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California Workers' Comp: How to Take Charge When You're Injured on the Job

by Attorney Christopher A. Ball

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Summary

Maximize the medical care and benefits you’re entitled to!

From industrial injuries to carpal tunnel syndrome, more than a million Californians a year suffer job-related injuries or illness. For many, receiving compensation can be a nightmare.

California Workers' Comp shows you how to handle a California workers' compensation claim from start to finish. Find out how to:

• file a claim
• protect your legal rights
• receive the medical care you need
• get the benefits you're entitled to
• deal with uncooperative employers, doctors and insurance agencies
• negotiate a settlement
• present your case before a judge

The 6th edition is completely updated with the latest regulations, and explains how the new AMA Guides affect your permanent-disability award.

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Table of Contents

Part I: All About Workers' Compensation

1. Introduction to Workers' Comp

A. What Is Workers' Compensation?
B. What an Injured Worker Is Entitled To
C. Where to Get Additional Information and Help
D. How to Use This Book
E. What This Book Does Not Cover

Step 1. Notify Your Employer of the Injury
Step 2. Get Medical Treatment If Needed
Step 3. Paying for Medical Treatment If Employer Denies Your Claim
Step 4. Tell the Doctor About Your Injuries
Step 5. The Doctor Decides If You Need Time Off
Step 6. Complete Workers' Compensation Claim Form and Application for Adjudication of Claim Form
Step 7. Secure Control of Your Medical Care
Step 8. You May Receive Temporary Disability Benefits
Step 9. Handling a Denial of Your Claim or Benefits
Step 10. Taking Problems to the Appeals Board
Step 11. After You Are Determined to Be Permanent and Stationary (P&S)
Step 12. You May Recover Completely and Return to Work
Step 13. You May Be Entitled to Vocational Retraining
Step 14. You May Be Permanently Disabled
Step 15. Go to Trial If There Is No Settlement
Step 16. Judgment Is Paid or the Matter Is Appealed

A. Is Your Job Covered by Workers' Compensation?
B. Do You Have a Compensable Injury?
C. Injuries Not Covered by Workers' Compensation

4. Cumulative Trauma Disorders

A. What Is a CTD?
B. Becoming Aware of Your Injury
C. Diagnosis and Treatment
D. Recovery and Permanent Injuries
E. Returning to the Workforce
F. Further Medical Treatment

Part II: Protecting Your Rights

5. What to Do If You're Injured

A. Request Medical Treatment
B. Report the Injury Within 30 Days
C. File Your Workers' Compensation Claim
D. The Insurance Company's Answer
E. Take Steps to Protect Your Rights

A. Set Up a Good Record-Keeping System
B. Read and Understand What You Receive in the Mail
C. Gather Important Records Pertaining to Your Claim
D. Request Copies of Documents and Evidence
E. Keep Your Address Current

A. Self-Insured Employers
B. The Insurance Company's Responsibilities
C. Your Responsibilities as an Injured Worker
D. Who's Who in the Insurance Company
E. How to Deal With the Insurance Company
F. Tactics Insurance Companies Use to Deny or Minimize Claims
G. Settling Your Case

A. Self-Insured Employers
B. The Employer/Insurance Company Relationship
C. The Employer's Responsibilities
D. If You're Out of Work Due to the Injury
E. Bankruptcy or Other Employer Financial Problems

A. What the Treating Doctor Does
B. Choose Your Treating Doctor (Get Medical Control in Your Case)
C. Be Sure You Receive Excellent Medical Care
D. Changing Treating Doctors
E. When Your Condition Becomes Permanent and Stationary (P&S) or Has Reached Maximal Medical Improvement (MMI)

A. Rules for Medical-Legal Evaluations
B. Compensability of Injury (Labor Code § 4060)
C. Nature and Extent of Permanent Disability or Need for Future Medical Treatment (Labor Code § 4061)
D. Other Issues to Be Resolved by Medical-Legal Evaluations (Labor Code § 4062)
E. Picking a Qualified Medical Evaluator (QME)

Part III: Workers' Compensation Benefits

11. Medical Benefits

A. Limitations on Medical Treatment
B. Payment for Current Medical Treatment and Evaluations
C. Future Medical Care Costs
D. Penalties

A. Qualifying for Temporary Disability
B. Amount of Temporary Disability Payments
C. How Payments Are Made

A. How Permanent Disability Payments Compensate You
B. Kinds of Permanent Disability Awards
C. Establishing Your Permanent Disability Status
D. How Permanent Disability Benefits Are Paid
E. Amount of Permanent Partial Disability Benefits
F. Life Pension Benefits
G. Permanent Total Disability Benefits

A. Vocational Retraining and Offers of Alternative or Modified Work
B. What Is Vocational Rehabilitation?
C. Six Steps in a Vocational Rehabilitation Plan
D. Eligibility for Vocational Rehabilitation (QIW Status)
E. How to Start Vocational Rehabilitation
F. Delays and Failure to Provide Rehabilitation Services
G. Preparing a Vocational Rehabilitation Plan
H. Completing a Vocational Rehabilitation Plan
I. Where to Get Help With Vocational Rehabilitation
J. Supplemental Job Displacement Benefit

A. Who May Receive Death Benefits
B. Death Benefit Amount
C. Additional Payments for Dependent Minor Children
D. Burial Expense for Deceased Worker
E. Unpaid Temporary or Permanent Disability Payments
F. How Death Benefits Are Distributed

A. Subsequent Injuries Benefits Trust Fund
B. The Uninsured Employers Benefits Trust Fund
C. Discrimination Benefits (Labor Code § 132(a))
D. Employer's Serious and Willful Misconduct

A. State Disability (SDI)
B. Social Security Benefits
C. Claims or Lawsuits for Personal Injuries
D. Claims or Lawsuits Based on Discrimination

Part IV: Settling Your Case

18. Rating Your Permanent Disability

A. Obtaining a Rating
B. What Is Involved in the Rating Process?
C. How to Rate a Disability Using the New Rating Schedule
D. Other Considerations in Rating a Permanent Disability
E. How to Rate a Disability Using the Old Rating Schedule
F. How to Use the Pre-1997 Rating Manual

A. What You May Receive in a Settlement
B. Two Kinds of Settlements
C. Determine the Value of Your Claim Using the Settlement Worksheet
D. What to Do Next

A. Deciding Whether to Negotiate Your Own Settlement
B. The Concept of Compromising
C. How to Negotiate a Settlement
D. Review and Sign Settlement Documents
E. Attend an Adequacy Hearing

Part V: The Workers' Compensation Appeals Board

21. Preparing Your Case

A. Identify Possible Issues in Dispute
B. How to Prove (or Disprove) Disputed Issues
C. Depositions
D. Subpoenaing Witnesses and Documents
E. Preparing for a Pre-Trial Hearing
F. Preparing for a Trial

A. Kinds of Hearings
B. Trial on Preliminary Issues
C. Trial on Entire Case (the Case-in-Chief)
D. File a Declaration of Readiness to Proceed to Set Your Case for Hearing
E. Copy, Serve, and File Documents
F. Receiving Notice of a Hearing

A. What Is Service of Documents?
B. How to Serve Documents by Mail
C. How to Serve Documents Personally
D. How to Serve Documents by Fax
E. How to File Documents With the Workers' Compensation Appeals Board

A. Finding Your Way Around the Appeals Board
B. Pre-Trial Conferences
C. Trial
D. Findings and Award

A. The Three-Step Appeal Process
B. Petition for Reconsideration
C. Writ of Review With the Appellate Court
D. Writ of Appeal to the California Supreme Court

Part VI: Beyond This Book

26. Lawyers and Other Sources of Assistance

A. Information and Assistance Officers
B. Hiring a Lawyer

A. Find a Law Library
B. The Basics of Legal Research

CHAPTER 3-IS YOUR INJURY COVERED BY WORKERS' COMPENSATION?
CHAPTER 5-WHAT TO DO IF YOU'RE INJURED
CHAPTER 9-TAKING CHARGE OF YOUR MEDICAL CASE
CHAPTER 10-MEDICAL-LEGAL EVALUATIONS
CHAPTER 11-MEDICAL BENEFITS
CHAPTER 12-TEMPORARY DISABILITY BENEFITS
CHAPTER 13-PERMANENT DISABILITY (AND LIFE PENSION)
CHAPTER 14-VOCATIONAL REHABILITATION/SUPPLEMENTAL JOB DISPLACEMENT BENEFIT
CHAPTER 15-DEATH BENEFITS
CHAPTER 16-EXTRAORDINARY WORKERS' COMPENSATION BENEFITS AND REMEDIES
CHAPTER 18-RATING YOUR PERMANENT DISABILITY
CHAPTER 19-FIGURE OUT A STARTING SETTLEMENT AMOUNT
CHAPTER 20-NEGOTIATING A SETTLEMENT
CHAPTER 21-PREPARING YOUR CASE
CHAPTER 22-ARRANGING FOR A HEARING OR TRIAL
CHAPTER 24-GOING TO A HEARING OR TRIAL

Appendixes

A1: Workers' Compensation Offices
A2: Temporary Disability Benefits Compensation Chart
A3: Permanent Disability Indemnity Chart
A4: Maximum Life Pension Weekly Payments for Injuries Between 7/1/96 and 12/31/02
A5: Workers' Compensation Forms

Forms to File With the Division of Workers' Compensation
DWC-1: Workers' Compensation Claim Form
Application for Adjudication of Claim
Declaration in Compliance With Labor Code Section 4906(G)
Declaration of Readiness to Proceed
Declaration of Readiness to Proceed to Expedited Hearing Trial
Pre-Trial Conference Statement
Notice of Change of Address
Proof of Service
Cover Letter to Workers' Compensation Appeals Board
Record-Keeping Forms and Worksheets
Record of Income and Benefits Received
Record of Time Off Work
Record of Medical Expenses and Request for Reimbursement
Record of Mileage & Transportation and Request for Reimbursement
Settlement Worksheets and Documents
Settlement Worksheet: Value of Workers' Compensation Claim
Stipulations with Request for Award
Compromise and Release
Forms to File With Your Employer
Employee's Designation of Personal Physician
Letter to Employer Requesting Copies of Documents and Evidence

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