BENEFITS UNDER CALIFORNIA WORKERS’ COMPENSATION

All California employers are required to provide their employees workers’ compensation. The purpose of workers’ compensation is to cover employees against medical and disability costs they have incurred after getting hurt or sick at work. Virtually all California employees, regardless of their immigration status, are covered by workers’ compensation.

The California Department of Industrial Relations Division of Workers’ Compensation (DWC) administers California’s workers’ compensation insurance program. Under federal and state law, if they are not self-insured, California employers must purchase worker’s compensation insurance. If an employer fails to comply with insurance requirements, workers can receive benefits through California’s Uninsured Employers Benefits Trust Fund (UEBTF).

Workers’ compensation insurance provides the following basic benefits to sick and injured Temecula workers:

MEDICAL TREATMENT BENEFITS

Workers who suffer work-related injury or illness are entitled to benefits that pay for the necessary medical treatment. According to California law, workers’ compensation medical benefits should pay for doctor visits, special treatments, diagnostic imaging, lab tests, prescription medication, needed medical equipment, and travel costs that are necessary for treatment.

DISABILITY BENEFITS

In many cases, workers who suffer injury or illness are unable to work for a period of time; others can never return to work. Injured workers who file a claim for California workers’ compensation benefits and get approved can receive two-thirds of their average weekly wage, up to a maximum amount dictated by California law. The maximum changes each year.

The length of time an injured or ill employee can collect workers’ compensation disability benefits depends on which of the following categories the worker falls into:

• Temporary total disability is for workers who cannot work for a certain period of time but can return to work at some point.
• Temporary partial disability is for workers who can still report to their place of employment but cannot perform the same duties or work for the same number of hours as before their injury.
• Permanent total disability is for workers who have an injury or illness that prevents them from returning to work or seeking gainful employment in the future.
• Permanent partial disability is for workers who suffer a permanent condition, disease, or disability, but they can still perform some tasks at their job.

SUPPLEMENTAL JOB DISPLACEMENT BENEFITS

Injured workers who receive workers’ compensation benefits because of permanent disability are also often eligible for supplemental job displacement benefits. California provides a voucher for disabled workers to seek formal education or add to their skill set if their employer does not offer them work, or if they do not return to their previous place of employment.

Recipients who receive the $6,000 voucher must comply with the following guidelines.

• The voucher can be used for tuition, books, tools, and other expenses related to attending school.
• The voucher can be used for a professional license, certification, fees for associated exams, and courses to prepare for exams.
• Up to $600 of the voucher can be used to pay for a licensed placement agency, a vocational counselor, and resumé consultation.
• Up to $1,000 of the voucher can be used to purchase a desktop computer, laptop, or other computer equipment.
• Up to $500 of the voucher can go towards miscellaneous costs that need not be documented.

DEATH BENEFITS

California workers’ compensation insurance pays death benefits to eligible surviving family members when an on-the-job injury or illness results in a Temecula worker’s death. Benefits include $10,000 for funeral and burial costs as well as monthly wage-replacement benefit payments. Dependent children are first in line to receive death benefits, and the injured worker’s spouse must not make more than $30,000 per year to qualify. In some cases, parents or grandparents can receive benefits when no children or spouses exist.

WHEN YOU NEED A WORKERS’ COMPENSATION ATTORNEY

While the DWC tries to make filing for workers’ compensation easy, it can still be a frustrating experience that makes it difficult for injured and sick Temecula workers to obtain the benefits they deserve.

An attorney can help an injured or sick worker at virtually any point in the workers’ comp claim process, even in preparing and filing an initial claim. Most of the time, however, the team at Gomez Trial Attorneys represents Temecula workers in cases involving:

CLAIM DENIALS

Your workers’ compensation claim might be denied for a variety of reasons, such as:

• Filing your claim late.
• Failing to report the injury to your employer in the required time period.
• Not receiving treatment from an approved medical provider.
• Disputing whether or not your injury or illness is actually work-related.

Regardless of the reason your claim was denied, you have the right to object to the denial and to ask the workers’ comp insurance company to reverse its decision. With the help of experienced workers’ compensation attorneys like those at Gomez Trial Attorneys, you can file an appeal that challenges your claim denial and seeks a hearing in front of a judge.

The DWC will tell you that you do not necessarily need an attorney to file an appeal, however, Gomez Trial Attorneys, urges all workers to seek the help of an attorney immediately after any claim denial. You only get one shot at filing your appeal, and it takes the skill and expertise of an experienced attorney to do it properly.

RETALIATION

Some workers who file a workers’ compensation claim face retaliation from their employer including termination, suspension, unwanted transfer, demotion, pay cut, reduction in scheduled hours, or threats of disciplinary action.

Retaliating against an employee who files a workers’ compensation claim is against the law. California law entitles victims of workplace retaliation to file a complaint. The experienced workers’ compensation lawyers at Gomez Trial Attorneys can help Temecula workers challenge and seek compensation for any retaliation they experience after filing a workers’ comp claim.

THIRD-PARTY LIABILITY

Workers in Temecula reserve the right to receive workers’ compensation benefits regardless of who was at fault for their work-related injury or illness. However, it is possible for an employee to contract an illness or suffer an injury at work because of the wrongful actions or decisions of someone other than their employer.

For example, construction workers in Temecula may suffer injuries because the heavy equipment they use is defective, in which case the equipment manufacturer might face legal liability for their injuries and losses. Similarly, workers who suffer illness or permanent harm as a result of toxic chemical exposure potentially have a lawsuit against the company that manufactured or distributed the chemicals. With the help of an experienced team of workers’ compensation lawyers, like those at Gomez Trial Attorneys, workers may have the ability to seek damages from these third parties.

INJURED AT A JOB SITE

Some job roles require people to work at a site not owned by their employer. While this is common for construction workers, it also occurs with utility workers, truck drivers, salespeople, and others in a wide variety of career roles. If you are injured at a job site, the property owner might be liable to you for damages, separate and apart from your right to receive workers’ compensation benefits. The team at Gomez Trial Attorneys evaluates whether an injured or sick worker has rights against property owners for job site injuries.

UNINSURED EMPLOYER

Although federal and state governments require employers to carry workers’ compensation insurance, some companies refuse to comply. In those cases, injured and sick Temecula workers can seek benefits from the state-administered UEBTF. These workers may also have a personal injury claim against their employer. At Gomez Trial Attorneys, we seek compensation for our injured clients from the UEBTF, and we fight to make sure that employers who break the law are held accountable for their wrongful actions.

INJURED WHILE DRIVING COMPANY VEHICLE

Just like anyone behind the wheel, Temecula workers driving company vehicles risk accidents and injuries. Those who suffer injuries from accidents may have legal rights to seek compensation from the party at fault, whether it is the other driver, an auto manufacturer, or whoever else may have caused the crash. The attorneys at Gomez Trial Attorneys have years of experience representing victims of traffic accidents throughout Southern California and they know how to make sure workers who suffer harm behind the wheel receive full compensation for their injuries and losses.

PRE-EXISTING INJURIES

A common complication with workers’ compensation claim is the existence of preexisting injuries. Workers’ claims are frequently denied because the workers’ compensation carrier thinks they had a preexisting injury or illness that is not covered. In these situations, the injured worker may need to prove that the workplace accident that occurred caused an injury separate from the preexisting one, or aggravated the preexisting condition.

The Gomez Trial Attorneys team is cognizant of the ways workers’ compensation insurance companies try to avoid financial responsibility by claiming a worker has a preexisting condition, and we fight hard to make sure they pay the benefits the law requires.

DENIED MEDICAL TREATMENT

Worker’s compensation insurance carriers are particular with medical treatment. If they approve a claim, they must pay for medical expenses. However, this only includes necessary medical treatment. Workers’ compensation insurance companies will sometimes deny claims or refuse to pay for specific medical expenses by claiming that the treatment was not necessary. Workers’ compensation insurance companies also deny claims when a workplace accident victim does not seek treatment from a specific doctor or type of doctor.

Gomez Trial Attorneys represent injured and sick workers who face push-back from workers’ compensation insurance companies over their medical treatment. We believe all workers should have control over their medical choices, and we fight hard to make sure they have it.

TEMECULA WORKERS’ COMPENSATION FAQ

Temecula’s booming tourist industry brings with it a significant number of employees in the tourism sector, including those who work at wineries, resorts, and events like the Temecula Valley Balloon & Wine Festival. This type of work, along with more traditionally dangerous work—such as in construction or transportation—brings with it a risk of sustaining on-the-job injuries and illnesses.

If you have recently sustained injuries or contracted an illness at your place of employment, you may struggle with multiple issues related to filing a workers’ compensation claim, or perhaps you have not yet filed a claim. Workplace illness and injury cause many to miss work and lose income, creating an economic burden for many households beyond the physical challenges of injury and illness.

Most employers in Temecula and throughout California are required to purchase workers’ compensation insurance that provides disability and medical benefits when an employee sustains an injury or contracts an illness in the workplace. Regardless of where you are in the claims process, you might feel overwhelmed and unsure about your next steps. While you do not always need a lawyer for a workers’ compensation claim, it’s typically the best course of action to discuss your case with a lawyer during a free consultation.

Getting an attorney involved sooner rather than later ensures your best chance of recovering benefits, and often helps a complex claim go more smoothly. Until you have the opportunity to meet with a Temecula worker’s compensation attorney, we have provided answers to some frequently asked questions about workers’ compensation in Temecula.

I WAS WORKING IN TEMECULA, BUT MY INJURY DID NOT OCCUR AT WORK. AM I STILL COVERED UNDER WORKERS’ COMPENSATION?

Workers’ compensation insurance covers job-related injuries and illnesses, even if they don’t occur on the premises of the company that employs you. This is especially common for construction workers, project managers, and others working on a job site, and for those who have to travel for their jobs. Employees that suffer injuries while running a company errand or attending a mandatory job-related social function also have the right to file a workers’ compensation claim to receive benefits for their injuries or illnesses.

HOW MUCH TIME DO I HAVE TO FILE A WORKERS’ COMPENSATION CLAIM IN TEMECULA?

Under California law, before you file a workers’ compensation claim, you must notify your employer of your injury or illness within 30 days. If your boss is traveling or out of the office for personal reasons, and you do not report your injury or illness, you risk jeopardizing your eligibility for workers’ compensation benefits. Your employer is required to provide you with a claims form within one day of learning about your injury or illness. If you were injured, and your employer has not provided you with a form, you can download it here. We can help you fill it out and file it.

You have one year from the date of your injury or illness to file a workers’ compensation claim, but it’s always in your best interest to take action sooner rather than later. Some severe injuries may leave workers hospitalized for weeks or months, making it difficult to go through the claims process. You must file within the one-year time limit, so you don’t lose your right to file.

HOW DOES WORKERS’ COMPENSATION CALCULATE MY TEMPORARY DISABILITY BENEFITS IN TEMECULA?

Once you have missed three days of work as a result of a workplace injury or illness, you are eligible for temporary disability benefits to cover a portion of your lost wages. Your payments will amount to two-thirds of your pre-tax average weekly wages, however, by California law, there is a maximum amount you cannot exceed. While this amount changes annually, it was approximately $1,300 in 2020.

Your claims administrator will look at a variety of different things to determine your payment amount. According to the law,he or she must provide you with the method that it used to determine your benefits payments.

HOW LONG BEFORE I RECEIVE MY TEMECULA WORKERS’ COMPENSATION BENEFIT PAYMENTS?

If workers’ compensation insurance covers your injury or illness, you should receive your first temporary disability payment within 14 days of your employer learning about the injury or illness and your doctor confirming that your condition prevents you from working. The payment should come from your claims administrator. Once you receive your first payment, you should receive additional payments every two weeks as long as you are eligible for temporary disability.

WHAT ACTIONS DISQUALIFY ME FROM WORKERS’ COMPENSATION BENEFITS?

Being at-fault for your injuries or illness won’t disqualify you from receiving workers’ compensation benefits. Workers’ compensation insurance does not require a determination of liability to collect benefits, but some actions may disqualify you from receiving benefits after a workplace injury or illness.

Here are some examples:

• You purposefully hurt yourself.
• You were using drugs or alcohol when you sustained your injuries.
• You were violating the law when you were injured or contracted an illness.
• You were violating company safety rules and best practices when you were injured or contracted an illness.

If any of the above scenarios apply to you, immediately contact a workers’ compensation attorney to advocate for you and potentially help you recover some compensation for your injuries.

IF MY EMPLOYER IS UNINSURED, CAN I STILL RECEIVE WORKERS’ COMPENSATION BENEFITS?

California law requires all businesses with one or more employees to purchase workers’ compensation insurance or to self-insure for employee injuries and illnesses. If your employer has not complied with the law, and your injuries should be covered under workers’ compensation, you can apply for benefits through California’s Uninsured Employers Benefits Trust Fund (UEBTF). The fund will cover your benefits, seek reimbursement, and sometimes pursue legal action against your employer for non-compliance. Your employer can also directly pay your benefits. Whether an employer choose to self-insure or purchase workers’ compensation insurance, it is required by law.

WILL FILING A TEMECULA WORKERS’ COMPENSATION CLAIM RESULT IN MY TERMINATION?

It is against the law for an employer to retaliate against an employee for filing a workers’ compensation claim and is grounds to bring a lawsuit against your employer. However, beware that this does not mean your employer may not fire you for some other reason. If you think you were terminated for filing a workers’ compensation claim, you need to contact us as soon as possible to learn more about the best course of action for your situation.

DO MY WORKERS’ COMPENSATION BENEFITS ONLY COVER THE COST OF MEDICAL TREATMENT?

A big portion of the benefits you receive for workers’ compensation includes paying medical bills for necessary treatment related to your occupational illness or injury. Workers’ compensation, however, also provides additional benefits. Depending on the severity of your injury or illness and your capacity for recovery, you might also be eligible for disability payments for a short time or permanently. Disability payments replace a portion of the income you lose when you cannot work as a result of your injury or illness. Those who cannot return to work are eligible for permanent disability benefits.

California also provides injured workers with supplemental job displacement benefits that provide funding for further training, education, and related costs to change professions and seek different employment. These benefits are for individuals with permanent partial disabilities who do not recover completely and do not return to work for their employers.

When a workplace injury or illness results in the tragic loss of a loved one, eligible surviving family members may also receive death benefits through workers’ compensation. Death benefits typically include burial expenses as well as disability payments for surviving spouses, children, and other dependents. After an initial lump sum payment of $250,000 or more based on the number of dependents, families continue to receive disability payments until the youngest child turns 18.

WHAT SHOULD I DO IF THE INSURANCE COMPANY DENIES MY TEMECULA WORKERS’ COMPENSATION CLAIM?

If your claims administrator denies your workers’ compensation claim, it means that he or she has determined that your injury or illness does not fall under the umbrella of a workplace injury or occupational illness.

You have the legal right to challenge this decision, but you must act quickly to meet the required deadlines. The first step to contesting your claim denial is to file an Application for Adjudication of the Claim in the county where you live or the county where you suffered injuries—Riverside county for Temecula residents and workers. You must also provide a copy to your claims administrator.

The application will get you a hearing in front of a judge, who will decide the outcome of your claim without a jury. You and your claims administrator, along with your attorney, will go before the judge and present your case. The judge will try to help facilitate an agreement. If you cannot reach an agreement, the judge will set a date for a future trial in front of another judge. After this trial, the judge will issue a written opinion and mail it to you and the claims administrator somewhere between 30 and 90 days after the trial. If you are unhappy with the decision, you can petition the Department of Workers’ Compensation (DWC) for reconsideration.

Sound complicated? It is, but we do this work every day, so call us if you want to challenge an unfair denial of your rightful workers’ compensation benefits.

MY EMPLOYER HAS CLASSIFIED ME AS AN INDEPENDENT CONTRACTOR. AM I ELIGIBLE FOR WORKERS’ COMPENSATION BENEFITS?

It depends. Workers’ compensation insurance does not provide insurance benefits to independent contractors, but some employers purposefully misclassify employees as contractors to avoid paying workers’ compensation insurance. Even if your employee has classified you as an independent contractor, you may qualify as an employee.

The DWC states that in order to be considered an independent contractor, you must have control over your work. Regardless of how your employer classified you, if any of the following apply to you, you may not be an independent contractor:

• Your employer controls the details of your work or how you go about your work.
• Your employer has the right to fire you.
• Your employer pays you a salary or an hourly wage instead of for services provided or for a particular project.
• Your employer deducts unemployment insurance or withholds Social Security from your pay.
• Your employer supplies you with the materials and tools needed to perform your job duties.
• Your employer requires you to work a specific schedule each week or each day.

Your employer may have improperly classified you as an independent contractor to keep his or her workers’ compensation premiums and payroll taxes low. Fortunately, we can help you determine whether you should be covered by workers’ compensation —and if not, we can look into your options for recovering compensation.

DO I NEED A LAWYER TO FILE A TEMECULA WORKER’S COMPENSATION CLAIM?

Retaining a lawyer to handle your workers’ compensation claim will help maximize your chances of success and prevent the insurance company from delaying, denying, or reducing the benefits you need and deserve. In cases that involve severe injuries, especially those that result in permanent disability, a skilled workers’ compensation lawyer can investigate your injuries and help you maximize your benefits.

The following are common workers’ compensation scenarios in which having Gomez Trial Attorneys’ aid will be in your best interest:

• You have filed a workers’ compensation claim after sustaining an injury or illness, and the claims administrator denies your claim. Your attorney can help you challenge the decision and give you the best chance of overturning it.
• Your claims administrator reduced your benefits. An attorney can help you challenge this decision, too.
• Your employer fired you, demoted you, suspended you, or threatened some other form of retaliation after you filed a workers’ compensation claim. This is against the law, and your lawyer can help you take legal action against your employer.
• You contracted a disease or illness from toxic chemical exposure, or you sustained injuries as a result of defective equipment. These situations are examples of third-party liability for workplace injuries. Your attorney can help you hold third parties liable for damages related to your injury or illness, often going beyond the benefits you receive from workers’ compensation.
• You suffered injuries on a job site. This is another example of third-party liability. Even though you were working, a negligent property owner or business owner might be liable for your injuries. Your attorney can investigate the situation and advise you on the best path to recover compensation.
• Your employer is uninsured. As mentioned above, you can still receive benefits from the State of California. Your lawyer can help you take legal action against your employer for failing to comply with state and/or federal law.
• You suffered injuries after a traffic accident in a company vehicle. In this instance, the other driver(s) might be liable for damages if their negligence led to the accident and your injuries. An attorney can review your case and potentially help you take legal action against the at-fault driver.

CONTACT OUR TEMECULA WORKERS’ COMPENSATION LAWYERS TODAY

If you suffered injuries or contracted an illness in connection with your job in Temecula, or you lost a loved one to a work-related health problem, then you deserve workers’ compensation benefits and any other compensation the law allows.

Gomez Trial Attorneys has extensive experience representing injured Californians, including those who have suffered injuries in the workplace. Contact us today online or at (619) 237-3490 for a free case evaluation to discuss your workplace accident and injuries and your rights to receive workers’ compensation benefits and other forms of compensation.

Gomez Trial Attorneys
27720 Jefferson Avenue
Temecula, CA 92590
(951)-900-3440