Who Chooses the Doctor?

The workers’ compensation system provides important rights and responsibilities for both employees and employers.  Employees can rest easy knowing that they can receive benefits and medical care costs if they suffer a work-related injury.  Employers can also feel a sense of relief knowing that the workers’ compensation system means that the employee cannot sue for the injury, except in certain limited circumstances.  Despite these reassuring facts, workers’ compensation does require several important procedural steps.  One of the most obvious is that the injured employee will have to get medical attention.  As the medical diagnoses and care are clearly an integral part of the workers’ compensation case, employers may wonder who gets to choose the doctor for the employee?

The medical care provider plays an essential role in the workers’ compensation case.  The doctor will diagnose the condition and determine if the injury was a result of working conditions.  The doctor will also decide how long the employee must stay out of work and what accommodations are necessary when the employee does return to the work force.  The doctor will also decide when the employee’s medical condition has stabilized and whether the employee has any permanent disability.

Before an injury occurs, an employee has the right to “predesignate” his or her personal doctor.  This means that if and when the employee sustains a work related injury, he or she can go directly to that personal, pre-designated physician for treatment.  California labor code 4600 requires employers to give employees the necessary paperwork to predesignate a treating physician.

If an employee has failed to predesignate a health care provider, then he or she will likely not be able to choose the initial physician that he or she sees for treatment of the industrial injury.  Typically the workers’ compensation insurance provider or the employer itself will have a “medical provider network.”  The employee will need to choose a doctor who is included in that network.  There are some important exceptions to this general rule.  First, if the employee needs emergency care, it is not required that he or she use a physician including in the medical provider network.  In addition, if the employer has failed to provide certain required notices or information, the employee may also not be required to use a doctor in the MPN.

We have extensive experience helping our clients understand the workers’ compensation process and how it can impact their business.  Contact us today for a consultation to talk about your business.

Handymen, Nannies, Small Businesses, and Workers’ Compensation

Millions of Americans run their own small business.  Whether that business is the primary source of income for the family or just a side job to help provide supplemental income, business owners are all well aware that there are many regulations surrounding formation and running a business.  In addition, many people choose to employ other individuals for help around the house, including nannies and handymen.  Whether you have a small business or you employ others to help you around the house, it is important that you understand your rights and responsibilities regarding workers’ compensation.

California labor code provides that employers are obligated to carry workers’ compensation insurance.  This is true even if the business has only one employee.  This is also true of businesses which are located outside the state of California but still do business in this state.  In other words, if your business is located in Oregon but you sometimes do business in California, you are stills subject to the California requirement that you carry workers’ compensation insurance.  For a sole proprietorship, the law does not usually require workers; compensation if the business has no employees.  The important exception to this is for roofing contractors.  All C-39 roofing contractors in California are required to carry workers’ compensation insurance and file a valid certification with the state.

It is also important to understand your obligation regarding workers’ compensation insurance if you use the services of a nanny or a handyman.  Under California labor code 3352(h), “any person employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or whose duties are personal and not in the course of the trade, business, profession, or occupation of the owner or occupant” is classified as an employee.  This means that you may be required to carry workers’ compensation insurance for your nanny or handyman.  California law goes on to state that if the person has worked less than 52 hours in the 90 days before the injury was sustained or earned less than $100 in wages during that time, the person is not an employee for worker’s compensation purposes.

We have extensive experience helping our clients understand the rights and responsibilities concerning workers’ compensation insurance.  Contact us today to talk about your options.

Corporations and Workers’ Compensation

Small businesses form the backbone of the American economy.  Millions of people very year start their own business.  When forming a business, a founder has a wide variety of choices concerning the type of business organization.  A business can be a sole proprietorship, a limited liability corporation, a limited partnership, or even a hybrid of more than one of these types.  There are benefits and drawbacks to each type of business structure.  If you are thinking of choosing a corporation as the structure for your business, you need to understand how workers’ compensation interacts with the rules for corporation formation.

One thing that business owners in California need to understand is that almost all employers are required to carry workers’ compensation insurance pursuant to California labor code 3700.  Failure to carry the required insurance can result in severe civil and even criminal penalties for the business owners.  Corporations are not exempt from this requirement.  Forming a business as a corporation can provide important shelters from liability as well as tax advantages, but these advantages do not include de facto exclusion from the requirement to carry workers’ compensation insurance.

Moreover, some relatively recent changes to the California labor code provides that executive officers and directors of corporations must be included in the workers’ compensation insurance coverage.  The exception to this is if the corporation is fully owned by the directors and officers.  If that is the case, the directors and officers may elect to be excluded from workers’ compensation coverage and benefits.  For this to apply the person must be a sole shareholder who is an officer or director of a private corporation.  In that case, that person is excluded from the legal definition of “employee.” Any director or officer wishing to opt out will have to fill out specific paperwork to accomplish this.  The document is executed under the penalty of perjury, and states that he or she meets the qualifications under the California labor code for being exempt from the insurance requirements.  For officers or members of the board of directors of a cooperative corporation and for owners of a professional corporation, there are additional waiver requirements that must be met.

.We have extensive experience helping our clients understand their rights and responsibilities with regard to California’s workers’ compensation insurance requirements.  Call us today for a consultation.

When Is Self-Insurance Allowed

Workers’ compensation is an important part of our legal system.  It provides support and financial assistance for injured employees.  It also provides immunity from additional tort law suits to the employer, except in limited circumstances.  California has the largest workers’ compensation system in the United States.  Under California law, employers are required to carry workers’ compensation insurance.  There are severe civil and criminal consequences for employers who fail to fulfill this responsibility.  There are a few narrow exceptions to this rule, including self-insurance.

Self-insurance means that the employer has assumed the financial risk associated with providing workers’ compensation benefits to their employees who sustain work-related injuries.  Workers’ compensation benefits can include not only the cost of medical treatment for the worker, but also other monthly benefits.  Clearly, this can represent a significant financial burden, especially for smaller businesses.

California law provides that there are strict requirements before a business can qualify to self-insure instead of purchasing a workers’ compensation insurance policy.  A business wanting to qualify for self-insurance must apply to the California Office of Self-Insurance Plans.  The business will have to provide particular information and evidence to support the application. First, the business must have been a legally authorized business form for at least three years.  Next, the business will have to provide three years of certified, independently audited financial statements with the application.  The business will also have to demonstrate it has an acceptable credit rating for three years preceding applying for self-insurance. If the company has subsidiaries, each subsidiary must file its own application.  The application may be filed separately or together with the parent company’s application.  If a current existing company that already has been approved for self-insurance creates a new subsidiary or affiliate, a new application can be filed.  If the parent company can demonstrate solvency, the subsidiary is automatically self-insured for 180 days.  The parent company must file an application for a permanent certificate during that time.

Once an employer is approved by the state to be self-insured, the employer is still subject to state audits.  The audits check for the accuracy of claims reserving practices as well as the correctness of the reported workers’ compensation liabilities.

If you have questions about workers’ compensation and your rights and responsibilities as a business owner, contact us today.  We can talk to you about your business and the workers’ compensation process.

Work Restrictions and Limitations

Following a work related injury, the injured worker will need to take many steps, including paper work and obtaining medical treatment.  In most cases, an injured worker will want to return to work as soon as possible.  Employees want to continue to financially support themselves and their families, as well as avoid the depression and other unfavorable side effects that can set in from staying at home for too long.  However, even if a worker is on the road to recovery, there may be restrictions or limitations on their ability to perform typical duties.

Obtaining medical treatment is obviously one of the first actions that the injured employee will need to take following a work related injury.  The injured worker’s treating physician will evaluate the injury and determine when or even if the worker can return to work.  The physician is likely to clear the injured worker for work before he or she is totally healed.  In these cases, the physician is likely to impose work restrictions or limitations.  These will allow the injured employee to return to work while still avoiding the risk of re-injury as much as possible.  Some of the common restrictions seen for workers who are temporarily disabled are no lifting more that particular weight, no standing for longer than a particular duration, or no climbing.  Clearly the restriction will vary depending on the injury.  The treating physician needs to promptly communicate the work restrictions to the claims administrator to make sure that the restrictions and limitations are communicated properly to the employer.  The employer is obligated to comply with the restrictions imposed by the physician.  In the event that the job cannot accommodate the restrictions, then the employee may have no choice but to continue to receive temporary disability benefit is until he or she is healthy enough to return to work without those restrictions.  In the case of a permanent disability, the employer needs to try to permanently modify the job to accommodate the permanent limitation. When that is impossible, the employer will need to find another job to offer the employee that provides at least 85% or more of the same salary and benefits as the former job.

Employers should note that California law strictly prohibits employers from taking retaliatory action against an injured worker simply because of the limitations imposed.  Employers are required to make reasonable accommodations for the restrictions imposed by the employee’s treating physician.

If you have questions about workers’ compensation and your rights and responsibilities as a business owner, contact us today.  We can talk to you about your business and the workers’ compensation process.

Death and Workers’ Compensation

Workers’ compensation exists to help make sure that an employee who sustains a work-related injury receives appropriate compensation for the injury, as well as reimbursement for medical costs required to treat or cure the injury.  In the optimal circumstance, the injury will be minor, easy to treat, and the employee will be able to return to work soon.  Unfortunately, not all work-related injuries are minor, and there are some cases where the employee dies as a result of the work-related injury.

In the typical workers’ compensation case, the injured employee is the one seeking workers’ compensation benefits.  If the employee dies as a result of the work related injury, the family members will be the ones to file for workers’ compensation benefits.  A family member of the deceased employee is eligible to file for death benefits in workers’ compensation if he or she was totally or partially dependent on the deceased employee for financial support at the time the employee sustained the injury that resulted in death.  The person filing for benefits also needs to show that he or she was a member of the employee’s household or was at least a close relative of the employee.  Common examples of qualifying family members include spouses, children, and parents of the deceased.  California law automatically assumes that certain people were totally dependent on the employee, including minor children, adult children who are unable to earn their own living due to physical or mental incapacity, or a surviving spouse who earned less than $30,000 in the twelve months before the employee’s death.  If a family member does not meet these requirements, he or she will have to provide evidence to the court that he or she meets the requirements under California law.

The amount of death benefits that will be received depends on the number of eligible dependents the deceased employee had.  If the employee had one dependent, death benefits will be $250,000.  Two dependents will result in $290,000 in benefits, and three or more dependents will mean $320,000 in death benefits.  If there were two or more dependents, the benefits will be equally split between all the dependents.

If you have questions about your business and workers’ compensation, let us answer them.  Contact us today for an appointment to talk about your business.

Slip and Falls in Workers’ Compensation Cases

Diligent employers take important steps to reduce the chances that their employees will be injured in the course and scope of their employment.  These steps may include keeping equipment up to date, forming safety committees, and providing regular training to make sure employees are aware of safety features on industrial equipment.  Despite the most diligent efforts to avoid injuries and risks to employees, injuries will often happen anyway.  One of the most basic types of injuries is that sustained after a “slip and fall.”

Slip and fall injuries are not uncommon in any profession, but those where workers spend a lot of time on their feet, such as retail or food service.  Like other industrial injuries, if an employee can demonstrate that he or she sustained injury after falling during the course and scope of their working duties, then he or she may be entitled to workers’ compensation.  For example, a food server who slips and falls on a wet floor in the dishwashing area of the restaurant during a shift could have a valid claim for workers’ compensation.

It should also be noted that slip and fall cases are common in tort law.  Customers or visitors can sue a business or property owner if they sustain injury after falling.  In those cases, the injured person will have to show that the conditions that led to the fall were caused by the business or property owner’s negligent or even intentional conduct.  However, workers’ compensation is a “no fault” system.  This means that the injured employee will not have to show that the conditions that led to the injury were caused by the employer’s negligence.  The employee will only have to demonstrate that the injury was sustained in the course and scope of the worker’s duties.  Note that depending on the duties of the employee, it is not necessary that the injury be sustained while the employee is physically at the employer’s place of business.  For example, if the worker is a courier who slips and falls while making a delivery for the employer, then the injured employee can seek benefits under workers’ compensation.

We have extensive experience helping our clients understand their rights and responsibilities with regard to their employees.  Call us today for a consultation.

When to hire a PI

Employers work hard to make sure that their employees are safe from injury on the job.  Unfortunately, there are times that despite the most careful precautions, an employee sustains a work-related injury and will accordingly submit a claim for workers’ compensation.  The vast majority of employees who submit a claim for workers’ compensation are validly injured and will want to return to work as soon as possible.  Unfortunately, there are a handful of dishonest people who will try to abuse the system.  If you are an employer who suspects your employee is not being totally honest about the work related injury, you may consider hiring a private investigator.

One reason you may want to consider hiring a private investigator is if the medical reports fail to match up with the severity of the injury that the employee is reporting.  This could be both in terms of the acute symptoms as well as how long it is taking the employee to recover.  When an employee commits fraud by exaggerating the severity or duration of his or her injury, it is called “malingering,” and can be a good reason to hire a private investigator.

Another reason could be if the employee’s social media shows him or her engaging in activities that do not seem compatible with the injury.  For example, if the employee states the his or her back pain prevents him or her for standing or sitting for any longer than thirty minutes, but social media indicates the employee spends weekends hiking, hiring a private investigator can help provide more proof of fraud.

Another red flag for fraud that may suggest you want to hire a private investigator is if the employee has filed lots of workers’ compensation cases in the past.  This may indicate that the employee knows how to “work the system” and has made a habit of filing fraudulent claims and malingering.  Hiring a private investigator can help you get details about past claims as well as information about how the employee is spending his or her time away from work.

A private investigator can fill many roles, such as setting up surveillance, collecting information from the internet, and talking to witnesses to the event.  The private investigator can help you uncover fraud and move forward.

We have experience assisting our clients with fraudulent workers’ compensation claims.  Call us today to talk about your business.

Acupuncture, Chiropractors, and Workers’ Compensation

After an employee sustains a work-related injury, there are many steps that will need to be taken, ranging from paper work to reporting the injury to insurance company to reporting certain injuries to state and federal entities.  One of the most important steps is making sure that an employee receives proper medical treatment.  Although some medical treatment may involve addressing acute and emergent injuries, such as a broken arm, other treatment plans may include more long-term types of treatment, such as physical therapy.  Some workers may elect to pursue alternative treatments.  Two of these treatments are acupuncture or going to a chiropractor.

Acupuncture is a form of alternative medicine with roots in China.  With acupuncture, tiny needs are inserted into the patient’s skin at very particular, key points.  Practitioners of acupuncture believe that proper practice can alleviate stress or pain.  Under the California Labor Code 4600, acupuncture is recognized as a valid treatment for work-related injuries. The labor code provides that an authorized practitioner of acupuncture may apply to become certified as a health care organization to provide treatment to injured employees.

Chiropractic care is based on manipulating and realigning joints, especially those in the spine.  Practitioners believe that proper chiropractic care can help address disorders affecting nerves and muscles.  As with acupuncture, California Labor Code 4600 provides that chiropractic care is a valid treatment course for workers’ compensation.  Unfortunately, many employers have reported negative experiences with some chiropractors.  In the past, some unscrupulous chiropractors would continue to make sure the injured worker came back for as many treatments as possible to maximize the money he or she could make from the patient.  In response, California law now provides that chiropractic visits shall be capped at twenty four for each industrial injury, unless the employer authorizes additional visits.  This law was passed in response to the fact that past studies revealed that workers’ compensation cases involving chiropractic care often paid out more than thirty percent more than other cases, and tended to last longer.  The law is intended to address the fact that many chiropractors often recommend chiropractic care as a life long course of care, and some were attempting to draw out treatment far after was actually needed for the work related injury.

If you have questions about what type of care is appropriate or available for your injured worker, call us today.  We have extensive experience helping business owners understand their rights and responsibilities under California law.

Workers’ Compensation and Medical Marijuana

Healthcare is a major industry in the United States, and advances are frequently made in medical technology, genetics, and pharmaceuticals.  Medical Marijuana is one area where there have been many recent advancements.  These advancements include not only medically and understanding how marijuana can help treatment a variety of conditions, but also in the law.  When an employee sustains a work-related injury, he or she may be prescribed medical marijuana to address their injury.  As an employer, it is important for you to understand how medical marijuana fits in the workers’ compensation system.

California Labor Code section 4600 states that any treatment that is reasonably required to cure an injury or relieve the employee from the effects of the injury will be covered under workers’ compensation.  The Workers’ Compensation Appeals Board has determined that this can include medical marijuana.  Naturally, a worker must receive prescription from a doctor for the costs to be covered.  Moreover, if the treatment plan includes medical marijuana, the plan is subject to independent medical review and utilization review to make sure that independent providers agree the marijuana is medically necessary to address the work related injury.

There are some other important issues to be aware of.  First, although California has passed law legalizing the use of medical marijuana, marijuana remains illegal under federal law.  Although these federal laws are not typically enforced in terms of medical marijuana dispensaries, this does not change the fact that the possession and sale of marijuana – even for medical use – remains illegal  under federal law.

In addition, just because an employee is using medical marijuana, that does not mean he or she is not subject to certain restrictions.  Just as an employee taking prescribed opiates may not be a suitable person to continue to operate heavy machinery, an employee may not be able to use medical marijuana during the work day.  Employers also need to keep in mind that there are rules about when an employer can require drug testing.  In addition, firing an employee for testing positive for medical marijuana can run afoul of regulations under the Americans with Disabilities Act.

We have extensive experience with the workers’ compensation system and explaining an employer’s rights and responsibilities.  Contact us today for a consultation.

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