Intentional Conduct and Workers’ Compensation

Workers’ compensation is an important part of the California legal process.  It provides a method for workers who are injured during the course and scope of their employment to receive payment for medical costs and replacement wages.  One of the features of the workers’ compensation system that provides protection to both employees and employers is the fact that the California workers’ compensation is “no fault.”  This means that neither the employer nor the employee has to prove that the other is at fault for the injury before the employee is eligible to receive workers’ compensation benefits.  An important exception to this, however, is where the injury is received after intentional conduct from the employee.

One of the most common examples to this is when an employee has intentionally injured him or herself on the job in an effort to get workers’ compensation benefits.  This can be classified as fraud and is one of the reasons it is important to properly document and investigate every workplace injury.  For example, if your employee was injured in a purported slip and fall incident, but you have video evidence that he or she intentionally fell to the ground, it is possible that this will render him or her ineligible to receive workers’ compensation benefits.

Another way that intentional conduct can render your employee ineligible to receive workers’ compensation benefits is if your employee was involved in a fight.  If your employee engaged in an illegal act, such as assault, this will render him or her ineligible to receive workers’ compensation benefits for any injuries sustained during the fight.  It is important to note, however, that if the employee was not the aggressor, he or she may still be able to collect workers’ compensation benefits.

Workers’ compensation benefits also come into play if an employee is injured in a car accident during the course and scope of his or her employment.  During the discussion with the car insurance company, the issue of fault will be relevant.  However, in the context of workers’ compensation, the fault of the employee is irrelevant.  If, however, you could prove that the employee intentionally wrecked the company vehicle, that would mean that he or she will not be eligible for workers’ compensation.

We have experience with helping clients understand their rights and responsibilities with regard to intentional conduct and workers’ compensation.  Call us today for a consultation.

Home Healthcare and Workers’ Compensation

All conscientious employers work hard to make sure that their employees are safe and do not sustain an injury while on the job.  Unfortunately, despite the most diligent efforts, it is still possible that employees may sustain an injury during the course and scope of their employment.  When this occurs, the employee will be entitled to workers’ compensation, which covers their medical costs, as well as a percentage of salary replacement.  The medical costs that are covered by workers’ compensation cover a wide variety of treatments, ranging from surgery to acupuncture to psychiatric treatment.  One issue that may come up during your employee’s workers’ compensation case is home health care.

Workers’ compensation covers the treatment and cure costs for injuries sustained through the course and scope of employment.  Once a medical professional has diagnosed your employee with a particular injury, the medical professional will then provide a treatment plan for your employee.  The treatment plan may include home health care.  A determination that an employee requires home health care will require an assessment of several issues and the employee’s needs for three types of services.  These services include skilled nursing and therapy services, assistance with personal tasks, and assistance with activities that allow a person to remain at home.  Personal tasks include tasks such as grooming, dressing, and eating.  Activities that allow a person to remain at home include shopping, cooking, and housework.  It is important to note that these services are not inherently medical services, meaning that no medical training is required to complete these tasks.  Nevertheless, they qualify under home health care services for purposes of workers’ compensation.

In 2015, the California Senate passed a bill requiring the California Workers’ Compensation to establish a fee schedule for workers’ compensation schedule.  Before that bill, the Official Medical Fee Schedule established the fee schedule for home health care services under workers’ compensation.  The bill also provides that the treating physician of the injured employee needs to prescribe home health care services, and also request authorization.  The process of utilization of review will allow the insurance provider or other payer to determine whether home health care services are necessary and appropriate.

We have extensive experience helping our clients understand what benefits their employees may receive through workers’ compensation.  Call us today to talk about your case and your business.

Lost Wages and Medical Costs – What Type of Benefit Will My Employee Receive

The workers’ compensation system is designed to help protect and help both employees and employers.  The employer is protected because when an employee sustains a work-related injury, the employee can usually only recover benefits through the workers’ compensation system.  In other words, the employee typically cannot file a civil suit against the employer for negligence.  An employee is protected because he or she does not have to prove fault or negligence on the part of the employer in order to obtain benefits.  If you own a business, it is important for you to understand the types of benefits your employee may receive.

One of the most obvious types of benefits that the employee will receive is medical costs for treatment of his or her injury.  The medical treatment benefits will include the costs of treatment for an acute injury, such as going to the emergency room or emergency surgery.  What some employers fail to realize, however, is that the covered medical expenses will also include ongoing expenses, such as physical therapy, acupuncture, or medical equipment.  If the injury is a mental injury, such as post-traumatic stress disorder, the medical costs would also include psychiatric care.

Temporary disability benefits are another type of benefits that will be awarded.  Temporary disability benefits are designed to provide a replacement for the lost wages for the time during which an employee is not able to return to work after sustaining a work-related injury. An employee will receive two-thirds of his or her average weekly pay for up to 104 weeks within five years of the date of the injury.

Permanent disability is not designed to address the same issue as a temporary disability.  Permanent disability is designed to address a permanent loss of function that the employee experiences as a result of the work-related injury.  The amount the employee receives will depend on the degree of disability, as determined by medical professionals, up to two hundred ninety dollars a week.

Workers may also be eligible for job displacement benefits.  If a worker is permanently disabled and as a result cannot return to his or her job, then he or she may apply to receive a voucher for retraining.  The injured worker can go back to school to be trained for a new position.

We have extensive experience helping our clients understand the benefits in a workers’ compensation case and what that means for their business.  Call us today for a consultation

What You Need to Know About AB 1107

California lawmakers work hard to make sure that the state laws are reformed to best protect and serve the residents of California.  The labor code and workers’ compensation are not exceptions to these efforts.  Workers’ compensation is a complicated area of the law and one of the oldest social institutions in California.  This does not mean, however, that these statutes do not need updating and improving.  The California Assembly recently passed A.B. 1107 in an effort to improve the workers’ compensation process.

California Assembly Bill 1107 amends labor code 4610.01.  The purpose of the amendment is to reduce the delays sometimes facing injured employees in receiving medical treatment for their work-related industrial injuries.  The bill as originally filed was partially in reaction to a case called King v. CompPartners Inc.  In that case, an employee was harmed when his medication was withdrawn after a wrongful utilization review.  The injured employee then tried to sue the utilization review provider in civil court, not under workers’ compensation, because of the injuries and the wrongful withdrawal of his medication.  The California Supreme Court held, however, that the injured employee’s exclusive remedies were under workers’ compensation and the employee could not sue the utilization review provider outside of that framework.  The bill was originally filed with the aim of reducing administrative time as well as access to treatment for injured employees by exempting treating physicians from utilization review under specific circumstances.  The bill was later amended to provide that stakeholders may challenge utilization review conclusions.  Critics of the amendment are concerned that the amendment will just result in more litigation and legal gymnastics, which could reduce an injured employee’s access to care.  This is because the injured employee’s treatment will likely be delayed while waiting for the legal dust to settle.  Conversely, proponents of the amendment state that allowing stakeholders to challenge the result of a utilization review provides another much needed layer of oversight.  These advocates of the process point out that having additional oversight can help reduce the incidence of fraud in the workers’ compensation field, which could help save millions of dollars every year for Californians.

We have extensive experience helping business owners understand the changing law and how it impacts their business.  Contact us today for a consultation

Vouchers and Workers’ Compensation

The workers’ compensation system is designed to help provide income replacement for employees who have sustained work-related injuries.  The system also provides reasonable medical expenses related to the treatment of the work related injury, ranging from surgery, prescription medication, or medical equipment.  In some cases, the worker will be able to return to work quickly or may not even miss work at all.  In other cases, the employee may require extended medical care and may not be able to return to work for months, and when he or she does return reasonable accommodations may be necessary for the employee to return to work.  If the worker has been permanently disabled but is able to do some work, another type of benefit he or she can apply for is Supplemental Job Displacement Benefits, which come as a voucher.  The voucher is a non-transferrable voucher that are for injured employees who want to return to school or obtain additional vocational training.  This training or education must be obtained at a state approved or accredited school.

Injured employees wishing to receive these benefits must meet certain conditions to be eligible.  First, the employee must have a permanent partial disability as a result of the work related injury.  The employee also must not have been offered other work by his or her employer.  The voucher is worth up to six thousand dollars to go toward the payment of tuition and retraining to start the employee in a new line of work.  The voucher is meant to cover expenses such as fees, books, cost of occupational licensing or certification fees, up to one thousand dollars for computer equipment, and up to five hundred dollars for miscellaneous expenses such as transportation and uniforms.

If the employee has paid these types of expenses, he can submit itemized receipts showing payment of these eligible costs to the claims administrator.  This must be done before the voucher expires, which is two years after the voucher was issued or five years after the employee sustained a work related injury, whichever comes later.  Alternatively, if you present the voucher to the school or vocational counselor, they may receive payment directly from the claims administrator.  Whether you are being reimbursed or the school is receiving payment directly, payment should be complete within forty-five days of the expenses being properly submitted to the claims administrator.

If you have questions about the voucher system and what that means for your business, call us today.  We can help you understand the workers’ compensation system.

Fatal Injuries and Workers’ Compensation

Employers make efforts to keep their business running as smoothly as possible.  This includes making sure that employees are safe at work and will not sustain work related injuries.  Despite these efforts it sometimes happens that an employee sustains an injury.  In the most tragic and unfortunate of cases, a worker may not only be injured but may sustain a fatal injury.  Workers’ compensation will provide benefits not only when the worker is injured and needs medical treatment to recover, but also when the industrial accident results in the employee’s death.

California law provides that the family members dependent on the deceased worker may apply for and receive workers’ compensation benefits.  These benefits will include reasonable burial expenses up to ten thousand dollars as well as regular payments.  The dependents that are eligible to receive benefits will fall into one of two categories – either total dependents or partial dependents.  Total dependents are those family members who were complete dependent on the deceased worker for care and support.  Conversely, partial dependents are those who only partially dependent on the deceased worker.  In addition, the amount of benefits will depend on how many dependents the deceased employee at the time of his or her death.  If the employee had just one total dependent, the benefits would be two hundred and fifty thousand dollars, which goes up to two hundred and ninety thousand for two total dependents, and three hundred twenty thousand for three total dependents.  If there are one or more totally dependent minors at the time of the employee’s death, the family will continue to receive death benefits until the youngest child turns eighteen.  If the minor is disabled, he or she is eligible to receive benefits for life.  The death benefits are paid that the rate of temporary total disability, but not less than two hundred twenty-four dollars a week.  Dependents who seek death benefits under workers’ compensation will need to commence proceedings seeking these benefits within a year of the employee’s death.  The absolute deadline for commencing an action for death benefits is two hundred and forty weeks from the date the injury leading to death occurred.

We have extensive experience in workers’ compensation cases ranging from minor injuries to death of an employee. Contact us today for a consultation to talk about your business.

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