Workers' compensation in California is meant to aid workers financially when they have been injured or fallen ill on the job or due to their job. Sometimes, disputes arise. An employee may not agree with the employer and the employer's insurance, while the latter may not agree with the employee. Disputes can lead to delays and denials. Disputes can also be costly.
At the LAW OFFICE OF SHANE P. BRADLEY, APC, our workers' comp lawyer in Sacramento handles workers' comp disputes alongside other workers' comp matters. If you have questions and need legal assistance, contact us at (916) 755-5929. We will schedule a free consultation so that you can get the answers you need and take the next step to solve your workers' comp dispute.
Do You Have the Right to Workers' Compensation in California?
Many workers, prior to actually suffering a work-related injury, believe that if they are injured on the job their workers' compensation benefits will just kick right in without any further effort on their part. Unfortunately, this is not true.
Every state has a system for workers' compensation claims. While they may differ from jurisdiction to jurisdiction, all require an injured worker to take some action before they are able to receive their benefits. Also, a worker must be able to prove their injury. If not, benefits can be disputed or denied.
So, if a worker is injured on the job, they typically have a right to workers' compensation. That right, however, is not automatic and is dependent on state law.
Common Disputes in California Workers' Compensation Claims
Once a worker has filed for benefits, two main types of disputes often arise. These disputes could involve (1) the insurer and commission or (2) the employer. For employees, it is important to know what could instigate a dispute so that they can proactively avoid them.
Employer and Insurance Company Disputes
Common reasons employers and insurers reject claims involve allegations that:
- The worker's injury pre-existed and is not connected to their employment
- The worker's injury was not sustained in the commission of their work-related duties
- The worker failed to notify their employer of the injury within the specified time frame
- The worker was not an employee and therefore not entitled to workers' compensation benefits
- The workers' injuries are not as serious as the worker claims
- The worker has failed to comply with requests, like getting a physical examination by an employer-based physician
Employers and insurers may also refuse claims when they suspect fraud or doubt the validity of the claim.
- The injury did not occur at work
- The injury did occur but is not as serious as claimed
- The injury did occur but is the fault of the worker.
Workers' Comp Dispute Resolution Options in California
There are options available to a worker whose claim for benefits has been disputed. In some cases, it is possible to work directly with the insurance provider. When possible, it is best to speak with a supervisor or a case manager. When this does not resolve the issue, a Qualified Medical Examiner can be consulted to make an opinion as to the nature, extent, and circumstances of the injury. Ultimately a hearing and trial at the Workers' Compensation Appeals Board is often necessary.
Alternative Dispute Resolution
Alternative dispute resolution (ADR) may be available as a method of resolving a workers' compensation benefits dispute. Mediation is one popular form of ADR as it is less formal than traditional court hearings and participation is generally voluntary.
Formal Hearing
Formal hearings regarding a workers' compensation claim are held before the Workers' Compensation Appeals Board. In this process, evidence will be presented by both sides and both parties will have the opportunity to present witnesses. A judge will preside over the hearing and issue a judgment.
Appeals Process
After a decision has been made by the workers' compensation judge, it is possible to appeal the decision by filing a petition for reconsideration. An appeal must be properly worded and filed within a certain time frame after the decision was issued.
Can a Workers' Comp Attorney in California Help with Disputes?
No matter what option an injured worker pursues, it is best to seek the assistance of counsel experienced in this area of the law. A skilled workers' compensation lawyer will be able to take over all communication with the insurer and the commission. They will speak on the injured worker's behalf and relieve them of that responsibility. A workers' compensation attorney will focus on obtaining the best possible outcome for their client, and not on what is best for the insurer or the commission.
Other ways they help include:
- Completing and filing the appropriate paperwork
- Gathering evidence on behalf of the injured worker
- Representing the worker in negotiations and before the workers' compensation commission
Speaking with a workers' compensation lawyer to find out how they are able to help is always a good idea.
Contact a Workers' Comp Lawyer in Sacramento Today
Workers' comp is designed to help workers injured on the job and who cannot work for a certain period of time. It is not designed to help workers who are injured but not due to their job. It's a costly program, and so tensions can rise when an employer or insurer suspects the injury does not qualify.
If you have questions about a workers' comp claim, speak to our workers' comp lawyer in California. We handle all types of cases and will provide honest, direct advice and solid representation. Contact the LAW OFFICE OF SHANE P. BRADLEY, APC today either using the online form or calling us directly at (916) 755-5929 to schedule a free consultation.