California workers are protected by the state’s workers’ compensation law, which requires all job providers to provide insurance protection. The idea is to help workers make ends meet while recovering from workplace injuries or other ailments acquired while on the job. When a worker is disabled, even temporarily, workers’ compensation insurance provides about two-thirds of the average weekly earnings and covers medical costs.
The state-mandated coverage helps injured employees have a job to which they can return while ensuring that their employers have trained and experienced workers who can return after healing up. It also protects employers against lawsuits when workers accept the coverage instead of filing claims for damages. However, the jobs awaiting injured workers are sometimes not the same ones they left when injured, and they pay less upon their return. Workers’ comp can make up the difference.
Wage Reductions and Job Training Are Covered
When an injured employee returns to work, he or she is not always physically capable of resuming the old job. Reduced duties and correspondingly reduced pay might be the short-term solution. When that is the case, workers’ compensation helps to make up the difference in wages between the current job and the old one the worker had when injured. The worker could also qualify for job training and collect a vocational rehabilitation benefit while learning a new trade to replace the income from the old job.
Worker Returns Could Go Awry
Losing the ability to continue working in a former capacity could lead to conflicts between the employer and the worker, or the workers’ comp insurer and the worker. If so, an attorney who is experienced in workers’ comp claims in the Van Nuys area may review the situation and help the worker to better understand his or her rights under California law. The attorney may also help their client understand how workers’ compensation coverage might apply in a particular situation. If a legal dispute arises, the attorney may help to argue the case and obtain the best possible outcome.
Additional Workers’ Compensation Benefits in California
To fully understand what California workers’ compensation covers, it’s important to highlight the benefit categories outlined under California Labor Code S3200–6002:
- Temporary Disability Benefits (TD): Replace lost wages while you’re recovering.
- Permanent Disability Benefits (PD): For injuries that permanently reduce your earning ability.
- Supplemental Job Displacement Benefit (SJDB): A voucher to retrain or upgrade your skills if you can’t return to your previous job.
- Medical Treatment: Covered care must be authorized through Utilization Review (UR).
- Death Benefits: Compensation provided to dependents of workers who pass away due to a work-related condition.
Understanding Utilization Review and Medical Provider Networks (MPNs)
When you’re injured, your medical treatment must be pre-authorized through a process called Utilization Review (UR). This ensures that the care you’re receiving is medically necessary according to California guidelines.
Also, treatment must often occur within your employer’s Medical Provider Network (MPN), a group of healthcare providers approved by the insurance carrier. If you disagree with a diagnosis, you may request a panel Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) to conduct an independent exam.
The Claims Adjuster and Maximum Medical Improvement (MMI)
A claims adjuster is assigned by the employer’s insurance company to manage your case. Once your treating physician believes your condition won’t improve further, you may be declared to have reached Maximum Medical Improvement (MMI). This triggers a disability rating and potentially opens the door to permanent disability benefits.
How to File a Workers’ Comp Claim in Van Nuys, CA
- Notify Your Employer within 30 days of your injury.
- Seek Medical Attention within the MPN.
- Complete and Submit the DWC-1 Form.
- The Insurance Company Has 90 Days to accept or deny the claim.
- Disputes? Request a QME or file with the Workers’ Compensation Appeals Board (WCAB).
Need help? Talk to a Van Nuys workers’ comp lawyer.
Why Choose a Van Nuys Workers’ Compensation Attorney?
At Hussain & Gutierrez, we specialize in protecting the rights of injured workers throughout Van Nuys and the greater Los Angeles area. We can help you:
- Navigate denied claims or delays
- Handle conflicts with insurance carriers
- File appeals with the WCAB
- Maximize your permanent disability settlement
- Understand your SJDB voucher rights
- Fight employer retaliation after filing a claim
Frequently Asked Questions (FAQs)
What injuries are covered by California workers’ compensation?
Workers’ comp covers injuries such as back injuries, carpal tunnel, repetitive stress injuries, work-related mental health conditions, and any physical harm resulting from your job duties.
How long do temporary disability benefits last?
Generally up to 104 weeks within five years of the injury. Some serious injuries may allow for 240 weeks.
Can I pick my own doctor?
Initially, you must choose from your employer’s MPN. After 30 days, you can switch within the network or request a QME.
What happens if my employer has no workers’ comp insurance?
You may file a claim through the Uninsured Employers Benefits Trust Fund (UEBTF).
What does a workers’ compensation lawyer do?
They guide you through the claims process, deal with adjusters, attend hearings, help gather medical evidence, and work to increase your benefit payout.
What is MMI, and how does it affect my case?
MMI stands for Maximum Medical Improvement. Once your condition is stable, the insurance will use your MMI status to determine permanent disability benefits.
Take Control of Your Workers’ Compensation Claim – Get a Free Consultation
If you’re unsure whether you’re getting the full benefits you deserve or your claim has been delayed or denied, don’t wait.
Hussain & Gutierrez – Van Nuys Workers’ Compensation Lawyers
Call Now: (818) 997-3700
Schedule Your Free Consultation
We’ll help you:
- Understand your rights
- File your claim properly
- Fight for the benefits you’re owed
- Avoid costly legal mistakes
Your recovery starts with a phone call. Let us fight for you.
