Workers' Comp FAQs
Get answers if you get hurt at work
Were you or a loved one hurt at work in San Diego County? You probably have lots of questions. Below are some top FAQs. If you have any other questions or want to find out if you need a workers' compensation attorney, contact the attorneys at McLaughlin & Sanchez now to arrange a free consultation.
- How much does workers’ compensation cover?
- How long can you be on workers’ comp in California?
- How does the claims process work?
- How long does it take to settle a workers’ compensation claim?
- Can I go to my own doctor for a work injury in California?
- Can I sue my employer while I collect workers' compensation benefits?
- How can you help me get the medical care I need?
- The insurance company's doctor recommended medical care, but I've been denied treatment. Is that allowed?
- Does it matter if the injury was my fault?
How much does workers’ compensation cover?
In California, workers’ compensation covers the full cost of reasonable and necessary medical treatment for an on-the-job injury. That includes medical procedures, surgery, physical therapy, medication, medical devices, and any other medical services you may need. There are no co-pays, deductibles, or other out-of-pocket costs when workers’ comp is paying for your treatment.
In addition, workers’ compensation pays temporary disability benefits if you’re unable to work due to your on-the-job injury. Workers’ compensation is calculated based on two-thirds of your pretax gross wage, subject to a state minimum and maximum.
If you have a permanent injury that affects your ability to do your job, workers’ comp also provides Supplemental Job Displacement Benefits (SJDB), which pays up to $6,000 for vocational skills training and other costs to help you find a new job that can accommodate your disability.
How long can you be on workers’ comp in California?
For most people, the temporary disability portion of workers’ comp can last up to 104 weeks (two years) from the date of the injury. However, for certain injuries, benefits can last up to 240 weeks (about four and a half years). For instance, this extension can be applied to those who have suffered from a third-degree burn, lung disease or crush injury. Benefits can be spread across five years if you don’t need all the weeks consecutively.
Permanent disability benefits, however, can last for years or even the rest of your life. There is also no end date for the medical portion of workers’ comp. If you need ongoing treatment or medication for a work injury, workers’ comp should pay for it for the rest of your life.
How does the claims process work?
If you are injured in a workplace accident and wondering how to file a claim, you must report the injury to your employer within 30 days. If your illness developed over time, report it as soon as you become aware of the connection to your job. The employer will give you a claim form. Filing this form begins the claims process.
In general, employees are eligible for 5 types of benefits under workers' compensation law. These include:
- Medical care for your injuries or illness
- Temporary disability benefits, if you unable to work for a short time
- Permanent disability benefits, if you don't make a full recovery
- Supplemental job displacement benefits, if you require retraining for a new job
- Death benefits-payment to spouse or dependents in the event the injury leads to death
McLaughlin & Sanchez can guide you through every step of the claims process. We have the knowledge and experience to pursue successful claims, whether legal action is required or not.
How long does it take to settle a workers’ compensation claim?
There’s no single answer to this; it depends on the nature of your injuries and how difficult the workers’ compensation insurance company decides to be. Some claims can be settled within weeks, but most take months or sometimes even years to resolve. The key is to make sure you have an attorney on your side who knows the process and will stand at your side every step of the way, no matter how long it takes.
Can I go to my own doctor for a work injury in California?
It depends. If your employer provides regular health coverage and you have given your employer “predesignation” (written notice) that you want your personal physician to treat any future work injuries, then you can go to your doctor. Otherwise, you must generally go to a doctor chosen by the insurance company or within the insurance company’s network. The rules vary depending on whether the insurance company has a medical provider network (MPN), a health care organization (HCO), or neither.
Can I sue my employer while I collect workers' compensation benefits?
No. Under workers' compensation laws, workers surrender their right to sue their employer when they agree to collect benefits after their injury. There may be certain exceptions, but in general, an injured worker collecting benefits cannot file a lawsuit against the employer.
McLaughlin & Sanchez know from experience that a lawyer is needed when dealing with workers' compensation claims. For example, some employers may discriminate against an employee returning from injury in retaliation. That is against the law, and legal intervention is often needed to put a stop to it.
Some employers contest workers' compensation claims. An experienced attorney can help you gather supporting evidence to prove that the injury occurred in the workplace and has left you unable to perform your duties. And if the claim is denied, an attorney can effectively make your case in all appeals and hearings.
How can you help me get the medical care I need?
Insurance companies and administrators look at workers' compensation claims in terms of dollars and cents. They want to pay as little as possible on the claim and make it go away. Because the law allows an employer to choose which doctor you see, you may be sent to a doctor who is likely to minimize the extent of your injury. If you need further medical care, you're on your own.
Our attorneys will fight to make sure you get the medical care and therapy you need to make as full a recovery as possible. We can direct you to a doctor who can give you an unbiased second opinion, and use that information to contest the initial findings. We will collect all the documentation and evidence we need to prove your medical needs.
We have many years of experience in dealing with medical care related to workers' compensation cases. We know how to get a successful resolution for our clients. If you've been injured in a workplace accident, contact us to learn how we can get you medical care you need.
The insurance company's doctor recommended medical care, but I've been denied treatment. Is that allowed?
Unfortunately, yes. But you can request what is known as an independent medical review of the decision. Attorneys Robert McLaughlin and Denise Sanchez can help you with the IMR if you can't get the treatment you need. Please get in touch with us today for a free consultation. We also invite you to see our blog post that further explores this medical treatment question.
Does it matter if my work injury was my fault?
In general, no. Workers’ compensation is a “no-fault” system, which means if you’re hurt at work, you’re covered, even if your own carelessness caused the injury. There are only a few specific circumstances in which your claim can be denied based on fault, including:
- You intentionally injured yourself.
- You were injured in a fight that you started.
- You were intoxicated (under the influence of alcohol or drugs), and your intoxication was the proximate cause of the injury (that is, you wouldn’t have been injured if you weren’t under the influence).
Note that even those exceptions have exceptions under some circumstances – for example, if a self-inflicted injury was due to work-related stress. The bottom line is that if you were at work when the injury happened, it’s most likely covered, and the onus is on the insurance company to prove otherwise.