What is Temporary Disability?

No employer wants to see his or her employees get injured, and employers take many admirable steps to prevent this from happening.  Unfortunately, work-related injuries will happen despite the best precautions and most careful of training schedules.  In the event that a worker does sustain a work-related injury, the injury will be classified as either permanent or temporary.  The classification of injury will have long-reaching effects for both the employee and the employer.

Temporary disability benefits will be available to an employee who has sustained a work-related injury while he or she is temporarily medically disabled and is prevented from returning to work due to the work-related injury.  These benefits are payable to the employee at the rate of two thirds of the regular wages of the injured employee.  There is a maximum benefit set out by California law.

There are two types of temporary disability benefits available.  One is Temporary Partial Disability (TPD) and the other is Temporary Total Disability (TTD).  TPD benefits are appropriate and available for those workers who have sustained a work-related injury, cannot return to his or her normal employment, but can work in some sort of modified position or capacity.  These benefits are paid at the rate of two thirds of the balance between what a worker normally earns and what he or she is earning in the modified position.  For example, if a worker typically makes $300 per week, but makes only $200 per week in the modified position, the difference between the two is $100.00.  Two thirds of $100 is $66.67.  The injured worker would receive the pay check of $200 per week plus $66.67 in TPD benefits. Note that there is a maximum for benefits set by California law.  If the modified salary is already higher than these maximum amounts, the worker will not be entitled to receive TPD benefits.

TTD benefits will be available to an injured employee where a doctor has determined that the worker is unable to return to any work for at least three days.  The TTD benefits are payable until the worker is able to return to regular work.  The benefits would also end if the employee is able to return to modified work in the event the employer offers such work.  Once the injury becomes “permanent and stationary,” as determined by a doctor, the TTD benefits will end, even if the worker has not returned to work at that time.

Employers should make sure they have a firm understanding of the different types of disability benefits.  Call us today at (714) 516-8188 for an appointment to discuss your business and workers’ compensation benefits.

What is Permanent Disability?

When an employee sustains a work-related injury, he or she may be entitled to receive payment from his or her employer through the workers’ compensation system.  In California, the workers’ compensation system is a no-fault system.  This means that the employee does not have to prove that the injury was the fault of the employer before being entitled to compensation.  The type, amount, and duration of workers’ compensation benefits that an employee may be entitled to is partly governed by whether the injury results in a permanent disability.

A permanent disability is defined as any lasting disability from an employee’s work-related injury or illness that affects the employee’s ability to earn a living.  In the event an employee sustains a permanent disability, he or she will be entitled to permanent disability benefits even if he or she can return to work.  In order to be determined to have a permanent disability, the employee must submit to a medical examination.  The doctor will decide if the employee has a permanent disability.  The doctor will wait until your injury has stabilized and is not likely to worsen or improve before evaluating the permanent disability.  The term for this state is either “permanent and stationary” or “maximal medical improvement.”  Once the employee’s injury reaches this state, the doctor will send a report to the insurance claim administrator reporting whether the employee has a permanent disability, and whether that disability is, in fact, work-related.  The doctor will decide how much of the permanent disability is attributable to the work-related incident, and how much is attributable to any pre-existing conditions.  The doctor will also write a report about the employee’s impairment, which refers to how much the injury actually affects the day-to-day activities of the employee.  The doctor will assign a number to the impairment, which is then plugged into a special calculation in order to calculate the percentage of disability.   Whole Person Impairment generally means how much the impairment will affect the employee’s ability to function in the future.  The employee’s age and occupation will also affect the calculation, as well as diminished future earning capacity, for injuries incurred after January 1, 2013.  The disability will be stated as a percentage, which will determine a specific dollar amount the employee will receive.  After the amount is calculated, an award of benefits will be granted, but must first be approved by a workers’ compensation judge.

Calculating and awarding permanent disability is complicated, and you need an experienced attorney working with your business through this process.  If one of your employees may be permanent disabled as a result of a work-related injury, contact us today at (714) 516-8188 to discuss it.

Reducing Your Business’ Workers’ Compensation Costs and Liability

Every employer should maintain the important goal of reducing work-related injuries to their employees as much as possible.  Not only is this the ethically and morally right step, but it can prove to help an employer with their bottom line.  By taking steps to reduce work-related injury, an employer may be able to reduce the workers’ compensation premiums paid, the risk of serious and willful claims, or the risk of a 132a issue arising.  There are some good steps that any employer can take to reduce his or her business’ workers’ compensation costs and liability for future costs.

First, almost all employers are required to maintain workers’ compensation insurance in the state of California.  There are some exceptions, but by and large, failure to adhere to this requirement can result in hefty penalties, both civil and criminal, for an employer.  Like shopping for health insurance or life insurance, a business owner should get more than one quote for workers’ compensation insurance.  Getting competitive quotes can help to reduce the ultimate cost of insurance premiums.

Second, an employer must pay special attention when submitting insurance information.  This is two-fold.  An employer must first be accurate when submitting information to the insurance company to purchase the policy, as well as keep the information updated.  Moreover, when submitting information about any work-related injury to the insurer, the employer must also be certain to submit accurate and detailed accounting of what happened, together with the necessary paperwork and witness statements.  Although an employer may be initially convinced that not reporting all his or her employees for the premiums or maybe omitting certain details of an injury will help reduce the up-front cost, this is fraud and can ultimately cost the employer much more in penalties.  It   can also end up resulting in no insurance at all to help with the costs.

Third, an employer can implement a good, solid safety program.  Some employers choose to set up safety committees made up of employees, to help create safety policies as well as help implement safety programs.  Rotating the members on the committee as well as making changes to a safety program on a regular basis can help keep the program fresh and keep employees from becoming complacent.

Finally, an employer can create an incentive program to adhere to safety standards.  Financial bonuses, trips, or extra time off for meeting certain safety goals can help create a work-place atmosphere that encourages adhering to safety standards.

If you have questions about how you can reduce your business’ workers’ compensation costs and liabilities, contact me today at (714) 516-8188.  We can discuss your business and what we can do for its financial future.

Defending a Serious and Willful Claim

When an employee sustains a work-related injury, an employer may very well be on the hook for the costs of medical care for the injury through the workers’ compensation system.  The workers’ compensation system is designed as “no fault” system, meaning that in order to receive compensation for the injury, the employee does not have to make any demonstration that the injury was somehow the fault of the employer.  In some limited situations, an employee may make an additional claim under the “Serious and Willful Misconduct” provisions of California Labor Code § 4553.  This code states that if an employer is   found to have caused an employee’s injury through “serious and willful misconduct” they will be ordered to pay an amount that is equal to half the value of all the benefits paid to the employee as a result of the injury.  Clearly, this can amount to a large amount of money.  Moreover, an employer cannot insure against serious and willful claim.  Accordingly, it is important that employers have a firm understanding of how to defend against such a claim.

The most obvious way is to make every effort to make sure that such a claim is never made at all.  An employer can take these steps by being vigilant about the condition of the work place.  Repairs and renovations necessary to keep a worker safe should be promptly made.  Employee complaints about safe working conditions should be reasonably heeded, and an employer should make repairs to working conditions when necessary.

That aside, an employee must prove that an employer failed to act, even though the employer had knowledge that a serious injury would probably result in order to prevail on such a claim.  Therefore, to defend against a “serious and willful” claim, a defense may focus on several areas.  An employee must demonstrate that an employer knew that the danger existed.  A good defense to this will for an employer to be meticulous about documenting each and every report from any employee complaining about a working safety condition.  If no employee every made a complaint about the condition that caused the injury, it could be difficult to prove that an employer knew of the risk.  Another way to defend against such a claim is to document the steps that the employer took in order to improve the risk of injury.  If an employer had taken steps to make sure that no injury would occur, this will provide an excellent defense, as an employee needs to prove a failure to act, not a failure to act appropriately.

Serious and willful claims are serious, and you need an experienced attorney to help you navigate these claims.  We can review your business together to help you with any claim your business is facing.  Contact us today at (714) 516-8188 if you have questions about Serious and Willful Misconduct Defense.

Car Accidents and Workers’ Compensation

According to the United States Census Bureau, Los Angeles County has the highest percentage of people commuting from out of county in the United States.  In addition, the commute to work for workers in and around Los Angeles County was higher overall than the national average, especially in the category of workers who commute at least an hour.  After workers arrive at work, it is extremely common for the driving to continue.  Workers make deliveries, go to clients’ homes, run courier services, drive trucks, and an enormous variety of other jobs which require vehicular transportation.  With so much driving going on, there are bound to be accidents.  In some cases, a car accident may be covered by workers’ compensation.

 Workers’ compensation provides a means for workers to obtain compensation when they have sustained a work-related injury.  Accordingly, when there is a car accident, the inquiry becomes whether the accident while the employee was engaged in a work-related activity.  Some examples of work-related activities would be driving to make a delivery or driving to a client meeting, running errands on behalf of the business such as picking up office supplies, or going to a service call.  All of these activities are within the scope of the employee’s job.  In other words, an employee is “on the clock” during these times, and going to the destination is necessary to complete their duties.

 What is not generally included are times that an employee is not engaged in work-related activities.  These would include running personal errands, going to lunch, or your commute to or from work.  These are times that you would generally not be getting paid for, and are not in the scope of an employee’s work-related duties. Therefore, if an employee sustains an injury during a car crash at times like those, it is not considered a work-related injury and is not compensable under workers’ compensation.  This is generally what is known as the “going and coming rule.”  In other words, if you are coming to or going from work, that is not generally covered under workers’ compensation.  The “going and coming rule” is not enunciated in the California Labor Code, and instead has been created through a series of cases.  There are many exceptions to the rule, as well, so employers should be cautious as to whether an exception applies.

 If you have questions about car accidents and whether your business is liable under workers’ compensation, contact me today at (714) 516-8188. Let’s talk about your business and its future.

Public Policy Reasons for 132a

The purpose of the workers’ compensation system in California is to make sure that employees receive financial compensation in the event they are injured while working.  The law recognizes that employers need to be taking steps to reduce the risk of injury to their employees, while also recognizing that an injury must be work-related in order for an employer to be responsible for the injuries to the employee.  After an employee is injured, there are additional laws that come into play in addition to the traditional workers’ compensation laws that typically come to mind associated with medical treatment and documentation.  California Labor Code 132(a) is an essential provision that all employers must be aware of and with which they need to ensure compliance.

California Labor Code § 132a provides that an employer may not discriminate or take adverse action against an employee who has filed a workers’ compensation claim.  If an employee suffers discrimination, retaliation, or adverse employment action by virtue of the fact that he or she has filed such a claim, the employer may face severe civil penalties and fines.  It is possible for an employer to discharge an employee even with a workers’ compensation suit filed, but it is essential that employer have reasons to back up a legitimate discharge or negative employment action.

The public policy behind 132a is fairly straightforward.  The law is designed to make sure that employees may exercise their rights under the workers’ compensation system following a work-related injury without fear of retaliation from an employer.  In fact, the law itself contains the statement that “It is the declared policy of this state that there should not be discrimination against workers who are injured in the course and scope of their employment.”  Without the protections provided by 132a, an employer would be free to simply fire any employee who decided to seek compensation for a work-related injury.  With such a strong deterrent, it is likely that few if any workers would actually seek relief under workers’ compensation.  As a result, unscrupulous employers would also have less incentive to ensure work place safety.  Workers’ compensation and 132a help to make sure that workers are safer and the system is not stacked against the employees.

 Labor Code 132a is an essential provision of workers’ compensation and you need to make sure your business is in compliance. I have experience helping clients both prevent 132a claims against their businesses as well as defending such claims.  Contact me today at (714) 516-8188 to talk about your business.

Catastrophic Injuries

Every employer takes all available precautions to help maintain workplace safety and minimize the risk for an employee sustaining a work-related injury.  Unfortunately, even with the most meticulous and careful of efforts, workplace injuries will still occur.  Workplace injuries under California law are divided into two categories: specific and continuous trauma.  A catastrophic injury is one that is life-changing and typically occurs without warning and quite suddenly.  These injuries will be long-term injuries and have long-term effects and implications for the injured worker.  Catastrophic injuries are often those types that impact the central nervous system, which means that there can be other effects on other bodily functions and systems.  Injuries to the brain stem or nervous system are often complex and difficult to treat, as they will typically have far reaching implications for the worker.  The injured worker will almost always require long-term or even life-long medical care to address the injury.  In many cases, the injured worker will not ever be able to return to work.  Some examples of catastrophic injury could be multiple and severe broken bones, serious burns, and serious head trauma.  Catastrophic injuries are frequently caused by automobile accidents, falls at construction sites, workplace violence, or industrial accidents.

As with any injury, the workers’ compensation system will require a permanent disability rating be affixed to the employee and his or her ongoing physical disability.  In most cases, the permanent disability rating cannot be increased due to psychiatric injury, sexual disorders, or sleep disorders arising from the injury.  However, there are exceptions to this rule.  One of these exceptions is if the injury is classified as a catastrophic injury.  Therefore, for injuries occurring on or after January 1, 2013, an employee may seek to recover not only for the catastrophic injury itself but also due for psychiatric injury, sleep disorder, or sexual disorder that is a result of the physical injury.

If you have questions about how to make your workplace safer and how to help avoid catastrophic injuries, call me today at (714) 516-8188. We can talk about different types of injuries, your business, and how to protect yourself and your employees.

Independent Medical Reviews

Following an incident at work wherein an employee sustains a work-related injury, that employee may need to seek medical treatment.  A workers’ compensation claim is almost sure to follow shortly thereafter.  A worker may be entitled to have the costs of his her or medical appointments and treatment covered by the employer or the employer’s insurance under the workers’ compensation system.  However, in some cases, there may be a dispute between the employee and the employer about whether a particular injury is of such a nature as to be covered under the workers’ compensation claim.  An Independent Medical Review (IMR) is one way that these disputes may be resolved.

Once an employee sustains a work-related injury and gets involved in the workers’ compensation system, a request for a particular course of medical treatment must pass through a “utilization review” procedure.  This review process is to make sure that any treatment prescribed by the treating physician is actually medically necessary to treat the work-related injury.  In some cases, the utilization review board may modify or deny the treatment recommended by the doctor.  If this happens, the injured employee may request that decision be reviewed through the IMR process.

Upon receipt of denial by the utilization review board, an employee may request an IMR by filling out and faxing in specific forms that will be provided to the employee.  The state will then decide within thirty days if an IMR is appropriate in the particular case.  If it is decided that an IMR is appropriate, a physician will be assigned to the employee’s case.  Note that this is a doctor chosen by the state, and not by either the employee or the employer.  The employee, employer, and insurance company will have the chance to send supporting documentation to the independent physician.  The independent doctor will review all of this documentation and then make a determination as to whether the treatment prescribed by the employee’s own physician is actually necessary to treat the work-related injury.  The independent doctor does not actually examine the employee at all.  It is all done through examination of medical records and documentation.  If the independent doctor does decide that the treatment is necessary, then the treatment must be then authorized by the insurance company within five days of receiving the IMR decision.  The overwhelming majority of IMR decisions uphold the determination initially made by utilization review.

If you have questions about your business and workers’ compensation, contact me today at (714) 516-8188. I am highly experienced in guiding my clients through this complicated area of law.

Larsen v. Securitas and Violence in the Work Place

The Occupational Safety and Health Administration reports that over two million workers are victims of workplace violence every year.  This often comes in the form of a worker being assaulted by another employee or a client or customer.  When this occurs, in some cases, a worker may seek to receive compensation for injuries through workers’ compensation.  The workers’ compensation system has certain exceptions and rules for work place violence.  One of these special provisions can be found in California Labor Code 4660.1.  This code provision provides that the impairment rating for a worker’s injury shall not be increased for sleep dysfunction, sexual dysfunction, or psychiatric disorder.  An exception to this rule is if the worker was a victim of a violent act.

In the May 2016 case of Deborah Larsen v. Securitas Security Services, the issue became what constitutes a violent act for purposes of the exception under 4660.1.  In that case, Deborah Larsen was acting as a security guard under the employ of Securitas.  She was performing her typical duty of walking patrol through a parking lot when she was hit by a car and sustained injuries.  She claimed that part of the injury included psychiatric disorder.  The employer did not contest that she sustained a work-related physical injury or that she was entitled to compensation as a result.  Instead, the employer argued that she was not entitled to compensation for the psychiatric injury.  Ms. Larsen argued that she was entitled to compensation under the violent act exception contained in 4660.1(c).  The WCAB noted that Ms. Larsen was “hit from behind with enough force to cause her to fall, hit her head, and lose consciousness.”  The Workers’ Compensation Appeals Board determined that this was sufficient to constitute a violent act.  The WCAB also determined that a violent act under 4660.1(c) is not required to be an act that is criminal or quasi-criminal in nature.  Instead, “it may include other acts that are characterized by either strong physical force, extreme or intense physical force, or are vehemently or passionately threatening.”

Another recent case also spoke to the issue of violent injury, and found that the violent act exception did not apply where the psychiatric injury was the result of the industrial accident and not as a result of the compensable physical injury.

If you are an employer and have questions about violence in the workplace in relation to workers’ compensation, call me today at (714) 516-8188. We can discuss your business, workplace violence, and workers’ compensation.

Southcoast Framing v. WCAB and Death Benefits

Workers’ compensation benefits come in a six different potential varieties.  Among these is death benefits.  If a worker is killed because of work-related accident, the worker’s surviving family may apply for and receive survivorship benefits.  The amount awarded will vary depending on the number of dependents that the deceased worker had, as well as when the death occurred.  The dependents may file for survivorship benefits up to 240 weeks after the death occurred.

In a case called Southcoast Framing v. Worker’s Compensation Appeals Board, the California Supreme Court addressed the issue of death benefits and what the surviving spouse and dependents are required to prove.  In that case, Brandon Clark sustained a work-related injury when he fell ten feet, suffering neck, back, and head injuries.  He was prescribed medication by the workers’ compensation physician as well as his own family doctor.  Mr. Clark then died as a result of accidental toxic overdose of a deadly combination of the medications.  Mr. Clark’s surviving widow and three dependent children applied for workers’ compensation survivor benefits.  The Qualified Medical Expert refused to assign a percentage of causation to the medication combination in relation to Mr. Clark’s death.  However, another physician testified that the combination of medication was toxic and lead to Mr. Clark’s death.   The trail judge determined that the combination of the medicines contributed to Mr. Clark’s death and accordingly approved the claim.  The appellate court reversed, holding that the medications were not “a substantial or material cause” of Mr. Clark’s death.

The California Supreme Court noted that the workers’ compensation system in California is a no-fault system designed to ensure that workers receive compensation while the employers are insulated from tort liability.  The Supreme Court ruled that the Court of Appeals inappropriately applied the tort standard of causation, which is incorrect and inappropriate in light of the no-fault system under workers’ compensation.  The Court also pointed out that it is the role of the legislature to extend or expand the burden of proof for death benefits cases, not that of the courts.  Because the legislature had decided that the application of proximate cause as the standard in workers’ compensation cases, the Supreme Court would not rule a different standard was appropriate.  Mr. Clark’s widow and children were permitted to recover survivorship benefits because the medication was used by Mr. Clark to treat his work-related injury and were the ultimate cause of his death.

If you have questions about survivorship benefits in workers’ compensation cases, contact me today at (714) 516-8188. We can discuss the state of the law and how that might impact your business.

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