Take Charge of Your Workers' Compensation Claim

by Ball, Christopher A.; Laurence, Bethany K.

• ISBN13: 9780873378031
• ISBN10: 0873378032
• Format: Paperback
• Copyright: 2002-04-01
• Publisher: Nolo

Summary

Approximately one million people a year suffer job related injuries or illness in California. For many, receiving compensation can be a nightmare. Updated to reflect the most recent changes in the law, this book guides them through the process of filing a legitimate workers' comp claim. Includes step-by-step instructions and all necessary forms. Appendix of recent court cases.

Author Biography

Christopher Ball graduated from Western State School of Law in 1975 and has practiced California Workers' Compensation law exclusively since 1991. He is certified as a Workers' Compensation Specialist with the State Bar of California

Table of Contents

Part I: All About Workers' Compensation
Introduction to Workers' Compensation
What Is Workers' Compensation?	2	(1)
What an Injured Worker Is Entitled to	3	(2)
Where to Get Additional Information and Help	5	(1)
How to Use This Book	5	(1)
What This Book Does Not Cover	6
Overview of a Workers' Compensation Claim
Notify Your Employer of the Injury	2	(1)
Get Medical Treatment If Needed	2	(1)
Paying for Medical Treatment If Employer Refuses Authorization	3	(1)
What to Tell the Doctor	3	(1)
The Doctor Decides If You Need Time Off	3	(1)
Complete Workers' Compensation Claim Form and Application for Adjudication of Claim Form	4	(1)
Secure Control of Your Medical Care	4	(1)
Receive Temporary Disability Benefits If You're Eligible	4	(1)
Handling a Denial of Your Claim or Benefits	5	(1)
Taking Problems to the Appeals Board	5	(1)
After You Are Determined to Be Permanent and Stationary (P&S)	6	(1)
If You Recover Completely and Return to Work	6	(1)
If You Are Entitled to Vocational Rehabilitation Benefits	6	(1)
If You Are Permanently Disabled-Negotiate a Final Settlement	7	(1)
Go to Trial If There Is No Settlement	7	(1)
Judgment Is Paid or the Matter Is Appealed	7
Is Your Injury Covered By Workers' Compensation?
Is Your Job Covered by Workers' Compensation?	2	(3)
Do You Have a Compensable Injury?	5	(4)
Injuries Not Covered by Workers' Compensation	9
Cumulative Trauma Disorders
What Is a CTD?	2	(2)
Becoming Aware of Your Injury	4	(2)
Diagnosis and Treatment	6	(3)
Returning to the Workforce	9	(3)
Further Medical Treatment	12
Part II: Protecting Your Rights
What to Do If You're Injured
Request Medical Treatment	2	(1)
Report the Injury Within 30 Days	3	(1)
File Your Workers' Compensation Claim	4	(10)
The Insurance Company's Answer	14	(1)
Take Steps to Protect Your Rights	14
Keep Good Records to Protect Your Claim
Set Up a Good Recordkeeping System	2	(1)
Read and Understand What You Receive in the Mail	2	(1)
Gather Important Records Pertaining to Your Claim	2	(5)
Request Copies of Documents and Evidence	7	(1)
Keep Your Address Current	7
The Insurance Company's Role
Self-Insured Employers	2	(1)
The Insurance Company's Responsibilities	3	(1)
Your Responsibilities as an Injured Worker	3	(1)
Who's Who in the Insurance Company	3	(2)
How to Deal With the Insurance Company	5	(3)
Tactics Insurance Companies Use to Deny or Minimize Claims	8	(1)
Settling Your Case	9
Dealing With Your Employer
Self-Insured Employers	2	(1)
The Employer/Insurance Company Relationship	2	(2)
The Employer's Responsibilities	4	(1)
If You're Out of Work Due to the Injury	5	(2)
Bankruptcy or Other Employer Financial Problems	7
Taking Charge of Your Medical Case
Important Role of the Treating Doctor	2	(4)
Choose Your Treating Doctor (Get Medical Control in Your Case)	6	(3)
Changing Treating Doctors	9	(3)
Be Sure You Receive Excellent Medical Care	12	(3)
When Your Condition Becomes Permanent and Stationary (P&S)	15
Medical-Legal Evaluations
Rules for Medical-Legal Evaluations	2	(1)
Picking a Qualified Medical Examiner (OME)	3	(2)
Compensability of Injury (Labor Code § 4060)	5	(2)
Nature and Extent of Permanent Disability or Need for Future Medical Treatment (Labor Code § 4061)	7	(3)
Other Issues to Be Resolved by Medical-Legal Evaluations (Labor Code § 4062)	10
Part III: Workers' Compensation Benefits
Payment of Medical Benefits
Payment for Accepted Claims	2	(2)
Future Medical Care Costs	4
Temporary Disability Benefits
Types of Temporary Disability	2	(1)
Amount of Temporary Disability Payments	2	(3)
How Payments Are Made	5
Permanent Disability (and Life Pension)
How Permanent Disability Award Compensates Worker	2	(1)
Kinds of Permanent Disability Awards	3	(1)
Establishing Your Permanent Disability Status	3	(1)
How Permanent Disability Is Paid	4	(2)
Amount of Permanent Partial Disability Benefits	6	(2)
Life Pension Benefits	8	(1)
Permanent Total Disability Benefits	8
Vocational Rehabilitational Benefits
What Is Vocational Rehabilitation?	2	(2)
Six Steps in a Vocational Rehabilitation Plan	4	(2)
Eligibility for Vocational Rehabilitation (QIW Status)	6	(2)
How to Start Vocational Rehabilitation	8	(2)
Delays and Failure to Provide Rehabilitation Services	10	(1)
Preparing a Vocational Rehabilitation Plan	10	(5)
Completing a Vocational Rehabilitation Plan	15	(1)
Where to Get Help With Vocational Rehabilitation	15
Death Benefits
Who May Receive Death Benefits	2	(1)
Death Benefit Amount	2	(2)
Additional Payments for Dependent Minor Children	4	(1)
Burial Expense for Deceased Worker	4	(1)
Unpaid Temporary or Permanent Disability Payments	4	(1)
How Death Benefits Are Distributed	5
Extraordinary Workers' Compensation Benefits and Remedies
Subsequent Injuries Fund Benefits	2	(1)
The Uninsured Employers' Fund	3	(1)
Discrimination Benefits (Labor Code § 132(a))	3	(1)
Employer's Serious and Willful Misconduct	4
Benefits and Remedies Outside the Workers's Compensation System
State Disability (SDI)	2	(1)
Social Security Benefits	3	(1)
Claims or Lawsuits for Personal Injuries	4	(1)
Claims or Lawsuits Based on Discrimination	5
Part IV: Settling Your Case
Rating Your Permanent Disability
Overview of the Rating Process	3	(2)
What Is Involved in the Rating Process?	5	(1)
Step-by-Step Example of How to Rate a Disability	6	(16)
Other Considerations in Rating a Permanent Disability	22	(1)
How to Use the Old Rating Manual for Injuries That Occurred Before 4/1/97	23
Figure Out a Starting Settlement Amount
What You May Receive in a Settlement	2	(1)
Two Kinds of Settlements	2	(3)
Determine the Value of Your Claim Using the Settlement Worksheet	5	(8)
What to Do Next	13
Negotiating a Settlement
Deciding Whether to Negotiate Your Own Settlement	2	(1)
The Concept of Compromising	3	(1)
How to Negotiate a Settlement	3	(5)
Review and Sign Settlement Documents	8	(15)
Attend an Adequacy Hearing	23
Part V: The Workers' Compensation Appeals Board
Preparing Your Case
Identify Possible Issues in Dispute	2	(3)
How to Prove (or Disprove) Disputed Issues	5	(2)
Depositions	7	(5)
Subpoenaing Witnesses and Documents	12	(3)
Preparing for a Pre-Trial Hearing (Mandatory Settlement Conference)	15	(1)
Preparing for a Trial	16
Arranging for a Hearing or Trial
Kinds of Hearings	2	(1)
Trial on Preliminary Issues (Case Not Ready to Settle)	2	(3)
Trial on Entire Case (the Case-in-Chief)	5	(1)
Complete Documents to Set Your Case for Hearing	5	(5)
Copy, Serve and File Documents	10	(2)
Receiving Notice of a Hearing	12
How to File and Serve Documents
What Is Service of Documents?	2	(1)
How to Serve Documents by Mail	2	(1)
How to Serve Documents Personally	3	(1)
How to File Documents With the Workers' Compensation Appeals Board	4
Going to a Hearing or Trial
Finding Your Way Around the Appeals Board	2	(2)
Pre-Trial Conference (Mandatory Settlement Conference)	4	(11)
Trial	15	(6)
Findings and Award	21
Appealing a Workers' Compensation Decision
The Three-Step Appeal Process	2	(1)
Petition for Reconsideration	2	(2)
Writ of Review With the Appellate Court	4	(1)
Writ of Appeal to the California Supreme Court	5
Part VI: Beyond the Book
Lawyers and Other Sources of Assistance
Information and Assistance Officers	2	(1)
Hiring a Lawyer	2	(1)
Legal Research
Find a Law Library	2	(1)
The Basics of Legal Research	2	(1)
Case Law Review
Is Your Injury Covered By Workers' Compensation?	3	(1)
What To Do If You're Injured	4	(1)
Taking Charge of Your Medical Case	5	(1)
Medical-Legal Evaluations	6	(1)
Payment of Medical Benefits	7	(1)
Temporary Disability Benefits	8	(1)
Permanent Disability	9	(3)
Vocational Rehabilitation Benefits	12	(1)
Death Benefits	13	(1)
Extraordinary Workers' Compensation Benefits and Remedies	14	(1)
Rating Your Permanent Disability	14	(2)
Figure Out a Starting Settlement Amount	16	(1)
Negotiating a Settlement	17	(1)
Preparing Your Case	18	(1)
Arranging for a Hearing or Trial	19	(1)
Going to a Hearing or Trial	19
Appendices
A1 Summary of Important Workers' Compensation Laws for Injuries Between 1/1/90 and 12/31/93
A2 Temporary Disability Benefits Compensation Chart
A3 Permanent Disability Indemnity Chart
A4 Workers' Compensation Forms
A5 Workers' Compensation-District Offices