Our California Workers’ Comp Law Firm Is Here To Help You
After suffering a workplace injury, you may feel overwhelmed and confused about what comes next. Carter Law Center is here to maximize your workers’ compensation benefits while you focus on your health and family. Our workers’ compensation attorney, Justin Carter, previously worked for an insurance defense firm. He has seen both sides of workers’ compensation claims and knows how to build a strong case on your behalf.
In California, injured workers are entitled to workers’ compensation regardless of their immigration status. Contact us to learn more. We are here to help. For a free consultation, call us in Elk Grove at 916-794-4006 or complete our contact form. We fight for injured workers throughout the Sacramento and San Joaquin valleys. Se habla español.
The California Workers’ Compensation Process
It’s important to realize that every workers’ compensation claim is different and the information below should only be considered a very rough outline of the process. The information provided is not to be construed as legal advice and is absolutely not a complete description of the process and the issues that may arise. At each step in the process, there are dozens of minor issues that should be considered. The outline below is only a very basic framework for understanding some of the core principles in the California workers’ compensation system.
Reporting Your Injury And Filing Your Workers’ Compensation Claim
Assuming you aren’t in an emergency situation, you need to report your injury to your employer as soon as possible. Your employer should give you a Claim Form (called a DWC-1) – a simple one-page form where you identify your injured body part(s), contact information, and the date and location of your injury. Your employer should then fill out the bottom portion of the form and identify their workers’ compensation insurance carrier.
Claim Accepted Or Denied
Generally, the insurance company has 90 days to inform you whether your workers’ compensation claim is accepted or denied. If it is accepted, they should provide you with various benefits, if you’re legally entitled to them, including temporary disability, medical treatment, permanent disability and, in some cases, a retraining voucher. If your claim is denied, the insurance company will inform you that they will not be providing you with benefits.
It’s likely that your employer and/or their insurance carrier has a contract with a certain medical facility and your employer should direct you to that facility for your initial treatment. The facility will examine you, possibly taking X-rays/MRIs if appropriate, provide you with medication or other necessary treatment, and provide you with a work status (whether you’re being taken off work, returned to work with limitations or returned to full duty).
If your claim is accepted and you’re taken off work by your doctor for injuries related to your claim, you should be entitled to temporary disability benefits. You also might be entitled to temporary disability benefits if your doctor returns you to work with certain limitations that the employer cannot (or will not) accommodate. Temporary disability benefits are essentially wage replacements when you are not able to work due to a workplace injury. The rate at which you’re to be paid is usually two-thirds of your average weekly wage, with a minimum of $242.86 a week and a maximum of $1,619.15 a week.
Permanent And Stationary
Once your doctor determines that you’re permanent and stationary – generally, that your injury isn’t going to get much worse or better in the near future – typically, your temporary disability benefits (if you were receiving them) will end. Your treating doctor will then likely issue a report called a Permanent and Stationary Report (PR-4). The report should discuss whether that doctor believes you have any permanent disability and include a general outline of what the doctor expects you to need in terms of future medical care.
Medical-Legal Evaluation (QME)
If you are not represented by an attorney and you or the insurance company disagree with some aspect of the Permanent and Stationary Report (PR-4), either of you can object to the report and request a three-doctor panel of Qualified Medical Evaluators (QMEs) from the State of California. There are strict time limits in requesting the panel and selecting the QME from the panel. The QME is a doctor who will examine you, review all of your medical records and write a report that includes, among other things, an amount of permanent disability, if any, and the doctor’s expectations as far as what you’ll need for future medical care.
Medical-Legal Evaluation (AME)
If you are represented by an attorney, and if your attorney and the insurance company agree, you might be evaluated by an Agreed Medical Examiner (AME) rather than a QME. If you’re unrepresented, you will not be able to enter into an AME agreement. The benefit of an AME is that, sometimes, the AME is a higher caliber evaluator, and an AME agreement removes the risk of getting a panel of three doctors that you don’t like. The job of the AME is, essentially, the same as the job of a QME (described above).
Generally, either the PR-4, the QME report or the AME report is the basis for settlement of your case. It’s very important to understand that the interpretation and valuation of the case based on the PR-4, QME or AME report can vary widely. At Carter Law Center, we will help you fight for a favorable outcome and the settlement you deserve.
Type Of Settlement (Stipulations/Award)
This is one of two ways to settle your case with the insurance company. The gist of settling by this method is that the insurance company and you will agree on an amount of permanent disability and they will pay you (biweekly usually) at a rate of between $160-$290/week until the total amount of permanent disability has been paid out. If the value of your permanent disability is very high, you could be receiving these biweekly checks for years. Also, when you settle by Stipulations/Award your medical treatment entitlement remains open. This means that the insurance company will provide you with necessary medical treatment under your workers’ compensation claim for the rest of your life so long as the need for treatment is related to your claim.
Neither party (you, nor the insurance company) has to settle the case. If you cannot agree on a settlement amount, your case will be set for trial and a judge will hear the evidence, review the medical legal reports (PR-4, QME, AME) and the judge will issue his/her opinion and an Award that sets forth what benefits you’re entitled to.
Call Today To Schedule A Free Consultation
You do not have to go through the workers’ compensation process alone. To schedule a free consultation at our Elk Grove office, call us at 916-794-4006 or complete our contact form. We represent injured workers throughout the Sacramento and San Joaquin valleys.
Se Habla español.