What Is the Difference Between Removal and Reconsideration?

When working in the legal system, it is essential to have a firm understanding of the procedures and rules if you are to be successful in your claim or defense.  Workers’ compensation is no exception, and to make sure that your business is protected, having expert legal advice in addition to some basic knowledge about the process can be the difference between successfully defending a claim against your business and having to pay an unfair judgment.  If your business is involved in workers’ compensation litigation, it is possible that the judge could make a decision with which you do not agree.  If that occurs, you have two options to attempt to overturn that decision.

The first option is called a Petition for Reconsideration.  If you have received a final order in your workers’ compensation case from the WCJ, you can file a Petition for Reconsideration.  Under California Labor Code § 5900, a Petition for Reconsideration asks the Workers’ Compensation Appeals Board to intervene in the case.  California case law provides that a final order is one that “determines any substantive right or liability” of the parties in the case.  California Labor Code § 5910 states that the person wishing for the WCAB to reconsider the WCJ’s ruling has just twenty days from the order to file the petition.  The available grounds to file for reconsideration are: 1) the WCJ acted without power or in excess of its power; 2) the order or award was procured by fraud; 3) the evidence is no sufficient to justify the findings of fact; 4) the existence of newly discovered information that was not available previously; or 5) the findings do not support the order or decision.  Filing the petition also has the effect of suspending the order for ten days.

The other option is a Petition for Removal.  In contrast to a Petition for Reconsideration, a removal request is asking for relief from an order that is not a final order.  As with the Petition for Reconsideration, the Petition for Removal must be filed within twenty days of the order from which the requesting party seeks relief.  To be successful, the appealing party must show: 1) the order from the WCJ will result in prejudice; 2) the order will result in irreparable harm to the appealing party; and 3) reconsideration after the final order will not provide an adequate remedy.

Deciding when and how to appeal a workers’ compensation order is a difficult decision.  Contact us today to talk about your proceedings and what we can do to help protect your business.

When Does the Subsequent Injuries Fund Pay On a Claim?

California law requires that the majority of employers carry workers’ compensation insurance to provide for their workers in the event that they sustain a work-related injury during the course and scope of their employment.  Unfortunately, some employers either do not carry this insurance or even do not realize that they are required to do so.  California Labor Code § 3351 defines “employee,” and the definition is broader than most people realize, including even workers such as handymen, nannies, and minors.  In the event an employee sustains an injury, the Uninsured Employers Benefit Trust Fund (UEBTF) may provide funding for the employee.  If the employer is illegally uninsured and fails to pay the compensation awarded to the employee by the Workers’ Compensation Appeals Board, the employee may submit a claim to the UEBTF for payment of his or her claims.

The Subsequent Injuries Benefits Trust Fund (SIBTF) is another source of compensation for injured workers.  Under California Labor Code § 4751, employees who had a previous permanent disability or impairment at the time he or she sustained another injury in the work place can apply to the SIBTF for compensation.  To be eligible for compensation from the SIBTF, the injury from the current employment combined with the previous disability or employment must have the combined effect of at least a seventy percent permanent disability for the worker.  Moreover, the new injury must cause at least thirty-five percent of the permanent disability.

Note that an employer does not have to be illegally uninsured for an injured employee to be eligible to receive benefits through the SIBTF.  The SIBTF is meant to help pay a portion of the permanent disability compensation for permanently disabled workers for qualifying workers, as described above.  If an employee qualifies to receive benefits through the SIBTF, the employer will pay only the portion of permanent disability that is attributable to the injury received through the current employer.  The SIBTF will pay the remainder of the benefits owed to the employee.  The purpose of the SIBTF is to encourage employers to hire workers who are already permanently disabled without fear that they will be held responsible to pay benefits that are attributable to a permanent disability incurred through previous employment.

We have extensive experience in assisting our clients understand the repercussions of all types of workers’ compensation claims on their business.  Call us today so we can talk with you about your business and its responsibilities.

Do I Have to Pay for My Worker’s Prior Disability if He Gets Injured? (Apportionment)

As an employer, you know that making sure you provide workers’ compensation benefits for your employees is important and in most circumstances is required by California law.  Workers’ compensation provides protection for the employee because it establishes a no-fault system under which an injured worker can receive compensation for his or her work related injuries.  It also provides protection for the employers, as this no fault system means that the employer does not have to worry about being sued by their employees for recovery for injuries sustained during the course and scope of employment.  Although you certainly understand that workers’ compensation is designed to compensate your injured employee for injuries sustained at your business, it is also important to understand your potential responsibility if the employee had sustained an injury previously at a different business.

Apportionment is designed to allow disability percentages to be assigned to previous injuries to the same body part injured and at issue in the current workers’ compensation case.  California Labor Code § 4664(a) states “The employer shall only be liable for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment.”  The law goes on to provide that if there is a pervious determination of permanent disability, then it is presumed that the permanent disability still exists at the time the next workers’ compensation claim is made.  If the request for apportionment is successful, the amount of workers’ disability benefits received by your employee in the current case will be reduced.  To successfully show apportionment, there are specific requirements concerning the doctor’s assessment.  First, a doctor must make a specific determination of apportionment.  This determination must be done using percentages of what existed at the time of the injury.  The doctor must also analyze the permanent disability based on the causation of the disability, not causation of the injury itself.  Third, the opinion must be based on facts and not on speculation.  Fourth, the opinion must be based on a “reasonable medical probability.”  Finally, the doctor must explain how and why he or she reached the particular conclusion.  There are other requirements for a successful claim such as showing the employee was actually compensated for the previous injury and the injury continued to be a source of disability after the accident.

We have extensive experience helping our clients understand apportionment and how to protect their business.  Contact us today for an appointment.

What Is Permanent Disability?

As a business owner, you take every measure possible to reduce the chance of injury to your employees as much as possible.  Unfortunately, no matter how much you strive for an injury-free work place, it is overwhelmingly likely that an injury will eventually occur.  If during the course and scope of employment, your employee sustains an injury, he or she will likely be entitled to receive workers’ compensation benefits.  The type and percentage of disability is a central component of disability claims.

The California Department of Industrial Relations defines permanent disability as “any lasting disability from your work injury or illness that affects your ability to earn a living.”  If an employee is permanently disabled, he or she will be entitled to permanent disability benefits, regardless of whether that injury renders him or her unable to work in the future.  In most cases, permanent disability is determined through Whole Person Impairment (WPI).  This will be determined after the employee is examined by his or her doctor or a Qualified Medical Evaluator.  The doctor or QME will determine the percentage of impairment level, meaning how the injury will impact the employee in his or her ability to work.  The QME will use the standards established by the American Medical Association in making this determination.  The impairment level will then be reduced to a percentage, using a formula which also takes into account the employee’s age and occupation. In cases involving psychological injuries, the injury must either be categorized as catastrophic or the employee must have witnessed a violent crime in the course and scope of employment.  Taking all of these elements into account, the disability evaluator or the judge will then use the statutory formula and decide the amount of permanent disability the employee is entitled to receive.  The amount the employee will be entitled to receive will also be impacted by the date of the injury in addition to the wages paid to the employee before he or she was injured.  The permanent disability benefits typically begin being paid after the end of temporary benefits and the doctor indicates that the injury has “stabilized.”  This means that the injury will not heal or improve any more.

If you have questions about disability payments to your employees, contact us today.  We look forward to discussing workers’ compensation with you and what we can do to help protect you.

How Long Can My Worker Stay Out on Temporary Disability?

There are many precautions that careful employers will take to make sure that workers are not injured during the course and scope of their employment.  Keeping equipment in good repair, having updated training for all workers, and creating a safety committee are just a few ways that may help reduce work-related injuries.  Despite the best safety measures, however, it is highly likely that a worker will eventually be injured on the job.  If this occurs and the injury is severe enough to prevent him or her from doing his or her job during recovery, then that person is said to be temporarily totally disabled.  This is a determination that can only be made by a medical professional.  While the worker is healing, he or she can apply to receive two thirds of the wages he or she received while performing the regular duties associated with his or her employment, up to a maximum amount set by statute.  Especially when a worker is out for a substantial amount of time, as an employer, you may wonder how long that worker can stay on temporary disability.

If a worker sustains an injury that prevents the employee from coming to work for at least three days or requires the worker to be hospitalized (or both), then the worker may apply for temporary total disability.  California statute provides that the first payment must be paid within just fourteen days of when a doctor makes the determination that the work-related injury renders the worker unable to work.  Once the payments begin, there are several ways that the worker’s entitlement to continued temporary disability payments may end.  One way is that the injured worker returns to work in some capacity, even if it is not to the original position.  Another way is that a medical professional determines that the injured worker has recovered to the extent that he or she can return to work in some capacity.  Third, if the injured worker has received total temporary disability payments for the statutory maximum of 104 weeks, the worker will no longer continue to receive payments.  Finally, if the physician determines that the worker’s condition is stable and he or she will no longer improve, then the payments may then change to permanent disability payments.

We have extensive experience in helping our clients understand their rights and responsibilities with regard to their employees.  Contact us today to discuss your business and what we can do to help make sure you comply with the law.

What Is Laches?

The workers’ compensation system is often described as a “statutory scheme.”  This is because in 1911, the California legislature was directed to create the statutes and framework to help provide compensation to workers injured in the course and scope of their employment.  Because the system is based on these statutes and those that were amended or added later, it is said to be statutory in nature.  Nevertheless, there have been some times when equitable principles have been applied to workers’ compensation cases.  One of these principles is laches.

Laches is a legal doctrine that means that an otherwise enforceable right may not be enforced if there is an unreasonable delay in asserting that right, and that delay results in injury to the opposing party.  In essence, if you wait too long to bring a suit or ask for redress under the workers’ compensation system, the court may refuse to allow you to enforce your right to recover, even if you would have been able to recover if you brought your suit sooner.  The California Supreme Court in Kaiser Foundation Hospitals v. Worker’s Comp. Appeals Board determined that laches is applicable to workers’ compensation cases.  In that case, the Supreme Court determined that a claim for a lien can be barred by a defense of laches.  Other court cases since then have also applied the doctrine of laches to workers’ compensation cases.  For example, Godbolt v. Wherehouse Entertainment and Ace Insurance Company, the issue of laches came up when a case was settled in 1988 through a compromise and release, although the agreement did not relinquish jurisdiction over potential liens.  Eight years later, the lien claimant contacted the defendant.  The claimant then contacted the defendant again in 2000, 2006, and 2007.  It was not until 2009 that the lien claimant finally hired an attorney and attempted to move forward with the lien.  The defendant asserted the defense of laches, due to the unreasonable delay in bringing the claim as well as claiming it had been prejudiced by the fact so much time had passed.  The WCAB determined that laches did not apply in this particular case because the defendant failed to make the necessary showing that it was actually prejudiced by the passage of so much time.

If you have questions about the defenses available to your business in a workers’ compensation case, we can help answer them.  Call us today for a consultation.

Do I HAVE to Buy Workers’ Compensation Insurance?

There are a variety of expenses associated with running your own business.  From inventory to lease payments to taxes, there are many expenditures included in your total overhead.  In California, workers’ compensation needs to figure into this computation.  Especially in the case of small businesses, many business owners wonder if it is necessary to purchase workers’ compensation insurance, as the cost can be extensive.  It is very important for business owners to understand the different permissible options under California law, as well as the consequences of not acting pursuant to the relevant regulations.

The option that is most common is purchasing a workers’ compensation insurance policy.  Pursuant to California Labor Code § 3700, a business must provide workers’ compensation benefits to its employees if it employs one or more employees.  Recent changes to the law provide that executive officers and directors of corporations are no longer exempt from the requirement that all employees must be covered, with some limited exceptions.  California Labor Code § 3351 defines “employee,” and it should be noted that “every person in the service of an employer under any appointment or contract of hire or apprenticeship, oral or written, whether lawfully or unlawfully employed” is included under the definition.  Moreover, other people such as minors, handymen, aliens, nannies, and several others are also included.

Self-Insurance can also be an option for some businesses.  Businesses or employers who want to be self-insured must fulfill very particular financial requirements.  In addition, the business must apply to the Office of Self-Insurance Plans for Approval.  The business or employer must provide 1) three calendar years in business in a legally authorized business form; 2) three years of a certified, independently audited financial statements; and 3) acceptable credit rating for three full calendar years leading up to the application.  Employers should note that subsidiaries must apply separately.

If you choose not to provide workers’ compensation insurance, the consequences could be severe.  Not only could you and your business face stiff fines, there is a possibility you could even face criminal prosecution.  The first offense could result in a fine of $10,000 and a year and jail, and subsequent offenses carry even stiffer penalties.

If you have questions about whether you are required to carry workers’ compensation insurance for your business, contact us today.  We can discuss your business and what we can do to protect its future.

What Is the Workers’ Compensation Appeals Board?

As a business owner, you know that taking the right steps for planning, financing, expanding, licensing, and other related activities is essential.  Understanding the right procedures can be the difference between your business’ success and failure.  This is just as true with the workers’ compensation system.  The procedure your business will go through during this process is important to understand in order to protect it and its future.  When a claim is made against your business for workers’ compensation benefits by an injured worker, the claims are usually informally resolved between the injured worker and the insurance adjusted.  If the claims cannot be informally resolved, the issues will be resolved by the workers’ compensation judge (WCJ).  There are a wide variety of issues the WCJ may be asked to decide, ranging from the level of injury sustained by the employee to the authorization for medical treatment.

If either party disagrees with the decision made by the WCJ, that party may appeal that decision to the Workers’ Compensation Appeals Board (WCAB).  The WCAB is made up of seven judges, called “Commissioners,” that are appointed by the governor, and then confirmed by the state senate.  The Commissioners serve in terms of six years.  Out of the seven, three will preside over an appeal.   The appeal is called a Petition for Reconsideration.  As with any appeal, there are strict deadlines, so having an experienced attorney for your Petition for Reconsideration is essential.  Missing a deadline could mean that you waive your right to request reconsideration of the WCJ’s decision.

After the Petition for Reconsideration is filed, each of the three Commissioners assigned to the case will review the petition.  Note that filing a Petition for Reconsideration with the WCAB does not mean that you have a full trial in front of the WCAB; rather, it means that your attorney will file particular documents with the WCAB explaining why the petition has merit.  There are several possible outcomes for the Petition.  First, it is possible the WCAB will simply dismiss the request.  Second, they could affirm the decision of the WCJ and deny the request for reconsideration.  Third, they could grant the request for reconsideration and return the case to the WCJ for additional proceedings.  Finally, they could grant the request for reconsideration and render their own decision.

If you have questions about the workers’ compensation process, you need an experienced team on your side.  Contact us today and we can discuss the procedure and how they will impact your business.

What Is Subrogation?

The workers’ compensation system was established in 1911 by the California legislature to help provide relief for workers who were injured in the course and scope of their employment.  The system is what is called a “no fault” system, which means that the employee is not required to prove that the injury was the fault of the employer in order to recover for his or her injuries and ongoing disabilities.  In some cases, however, a third party’s actions or inactions may have contributed to the employee’s injury.  Under California Labor Code § 3850, et seq., an employer or the employer’s insurance company may exercise their right to subrogation in this instance.  Subrogation is the right of the employer and/or the insurance company to recover the amount paid under the workers’ compensation suit against a third party.  There are several ways that an employer may use subrogation to recover these expenses.

An employee may seek to recover against a third party whose negligent or even intentional conduct contributed to the accident causing the injury.  An employee may seek to recover, for example, from the equipment manufacturer for faulty safety systems or may sue a negligent driver for a car accident occurring during the course of the employee’s work.  If an employee files his or her own lawsuit against such a third party, an employer has a couple of options.  One option is to serve a Notice of Lien on all of the parties in the lawsuit.  This type of lien is considered a first lien against any recovery obtained by the injured employee.  This means that if the employee obtains a judgment from the lawsuit against the third party, the lien will be paid right after the employee’s attorney fees and legal expenses are paid.  Another option is to intervene in the law suit.  This means that your business will become a party to the lawsuit and will participate in the litigation.

If the employee does not decide to file his or her own lawsuit, your business or your workers’ compensation insurance company still have the independent right to file a lawsuit against a third party.  You should note that the statute of limitations will apply to your business, just as it would apply to the right of the employee to bring his or her own law suit.

If you have questions about subrogation or workers’ compensation, let us answer them.  Call us today for a consultation.

What Is Cumulative Trauma?

The legal system includes a variety of terminology that can seem confusing to non-lawyers, and the workers’ compensation system is no exception.  It is important to understand some of the basic terminology used in the workers’ compensation system to best defend your business.  One important different to understand is the difference between specific trauma and cumulative trauma.  Specific trauma is the kind of injury that typically comes to mind when you think of workers’ compensation, such as a broken arm in a car accident or a concussion from a fall from a ladder.  Cumulative trauma is a bit more nuanced.

Cumulative trauma, also referred to as a “repetitive stress injury,” is an injury sustained from repetitive stress or motions over time.  Carpal tunnel syndrome is the classic example of cumulative trauma, as it takes repeated motion, performed over time, in order to actually develop carpal tunnel.  Another example is the Chronic Traumatic Encephalopathy sustained by professional football players as a result of sustaining multiple concussions.  Cumulative trauma is a compensable injury under the workers’ compensation system, just like specific trauma.

Like specific trauma injuries, workers must bring a claim for cumulative trauma within a specific time frame.  Under California Labor Code § 5412, the worker must bring a claim within one year of discovering the claim or within a year of when the claim should have been discovered, had he or she been exercising reasonable diligence and care.

The California Workers’ Compensation Institute found that on average, cumulative trauma injuries were 53% more expensive than specific trauma cases.  In addition, workers claiming a cumulative trauma injury were much more likely to be independently represented by their own attorneys.  The institute also found that cumulative trauma is most prevalent in the manufacturing industry, which is attributable to the repetitive manual motions typically required of the workers.  Moreover, the study found that a worker claiming a cumulative trauma is ten times more likely to claim another injury.  With these types of statistics, it is clear that it is essential that you have a firm understanding on cumulative trauma and how to protect your business and your workers from these types of injuries and claims.

We have extensive knowledge in helping our clients understand cumulative trauma and the potential impact on their business.  Call us today for a consultation.

Ratings and Reviews

CBLS