GENERAL INFORMATION ABOUT WORKERS’ COMPENSATION CLAIMS.
THE INFORMATION IN THIS WEBSITE IS GENERAL IN NATURE, AND SHOULD NOT BE READ OR UNDERSTOOD AS LEGAL ADVICE. IT SHOULD NOT BE SOLELY RELIED UPON IN MAKING A DECISION THAT MAY AFFECT ANY LEGAL MATTER. ONLY A CONSULTATION WITH AN ATTORNEY REVIEWING THE FACTS AND CIRCUMSTANCES IN YOUR PARTICULAR CASE CAN GIVE YOU THE ADVICE YOU NEED.
Pursue medical treatment as needed
The money you may receive for your injury will not make up for the loss of work capacity, earnings and the pain and suffering you endure when suffering a significant injury. Your health and your ability to function as fully as possible should be your primary interest. If you have trouble getting your employer’s insurance to pay for treatment, and if you have your own medical insurance, don’t hesitate to demand that your own medical insurance company pay for treatment. Once your employer’s liability for the injury is established, the employer’s workers’ compensation insurance may have to reimburse your own insurance company and if you have paid for care out of your own pocket, it is possible you will be reimbursed.
All these benefits must be provided by your employer or its insurer when an employee has suffered a work related injury, and if they unreasonably withhold providing you with any of them, substantial penalties can be assessed and paid to you. Employers may, however, seek to limit treatment based on medical opinions called “Utilization Reviews”. If treatment is denied by UR, you should appeal and request the State to provide an “Independent Medical Review” of the UR denial. We at the Gold Country Workers’ Comp Center will handle that for you. Your chances of getting denied treatment are much better if appealed correctly.
There are limits to certain treatments
You are limited to 24 visits with a chiropractor under the compensation laws, and even then, the chiropractor may not get paid if treating, for example, a foot injury, or ancillary health issue not directly caused because of you work related injury. You are also limited to 24 physical therapy visits and 24 acupuncture therapy visits.
Maximize your income while not working
There are various programs that may be able to provide you with extra income while you are not working.
If you miss work for ANY reason, including a work related injury that your employer or its insurance company disputes, immediately APPLY FOR STATE DISABILITY INSURANCE (SDI) BENEFITS. This program is funded by money withheld from your wages, so you should apply if you aren’t getting disability payments from your employer. Once employer liability is established, your SDI account will be reimbursed by the employer’s insurance. Go to EDD.gov for more information and to apply. Click here for a list of SDI offices.
Prepare early to resolve your claim
Finally, once your condition has stabilized, your employer will send you a notice discouraging you from contacting an attorney. Insurance companies will often suggest that you don’t need an attorney to get benefits, and remind you, correctly, that an attorney’s fees are deducted from your award.
The interest of any insurance company is to minimize any award to be paid to you and if they have to pay for it, to also minimize the medical care you are provided . They may try to dissuade you from obtaining legal counsel because an attorney will often produce payment to you of more benefits than their charged fee. The attorney’s fee is deducted from the last payments to be made to you. The attorney’s fee is deducted from your award, and you need not pay for any fees or costs “up front”.
Check the FAQs page about when you should contact an attorney. Because of the many ways a claim can be minimized by the employer or insurance company, it’s better to call an attorney sooner rather than later AND it costs no more.