Workers' Compensation

At Hiden, Rott & Oertle, LLP (HR&O), we understand the importance of identifying and uncovering our opponent’s weaknesses.

This insight benefits the injured workers we represent, as we continue to succeed in extracting more favorable settlements than most other attorneys. We have repeatedly done so, by decreasing the strength of the defendant’s case, which ultimately provides our opponents with insight into a more realistic measurement of their client’s case.  This insight consistently reduces our opponent’s level of optimism and minimizes the likelihood of a bargaining impasse.

It is quite common for family members, neighbors, co-workers, and fellow union members to repeatedly make referrals to our Firm.

In fact, HR&O lawyers continue to appreciate the greatest compliment of all, to receive client referrals from prior opposing attorneys.

The following Workers’ Compensation overview is designed to provide an insight into California’s state-mandated insurance program that ensures medical and monetary benefits to employees, who suffer job-related injuries and illnesses, as well as benefits for dependents of those workers who are killed because of work-related accidents or illnesses.

Limits To Workers’ Compensation

While Workers’ compensation covers most on-the-job injuries, there are however some limits.  For example, injuries that happen because an employee is intoxicated or uses illegal drugs are not covered by workers’ compensation.

Situations Where A Claim May Be Denied

A claim may also be denied in situations where an employee starts a fight; suffers injuries while committing a serious crime; or suffers injuries while violating company policy.

Repetitive Activities Can Cause Injuries And Illness

An injury need not be caused by an accident, such as a fall from a roof, to be covered by workers’ compensation.  Many workers’ receive compensation for injuries that are caused by overuse or misuse over a long period of time.  For example, job activities involving repetitive bending, lifting, stooping, pinching, and pulling, can cause carpal tunnel syndrome or neck or back problems.

An employee may also be compensated for illnesses and diseases that are the gradual result of work conditions causing heart conditions, lung disease, stress-related digestive problems or even skin cancer.

Injuries Suffered While Away From Work

As long as an injury is job-related, it will probably be covered by workers’ compensation.  For example, injuries sustained while traveling on business, performing a job-related errand, or even attending a required business-related event.

Expected Benefits

The workers’ compensation system provides wage replacement income, which is,  typically two-thirds of an employees’ wages up to a fixed ceiling;  medical benefits, which includes physician visits, prescription drugs, mileage reimbursement, medical testing, physical therapy and even prosthetics;  and job retraining or job displacement.

For those employees that become permanently disabled, they may be entitled to receive long-term or lump-sum benefits.  The amount of the payment will depend on the nature and extent of their benefits.

Death Benefits

When an injury causes the death of an employee, the employer is generally liable for reasonable burial expenses and a death benefit, which is to be paid to that employee’s dependents.

Burial expenses can also include a funeral ceremony, even in cases where the employee’s body is never recovered, i.e., employee’s body destroyed in an explosion at work.

To qualify as a dependent and eligible for workers’ compensation death benefits, a person, at the time of the employee’s death must either have been in “good faith” a member of the family or household of the employee, or bear some type of special relationship, such as a husband or wife, child, brother or sister, uncle or aunt, or in some cases, even a father-in-law or mother-in-law, just to name a few.

The question of who qualifies as a legal dependent and the extent of his or her dependency is determined by the facts, as they exist at the time of the injury of the employee rather than the date of that employee’s death.  For example, while two people of the same sex occupying the same residence does not indicate dependency within the meaning of the California Labor Code, the Workers’ Compensation Appeals Board (WCAB) found that a male lover was a “good faith” member of decedent’s “household” and awarded him death benefits.  The WCAB awarded these benefits even though the decedent and his partner’s homosexual relationship was not a recognized marriage, and even though the decedent employee allegedly had homosexual relations with other people during the time he was a member of decedent’s “household”.

In fact, a “putative spouse” (a person who has entered into an invalid marriage with another) may be awarded death benefits, provided he or she believes that they are validly married.

It is important to note, a dependent is not required to live in the same state as the decedent, in order to receive death benefits.  In fact, a dependent can live in another country and still receive death benefits.

To receive the maximum death benefit, a dependent must be able to distinguish he or she as a total dependent from a partial dependent.

There is conclusive presumption of dependency in the case of a child under the age of 18 years.  This presumption also extends to children over 18 years that are physically or mentally incapacitated from being gainfully employed.
Sometimes collecting death benefits can be a slow process.  However, an employer must either accept or deny liability for the death within 90 days of the filing of the death claim.  Otherwise, that employee’s death is rebuttably presumed compensable under California law.

Death benefits are usually paid in installments, in the same manner as temporary disability indemnity payments, every two weeks.  However, in some cases a lump sum buyout can be agreed upon between an employer’s insurance carrier and a dependent provided that the Workers’ Compensation Appeals Judge approves this settlement.

The Right To See Your Own Physician

Employees have a right to designate their own physician, as long as they do so before they suffer an injury or an illness and follow the appropriate legal requirements.

If an employee does not “predesignate” their physician, they have the option of choosing a physician on their employers or their employers insurance company’s medical provider network (MPN) list.

Typically however, many of these physicians are recruited by employers and insurance carriers, which explains why so many employees designate their primary treating physician in advance of a work injury.

Contact A Competent Workers’ Compensation Lawyer

Workers’ compensation laws are riddled with time deadlines and mandatory procedural requirements.  If these time deadlines are overlooked, it can sometimes translate into the difference between benefits being received and benefits being denied.

To secure the results you are entitled to, contact Attorney, Michael Ian Rott, at: 619-296-5884 or via e-mail: mrott@hrollp.com.