Costa Mesa Workers Compensation Attorney

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Costa Mesa Workers Compensation Attorney

Costa Mesa Workers Compensation Lawyer

Staying safe on the job should be a guarantee. However, work-related accidents are a reality in any field and should be addressed as soon as they occur. California state law mandates that all employers provide workers’ compensation insurance for their employees, regardless of the size of their staff. Making a workers’ compensation claim is essential for getting the financial support needed to take time to recover, but making these claims could be tricky. In the Costa Mesa area, the legal team at Leviton, Diaz & Ginocchio Inc. can help you create a strong and comprehensive workers’ compensation case.

What Is Workers’ Compensation?

Typically referred to as “workers’ comp,” workers’ compensation is the support payment made by your employer to help you process, recover from, and pay for work-related injuries. In some fields, injuries are more likely to occur than in others, for example, in construction or kitchens, but all workplaces can produce work-related injuries. The support provided in a workers’ compensation case can be used for medical bills, wage replacement, short-term disability pay, and sometimes, accidental death benefits for loved ones.

Workers’ compensation can cover injuries caused by immediate factors at work or repetitive, long-term injuries that take time to develop. For example, head trauma caused by falling debris or building material at a construction site would receive the same amount of attention as injuries that take time to develop, such as carpal tunnel. Although workers’ compensation is typically tied to those working in more physically demanding fields, those working in offices or other low-impact positions can still develop injuries from their work. Addressing all injuries, especially those that are impacting your daily life and ability to complete your job, is crucial for ensuring that you receive the benefits and support to which you are entitled.

costa mesa workers compensation lawyer

Can Employers Deny a Workers’ Compensation Claim?

Workers’ compensation may appear straightforward, but certain circumstances may preclude receiving workers’ compensation benefits. As with termination or separation cases, some violations of specific company policy, or blatant actions bound to cause an injury, may not be applicable for receiving workers’ compensation. Some companies provide training manuals that outline how to complete certain work tasks, and when they are not followed, these injuries can happen. Depending on the nature of the accident, an employer has the right to deny a workers’ compensation claim for injuries that:

  • Are the result of a fight or inappropriate behavior in the workplace.
  • Were the result of ignoring or violating company safety guidelines.
  • Were sustained by an employee under the influence of narcotics or alcohol.
  • Were self-inflicted or purposely done to receive workers’ compensation.

Although seemingly reasonable, employers often use these standards to refuse or deny valid workers’ compensation claims unfairly. For example, an employer may claim that a slip and fall injury resulted from not following the company dress code for proper footwear, despite unaddressed leaks or puddles on the floor from malfunctioning equipment or plumbing. Often, employers will drug-test employees after an accident, but they are only supposed to do so if there is a reasonable suspicion that the injured employee was under the influence at the time of the accident. When faced with backlash from a company over workers’ compensation claims, finding a workers’ compensation lawyer is critical for properly addressing and combating these refusals of coverage.

How to Make a Workers’ Compensation Claim

Immediately after a work-related injury occurs, if possible, you must notify your employer when and how the injury occurred. The statute of limitations on workers’ compensation claims expires thirty days after the date of the incident, meaning that the sooner you file your claim, the better your chances are at getting it accepted. After this initial conversation, the process for filing a workers’ compensation claim is as follows:

  • Decide who will be your main medical provider: The primary treating physician for your work-related injury can be the physician you had previously specified in writing with your employer before the injury. If not, you will need to select a doctor from the medical provider network (MPN) or health care organization (HCO) of your employer, or your employer may choose a doctor for you. Once one is found, begin any necessary treatment.
  • Watch for the claims administrator’s choice: The administrator will decide whether to accept or reject your claim after reviewing it. If a claim is approved, workers’ compensation money will be used to pay for any additional medical care. If your claim is refused, it indicates the administrator does not think you qualify for benefits, and you will need to try to work things out or file an appeal.
  • Keep up your medical care: Once your claim has been approved, your primary treating physician will propose appropriate care to speed up your recovery, with the associated costs covered by your employer. The claims administrator will also receive reports from your doctor regarding your readiness to resume employment.
  • Ensure disability eligibility: The claims administrator will determine your eligibility for temporary or permanent disability benefits. These will compensate you for some of your missed pay based on the findings from your doctor. If you are unable to work for more than three days following your injury, temporary compensation may begin right away. Permanent benefits cannot be decided until your doctor certifies that you have obtained optimum medical improvement, which could take a few weeks or longer.
  • Make sure your benefits are paid: Your employer is responsible for the timely reimbursement of medical expenses, while the claims administrator will pay disability payments on a biweekly basis for the duration of the claim. If your employer does not provide you with acceptable work and you have a permanent partial impairment, you may also be qualified for a Supplemental Job Displacement Benefit.

For claims that have been accepted, these benefits are to be given out after settling your claim. After finishing the claims process, any benefits or payouts from your employer should be delivered within 30 days of the final settlement. As with any legal situation, the best-case scenario may not always happen, causing you to seek further legal action to settle your claim. If you feel that your claim was denied when it should not have been, you will have to contact a workers’ compensation firm and appeal your case.

costa mesa workers compensation attorney

The Appeals Process for Denied Workers Compensation Claims

In some situations, your workers’ compensation claim may be denied. For some claims, the reasoning behind the injury may be discovered to be no fault of your employer. Investigating these denials to the extent to which they are delivered is important for understanding the reasoning behind the decision. If you decide to file an appeal, you should be ready for the subsequent procedure and be aware that your lawyer will be able to represent you throughout the entire process. After finding representation, the appeals process is as follows:

  • Submit a claim adjudication application: This is the first step in ensuring that a workers’ compensation judge can hear your case. The paperwork must be delivered to the claims administrator in charge of reviewing your case and the Division of Workers’ Compensation office for your county. Usually, you have one year from the time you were hurt or became aware of the damage to submit your application.
  • Declare your readiness to proceed in writing: You can submit a Declaration of Readiness to Proceed, which formally requests a hearing with a workers’ compensation court if your attempts to settle a disagreement with the claims administrator have been unsuccessful.
  • Go to a Mandatory Settlement Conference: Your attorney, the claims administrator, and any additional parties to the case will meet with the court to negotiate a settlement during the settlement conference. If the settlement is approved, this may be the end of the appeals process.
  • Prepare for trial: If the negotiation for a settlement fails, the judge will set a trial date and might mandate a period of pre-trial discovery, during which you and your lawyer will prepare to present evidence in support of your claim. The judge will determine, after considering the evidence, whether to hear the case.
  • Apply for a Petition for Reconsideration: If your claim is still rejected after the judge makes their ruling, you can ask the California Workers’ Compensation Appeals Board to reconsider their decision if you think the court’s ruling was unfair or erroneous. If you have a good case for an appeal, your lawyer will let you know.

Although the process of appealing a denied workers’ compensation claim may be stressful, it is necessary for receiving the payment and benefits you are entitled to as a worker. Whether it be mishandling by insurance or falsified claims made by your employer, which are unfortunately common, pointing these out and bringing them before the court can be extremely beneficial for your claim.

Do All Workers’ Compensation Cases End in a Settlement in Costa Mesa, CA?

In California, there is always some sort of resolution to a workers’ compensation case. Most instances result in a consensual settlement between the employer’s insurance provider and the injured employee. These scenarios are the easiest to understand and typically move along quickly. Some disputes, nevertheless, will be resolved in court. If your employer’s insurance provider refuses to pay, you may need to file a claim to ensure that you receive just compensation. In cases where the injury was not caused by the employer, such as injuries sustained during a workplace fight, the investigation may reveal that money is now owed.

FAQs About Costa Mesa, CA Workers Compensation Law

What Settlement Percentage Does a Workers’ Comp Attorney Get in Costa Mesa, California?

The percentage of a settlement awarded as attorney fees can range based on where the case is filed, but most attorneys receive around 15%. For cases involving discrimination when making a workers’ compensation claim, California Labor Code 132a requires employers to pay out an extra settlement to the legal team of the fired employee, separate from the overall settlement.

When Should I Hire a Workers’ Comp Lawyer?

Depending on your injuries and your expected time out of work, consulting a workers’ compensation lawyer is always in your best interest to start properly addressing your claim. For those facing retaliation claims for getting injured on the job, finding representation before approaching any court appearance is crucial for beginning your case.

How Long Does a Workers’ Comp Case Take in California?

After you file your claim, your employer’s insurance will typically take around thirty days to process, review, and settle the case. However, if it is contested or denied, this process may take longer to settle. For example, if your employer is trying to falsely claim that you were under the influence of drugs or alcohol when the accident happened, bringing this before a judge should be a priority. Proving your case in court will prolong the deliberation process.

How Do I Settle a Workers’ Comp Claim in California?

After you file a claim with your employer, a typical, clear-cut workers’ compensation case will take thirty days to deliberate and settle. After agreeing with your employer and their insurance, you will be awarded your settlement around thirty days after the closure of your case. If you or your counsel reject any terms of the proposed settlement, these issues will be discussed in court before agreeing to a final offer.

Do I Need a Workers’ Comp Attorney in California?

Although California’s workers’ compensation system was created so that you do not require legal representation, it is often important to enlist a qualified expert’s assistance to ensure you receive all the benefits to which you are legally entitled. With the help of an attorney, you can be sure that your rights are properly represented throughout your case.

Find the Right Workers’ Compensation Law Firm for Your Claim

Getting the support that you deserve for your workplace injuries should be standard for any workers’ compensation case. Although seemingly clear-cut, any workers’ compensation claim can get exceedingly more complicated than planned. Before reaching this state, hiring a workers’ compensation lawyer is imperative for crafting a solid case. At Leviton, Diaz & Ginocchio Inc., we specialize in workers’ compensation cases ranging across various fields, helping workers in any sector get the compensation they deserve. To get started on your claim, visit our website and contact us for a consultation today.

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