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Workers' Compensation Frequently Asked Questions

What is commonly referred to as is "Work Comp", is a state mandated insurance program providing financial and medical compensation to employees who have had the misfortune of suffering a job-related injury or illness. With approved claims, injured workers receive benefits regardless of who is at fault. That's right! Whether the blame falls on the employee, employer, co-worker, client or customer, or some other random person, it matters not. You are entitled to your rights!


State law requires all California employers provide injured workers with certain benefits. Required benefits include 100% coverage of ANY reasonable medical treatment necessary to cure and/or relieve the complications of work related injuries, temporary or permanent disability payments in the event of lost wages or when you've been deemed Permanently Disabled, supplemental job voucher for career retraining and death benefits for families who have lost a loved one due to a work related death.


The California Labor Code prohibits employers from discriminating against employees because of a filed Workers' Compensation claim. Furthermore, the employer cannot fire you for your intent to file a Workers' Compensation claim. If found to be in violation of these provisions, the employer can be forced to reinstated the terminated job, restitution can be ordered, and penalties can be imposed by the Workers' Compensation Appeals Board.


Fees are contingent based upon the awarded benefits, permanent disability or negotiated settlement. That means that the attorney doesn’t get paid unless you get paid. Attorney fees typically range from 12-15% and subject to approval by the Workers’ Compensation Appeals Board.


You should immediately notify your employer that you have been hurt or injured. But, in the event that you didn't, you have 30 days from the date of your injury to file a claim. You have one year from the date of injury, or one year from the date you last received a benefit, to file your claim with the Workman's Compensation Appeals Board (also known as WCAB).

As a client, the Law office of Harley Merritt will assist you in filling out and filing any necessary forms.


Free claim forms can be obtained from the State of California Department of Industrial Relations website: http://www.dir.ca.gov/dwc/dwc_home_page.htm


Work related injuries and illnesses can often develop over a period of time. We call this type of work injury a Cumulative Trauma (also known as CT) and yes, it is absolutely covered by Worker's Compensation. CT injuries commonly occur due to continuous use of your body, using repetitive motions and movements or incidents containing long term exposure to hazardous chemicals, resulting in an Occupational Disease, to name a few examples.


You do have the right to pre-designate a doctor of your choice, but this has to be done before the injury has occurred. The form for predesignating a doctor is typically given to you when you at time of hire and it is your responsibility to verify that the desired doctor accepts Workers Compensation Insurance.

However, it is more common that a doctor has not been pre-designated and you will be referred to a doctor within the Insurance Company's Medical Provider Network (MPN). If you find yourself in need of a doctor, our dedicated staff will be more than willing to locate your Insurance Company’s MPN List and provide you with information on how to designate a wide range of medical specialists.


It isn't over! Scheduling a medical-legal examination is the next step and we're here to help you. Having an attorney can be very beneficial in the process of obtaining a panel Qualified Medical Examiner (QME) list. The Insurance Company is required to send you the necessary forms and this is something that you can do on your own, but it's complicated navigating the Work Comp world and trying to keep up with all the legal language and confusing court system. When represented by the Law Office of Harley Merritt, you can rest assured that we will choose the most appropriate QME doctor for the evaluation (some doctors are better than others, depending on the case).


Any medications or treatment requested by your doctor must first be submitted to the Insurance Carrier via a Request for Authorization Form, which will have a physician's report attached. The RFA is then subject to review by the Insurance Company, through a process called Utilization Review. The Insurance Company has five business days, or 14 days if they are requesting more information, to response to your doctors' request. When medication and/or treatment have been denied by Utilization Review, it can be appealed through Independent Medical Review (IMR). The IMR appeal must be submitted within 30 days.


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