FAQSUnderstanding the law and what benefits you are entitled to is critical to avoiding mistakes early in your case.
FAQs – Workers’ Compensation
When faced with a work injury many potential clients have questions they’d like to ask prior to meeting with an attorney. We have included answers to a number of frequently asked questions below. If you have any other questions, please contact Ainbinder & Pratt.
If the Insurance Company is Cooperating and I Am Getting Medical Treatment and/or Temporary Disability Benefits, Why Do I Need a Lawyer?
While the insurance company may be paying you benefits now, the time will come when either your benefits stop or it is time to settle your case. Naturally, an insurance adjuster will try to save his/her employer (the insurance company) as much money while paying you as little money (if anything at all). In addition, workers’ compensation settlements are based on any impairment you have after a doctor declares you permanent and stationary (maximal medical improvement). In all likelihood, if you are not represented by a lawyer and have been dealing directly with an insurance adjuster, you are treating with a doctor recommended by the insurance company or who you “selected” from a list of doctors given to you by the insurance company. Either way, your unfamiliarity with doctors in the workers’ compensation arena can land you with a conservative doctor who will ultimately decide your permanent disability rating and your need for future medical care. These two categories are what your settlement will be based on so now is the time to position yourself and your case most favorably with the help of a lawyer on your side.
Will I Get More Money if I Hire a Lawyer?
The lawyers at Ainbinder & Pratt are skilled negotiators. Not only is it important to position your case in the early stages for maximum recovery, but also when it comes time for settlement, you should have a knowledgeable attorney negotiating on your behalf. The insurance company has lawyers working for them and you should have skilled lawyers working for you. Also, attorneys’ fees are only 15% — a skilled attorney whose primary focus is handling workers’ compensation cases will be able to get you a settlement that far exceeds the attorneys’ fees charged.
I Am Currently Represented By a Lawyer, Can I Switch Lawyers if I Am Dissatisfied?
Yes. You are entitled to change attorneys. Attorneys’ fees are not increased if you decide to change representation. In other words, the 15% attorneys’ fee will be split between the attorney that settles your case and all other prior attorneys.
When Will I Start Receiving Money?
If a doctor has indicated that you are temporarily unable to work as a result of an admitted workers’ compensation injury, then you are entitled to receive temporary disability payments up to $1,128.43 per week. The amount you are entitled to depends on your average weekly earnings. Temporary disability is determined by calculating 2/3 of your average weekly earnings for one year (depending on length of employment) prior to the injury.
Should I Apply for State Disability Through EDD?
If your claim is denied or delayed, you may file for state disability benefits through the Employment Development Department (EDD), which typically pays the same amount as workers’ compensation temporary disability payments. Your doctor should have the necessary forms at his/her office or you can print the EDD form on-line and bring it to the doctor for him/her to complete.
You cannot collect EDD state disability benefits and workers’ compensation temporary disability benefits at the same time. If the insurance company begins sending you temporary disability checks while you are collecting EDD disability, then you must notify EDD immediately to cease benefits.
My Employer Has Not Sent Me to a Doctor and I Need Medical Treatment, What Do I Do?
It is common for an employer to ignore its employee’s request for medical treatment after an injury occurs. Once you hire the Law Offices of Ainbinder & Pratt to represent you, we will immediately arrange for you to be seen by a doctor at no cost to you.
Does My Employer Have to Give Me a Claim Form After I Report My Work Injury?
Yes. Your employer must give you a claim form to fill out regarding your injury. On the claim form, there is a portion for you to fill out and a portion for your employer to complete. Your employer must give you a copy of the completed form within one working day after you filed it. Keep this copy. The claims administrator (usually from your employer’s insurance company) generally must decide within 90 days whether to accept or deny your claim.
Why Did I Stop Receiving Temporary Disability Checks?
There can be a number of reasons you stopped receiving temporary disability payments. Temporary disability payments will end when:
1. Your treating doctor says that you can return to your usual job, whether or not you actually return to work; or
2. You return to your usual job or to modified work at your regular pay; or
3. Your treating doctor states you have reached maximum medical improvement (“permanent and stationary” status) which means your condition is neither improving nor getting worse, or
4. You have reached the maximum number weeks (104) allowed for TD benefits pursuant to the Labor Code.
When temporary disability payments end, the insurance company must send you a letter explaining why the payments are ending. The letter must be sent within 14 days after your final temporary disability payment and must list all temporary disability payments sent to you.
Even though there is generally a 2-year maximum for temporary disability payments, there are certain exceptions and medical conditions that extend the cap. Call to speak to a lawyer today to discuss your particular situation.
If your temporary disability checks have stopped without explanation, contact a lawyer immediately.
The Doctor Released Me and My Temporary Disability Payments Stopped, But I Still Cannot Work. Are There Any Other Benefits I Can Receive?
Yes, within 14 days of your last temporary disability check, the insurance company must start advancing permanent disability payments. You may also be eligible for state disability benefits. Additionally, your case may be ready for settlement so you should discuss your options with a lawyer.
Even though the goal of the workers’ compensation system is to return injured workers to the workplace in their pre-injury condition, often times injured workers cannot return to their jobs and are left with a certain level or percentage of permanent disability as a result of their injuries. If a doctor declares you permanent and stationary and assigns a percentage of impairment, you are entitled to compensation based on that percentage. You may also be entitled to lifetime medical care and vocational rehabilitation benefits. Contact a lawyer to discuss your options.