentation of medical evidence is critical because the more permanent the disability, the greater the compensation an injured employee may be entitled to. This compensation is generally not paid in one lump sum. Rather, the payments are spaced in intervals over time.

Lifetime future medical treatment benefits are often awarded in conjunction with permanent disability benefits. This is only logical, as an ongoing disability will require ongoing medical care. However, because the lifetime future medical treatment is inherently prospective in that it concerns the future, the parties – the employee and the employer’s insurance company — will often agree in advance to the employee’s future healthcare needs with regard to the injury and resulting disability, and plan accordingly. This agreement is referred to as a “stipulation” in the workers’ compensation context. Medical evidence is weighed in the negotiation process; sometimes it is very clear-cut, as with physical disabilities, whereas other times it is somewhat ambiguous, as with psychological disabilities.

What To Do If You Have Been Injured At Work In California

If you have been injured in workplace accident, reach out to an experienced California workers’ compensation attorney. An injury-related interruption of one’s career, whether short-term or long-term, can have serious financial and health-related consequences. An attorney will fight for your rights and work to get the maximum benefits you may be entitled to.

Written by Workers Compensation Blog