Back and Neck Injuries

Every year, thousands of workers are injured in the course and scope of their employment.  In California, these workers can then apply for workers’ compensation benefits.  Workers’ compensation helps defray the sometimes considerable medical costs for the treatment of the injury, as well as provides a certain degree of wage replacement for the time the employee is out of work.  Workers are susceptible to a wide variety of injuries depending on their job, but back and neck injuries are common across many different industries.  Understanding the common causes and consequences of these injuries is important if you are a business owner.

One common cause of back and neck injuries on the job is lifting heavy objects or the employee overexerting him or herself.  Jobs may require that an employee push, pull, lift, or carry objects.  Even if this is an infrequent requirement of the job, any time the employee is handling more than about twenty pounds, he or she could be at risk for hurting his or her neck or back.  One way to help protect your employees from these injuries is to make sure they are familiar with the proper way to handle heavy objects and are provided with safety equipment, such as back supports.

Another way your employee can injure his or her neck and back is during a slip and fall accident.  Some contributing environmental factors for slip and fall accidents can be poor lighting, cluttered walkways, wet floors, or broken flooring.  An employee can slip, fall and sustain a serious neck or back injury when striking the floor or even in an attempt to stop him or herself from falling.

Car accidents can be another cause of neck and back injuries.  Truckers, delivery drivers, and home healthcare workers are just a few examples of employees who are likely to spend a lot of time in a vehicle during work hours.  A car accident can result in whiplash, fractured vertebrae, or nerve damage.

It is essential that if you believe there is a chance that your employee has sustained a neck or back injury on the job that you encourage them to seek medical treatment immediately.  Neck and back injuries can be very serious, and failure to obtain prompt and proper treatment can seriously aggravate the injury.

If you have a question about your rights and responsibilities regarding workers’ compensation and your employees, contact us today.  We can talk with you about the role of workers’ compensation with your business.

Improving Workplace Safety to Lower Workers’ Compensation Costs

Every conscientious employer wants to lower the risk associated with their workplace.  Not only is lowering the risk to our employees in the workplace the right thing to do, it can also monetarily benefit your business.  Clearly, if your employee is not injured, you will not have to pay out workers’ compensation benefits, hire an attorney, or other direct costs.  Moreover, reducing the incidences of injury can help to lower your workers’ compensation insurance premium.  There are several ways you can look into improving your workplace safety to lower your workers’ compensation costs.

One way you can help lower your workers’ compensation costs is to make sure all of your equipment is up to date and in good repair.  Some business owners try to avoid costly updates or repairs in an effort to save money. However, this can spectacularly backfire.  If you allow machines to fall into disrepair, the chances of your employee getting injured while using the equipment goes up, thus adding to your workers’ compensation costs.

Another way you can help lower workers’ compensation costs is to start a safety committee at your work.  Safety committees are groups formed from groups of your employees.  During regularly scheduled meetings, employees address common safety problems seen in your workplace, and can discuss how to improve conditions to reduce the chances of someone getting hurt.  The safety committee can also help to foster a corporate culture that promotes safety in the workplace.

Third, you can and should provide training to your managers and employees about the particular dangers that are present in your workplace.  For example, if you work in an office environment, training should include the potential dangers posed by occupational illnesses, such as repetitive motion injuries like carpal tunnel syndrome.  Providing education to your employees about the obvious dangers in your workplace can help reduce your workers’ compensation costs, as building employee awareness can help your employees identify and avoid sustaining an injury in the first place.  Providing additional training on current safety measures and the most recent safety standards also helps to reduce the likelihood of workplace injury and thus your business’s workers’ compensation costs.

If you are a business owner and have questions about your obligations under workers’ compensation, call us today.  We can help you understand the workers’ compensation system and how your business fits within it.

Most Common Types of Workers’ Compensation Fraud

The workers’ compensation system is an essential safety net for millions of workers every year who sustain a work-related injury during the course and scope of their employment.  Workers’ compensation provides medical benefits for injured workers, as well as a portion of replacement wages.  Although the vast majority of workers’ compensation claims are valid and important to help workers get back to working condition after they sustain an injury at work, there is a small percentage that are fraudulent.  There are some types of workers’ compensation fraud that are more common than others.

One of the most common types of workers’ compensation fraud is the intentional misclassification of workers.  Under California law, an employer is required to carry workers’ compensation insurance and pay benefits only for their employees.  As a result, some employers will intentionally misclassify their employees as independent contractors, as the legal requirement to cover a worker’s workers’ compensation benefits does not extend to independent contractors.

Another common type of workers’ compensation fraud is when an employee lies about the existence of a work-related injury or greatly exaggerates the severity.  This is often seen when, for example, an employee claims a back injury is so severe he cannot possibly come to work, but then there are photos of him on social media engaging in rigorous physical activity, like skydiving or downhill skiing.  Employees found to be committing this type of fraud can face criminal charges, fines, and be required to pay back the insurance company or employer for any benefits that have been paid.

Some types of workers’ compensation fraud are actually committed by the medical providers, as opposed to the employees or the employers.  In some cases, unscrupulous medical providers will inflate medical bills or even completely manufacture them, hoping that the insurance company’s deep pockets will take care of the cost.  There have been other, much more complex, schemes for workers’ compensation fraud involving payment of kickbacks and creation of shell corporations.  One such scheme, for example, went on for fifteen years and netted one surgeon five million dollars in illegal and fraudulent kickbacks.

If you have questions about workers’ compensation fraud, call us today. Contact us today for a consultation to talk about your business.

Time Limits and Workers’ Compensation

In the wake of an employee injury at your business, there are many issues that need to be taken care of.  First and foremost, the employee will need to receive medical treatment to address the injury or illness.  Once the dust settles, you will likely be aware that there are procedural issues involved in commencing and moving forward with the workers’ compensation system.  Time limits involved in workers’ compensation are essential to observe, just as in every other civil case.  If your business is facing a workers’ compensation case, you need to have a handle on some of the basic time requirements and limits.

First, you need to understand that there is a time limit associated with reporting the injury.  An employee who has sustained a work-related injury has thirty days to report the injury.  If he or she fails to report it, then there is a chance that he or she will lose the ability to collect workers’ compensation benefits.  People involved in these cases need to understand that the thirty-day time limit can be complicated to calculate.  The deadline starts to run when the injured worker was injured or when the injured worker had reason to believe the injury was work-related.

Another important timeline to understand in the California workers’ compensation system is the deadline by which the workers’ compensation insurance company must respond to a claim for workers’ compensation.  The insurance company must respond to the claim within ninety days.  If the insurance fails to respond, then the law presumes the claim has been approved.

Employers and employees should also keep in mind that there are time limits regarding how long an injured employee may continue to receive benefits.  For most injuries, if an employee is ruled to be temporarily disabled, he or she can receive a maximum of one hundred and four weeks of temporary disability payments in a five year period.  There are, however, exceptions, such as when a worker has sustained severe burns or chronic lung disease.  If that is the case, an injured worker may receive benefits for two hundred and forty weeks.

We have experience with helping clients understand important timelines during workers’ compensation cases.  Call us today for a consultation.

How Long Will My Workers’ Compensation Case Take?

Being involved in litigation is never pleasant.  Litigation means conflict, and if you are running a business, you likely do not have the time or energy to devote to this extra struggle.  If your employee has sustained a work-related injury, it will come as no surprise when a workers’ compensation case follows soon thereafter.  Once you know that the workers’ compensation case is pending, you likely want to know how long it will take until the case has been resolved.

Unfortunately, the answer to this question is “it depends.”  Cases can vary wildly in length due to variance in complexity, the seriousness of the injury, and whether you or your insurance company disagree with the medical assessment, just to name a few reasons.  If there is a suspicion of fraud, the case can become even more complicated and lengthy.  In a nutshell, the more detailed and complex the case, the longer it is likely to take.  This is because it is likely to take a longer time to gather the evidence needed for each side to prove his or her respective position.  All that said, if the case is straightforward, the injury relatively minor, and neither side disagrees about any issues, the case could be potentially over in as little as a couple of months.  The parties are free to reach an agreement at any point during the case, even at the very beginning.  Employers should be advised, however, that any settlement agreement must be approved by the workers’ compensation judge.  It is possible for a judge to reject the settlement, even if the employee, the employer, and the insurance company have all signed the agreement.  The judge will examine whether the settlement is adequate considering all of the circumstances.

There are some areas of the case that are particularly prone to delaying the case.  One area is filing the claim.  Without the claim of injury, the case cannot move forward.  Investigating the claim can also be a source of delay, as the investigator has ninety days from the date the claim is filed pursuant to labor code 5402(b).  If there is a dispute about whether an injured employee is permanently impaired.  If that happens, either side may request an assessment of a qualified medical examiner.

If you have questions the timeline of a workers’ compensation case, call us today.  We can talk to you about your case and how long it may take.

Medical Care Workers and Workers’ Compensation

After an employee has been injured in a workplace accident, he or she is likely to apply for and receive workers’ compensation benefits.  Although the type of benefits can range from treatment for acupuncture to replacement for lost wages, every workers’ compensation case will involve some sort of medical care for the injured employees.  There are a variety of medical care workers that may be involved in your workers’ compensation case.

One type of medical care worker that may be involved in your workers’ compensation case is the nurse case manager.  In some cases, the insurance company will retain the services of a nurse case manager to oversee a case.  The nurse case manager is usually a registered nurse and has several roles.  The nurse case manager will take on tasks such as arranging for transportation for workers having trouble getting to their appointments, scheduling medical appointments, and ensuring the proper prioritization and documentation of injuries.  The nurse case manager also is responsible for ensuring the correct care and treatment is being administered for the that injured employee’s particular injury.  They are responsible for communicating this information to the insurance adjuster and maybe in attendance at some medical appointments or court hearings.

Another type of medical care worker that may be involved in the workers’ compensation case is a home health care worker.  Home health care can be necessary for certain injured employees, but it can also be an exceedingly costly benefit.  Employees and employers should both be aware that California Labor Code § 4600(h) places important restrictions on the availability of this benefit.  Under this labor code, a licensed physician must provide a prescription for the home health services, and this prescription can only be used to get up to fourteen days of retroactive benefits.

Finally, a qualified medical examiner (QME) may be involved in workers’ compensation cases.  QMEs are doctors that have special certification from the workers’ compensation medical unit to examine injured workers.  A QME’s role is to evaluate the injured worker and determine the level of disability.  The level of disability will be used, in turn, to calculate the amount and duration of benefits for the injured employee.

If you have questions about the workers’ compensation process and the professionals involved, call us today.  We can talk with you about workers’ compensation and your business.

Workers’ Compensation and Product Liability

The workers’ compensation system has an extensive system of legislation determining what type of injury is eligible under the system.  Workers’ compensation legislation also provides that the system is a “no-fault” system.  This means that the employee is not obligated to prove that the employer’s negligent or intentional conduct was the direct or indirect cause of the conditions that lead to the work-related injury.  The system also limits the ways in which an injured employee can seek to recover; an employee is generally prevented from filing a civil suit in court while also pursuing recovery through workers’ compensation.  One of the exceptions regarding this rule involves product liability.

Product liability actions mean that the manufacturer of a product can be held liable in some situations when the equipment malfunctions and causes injury.  Product liability comes into play with workers’ compensation most often when an employee is injured by defective equipment in the workplace.  The employer can then seek to recover or receive reimbursement from the manufacturer for the costs the employer has had to pay through workers’ compensation.  For example, if an employee is badly burned when an oven malfunctions and the worker then files for workers’ compensation, the employer can then seek to recover the money it had to pay to the employee from the manufacturer of the oven.

Another way that products liability can figure into workers’ compensation is through the operation of a power press.  Some employers may be tempted to remove certain safety precautions installed on power presses in the interest of increasing productivity and profit.  A power press is specifically identified as any material-forming machine used to die, press, impact, stamp, punch, or extrude material.  Power presses do not income those machines simply used to cut material.  Under California Labor Code § 4558, if an employer knowingly removes the guard, the employee may be able to recover both in civil court and in through workers’ compensation.  However, if a manufacturer-installed the press, or designed it in such a way as to make it unsafe, the manufacturer may be on the hook for the employee’s injuries instead of the employer.

We have extensive experience helping our clients understand how products liability fits into workers’ compensation.  Call us today to talk about your case and your business.

Workers’ Compensation Mediation

Civil litigation has a reputation for being complicated and dragging on for months or even longer.  Workers’ compensation is no exception, and when the sides disagree about central issues, the case can become complicated and lengthy.  As a way to cut down on the time and expense involved in litigation, many people are turning to mediation.  During mediation, the two sides will sit down with a neutral third party who will try to facilitate a settlement.  Mediation allows the two sides to come to an agreement that fits their needs and preferences.  If your business is facing a workers’ compensation suit, you should know what to expect from workers’ compensation mediation.

During a workers’ compensation mediation, you and the employee will both appear and discuss the case with the mediator.  The mediator is not a judge and cannot force either side to settle.  Instead, the mediator’s job is simply to help the two sides communicate and try to reach common ground on some or all of the issues.  You and the other side will both be able to present discussion and argument to the mediator about the merits of your respective positions.  Neither of you will be under oath, and the rules of evidence that are applicable in a courtroom are not applicable during mediation.  Typically before the parties arrive, the employee and the employer (or the employer’s insurance company) will have sent a detailed position statement to the mediator outlining the details of the case and the source of contention.  It is usually helpful for both sides to bring all relevant documents, especially if the parties have already completed discovery.

During mediation, the sides can discuss any part of the case that is still in disagreement.  In general, the mediator will put the two sides in two different rooms and go back and forth between the two, trying to help them find common ground.  It can take hours for an initial settlement offer to be made, and the offer is usually followed up by a counteroffer.  If the parties are able to reach a settlement on at least part of the case, the agreement will be reduced to writing and the parties will sign.  The agreement will later be presented to the court for the judge’s signature.  IF the parties are unable to reach an agreement on all of the issues, they can still proceed to a final hearing on only those issues that remain.

We have experience assisting our clients in workers’ compensation mediation.  Call us today and we can talk about your case.

High-Risk Occupations and Workers’ Compensation

Even though careful and diligent employers work hard to reduce the chance their employees will sustain a work-related injury, injuries are eventually inevitable.  Some professions are pretty low risk, such as typical office work.  However, there are other jobs that involve an inherently higher level of risk.  Understanding which professions more often lead to injury or even death can help you take measures to reduce the risk to your employees.

One category of people who are at high risk for workplace injuries is those who work at great heights.  This includes people such as window washers, roofers, and painters.  In recognition of the extra risk involved in working at great heights, some professions have extra workers’ compensation coverage requirements in terms of sole proprietors and the inability to opt-out of carrying workers’ compensation insurance.

Unsurprisingly, first responders also work in high-risk occupations.  It is obvious that police officers risk life and limb on a daily basis while dealing with criminals.  In addition, EMTs face risk by being required to go into unknown circumstances with injured or very ill people.  EMTs also can potentially be injured when lifting and moving incapacitated patients.  Similarly, firefighters may have to shift heavy objects in order to save fire victims.  They also obviously face risk of burns and heat-related injury.  Moreover, they can be exposed to dangerous chemicals while on the job.  The California Labor Code contains extra provisions to protect first responders’ ability to receive workers’ compensation benefits.

Truck drivers are also in a high-risk occupation.  There is a level of risk involved any time you are in a vehicle on the road.  Distracted and impaired drivers are a very real danger.  Moreover, some cargo carried in large trucks is hazardous, such as chemicals or gasoline.  Employers should take careful measures to make sure their trucks are in good working order.  Keeping the vehicles in good repair will help make sure the driver and passengers stay safe, as well as protecting others on the road.

Doctors, nurses, and other healthcare professionals also face high risk in their occupations.  They are regularly exposed to potentially contagious and even life-altering diseases.  Moreover, some patients can be combative or violent.  Finally, there is a risk of injury from lifting and moving patients.

If you are a business owner and your employees are in high-risk occupations, it is important for you to understand your rights and responsibilities.  We can help you understand the workers’ compensation system and how your business fits within it.

What if I Disagree with the Disability Rating

After an employee sustains an injury in the course and scope of his or her employment, he or she is entitled to file for workers’ compensation benefits.  These benefits cover not only a portion of their replacement wages, but also their related medical costs for the treatment of their work-related injury.  When an employee is initially injured, he or she may be deemed to be temporarily disabled by a healthcare worker.  After the injury has stabilized, i.e. determined to reached its maximum recover, the employee may then be determined to be permanently disabled.  During this determination, the employee will be assigned a disability rating.  This disability rating is significant because the permanent disability rating will determine the amount of benefits the worker will receive in the long run.

To calculate the permanent disability percentage, it is required to perform an assessment of the injured employee’s whole person impairment.  The whole person impairment is then used in a particular format  to create the disability percentage.  It is not uncommon for the employee or the employer to disagree on whether the disability rating is correct.  They may disagree on the severity of the impairment or on the type of impairment.  If you disagree with the impairment rating given to your employee by the Treating Doctor, you can request that he or she submit to a new medical examination with a Qualified Medical Evaluator (QME).  Be advised, however, that a court will not order an injured employee to just continue to submit to repeated medical examinations until the employer gets the impairment rating he or she thinks is appropriate.  Employees also need to remember that time is not unlimited to appeal the disability rating and request a new medical examination.  Accordingly, an employer should not delay in pursuing the appeal if he or she believes the rating is incorrect.  Employers also should keep in mind that simply alleging that an award is too high is not likely to achieve a favorable outcome during an appeal.  Employers should be able to articulate why an award is too high or inaccurate.  For example, if the employee alleges his or her shoulder is seriously injured, the employer may want to be able to present evidence that the employee is regularly lifting heavy boxes or pursuing heavy athletic activity.

We have extensive experience with helping business owners understand the role of disability ratings.  Call us today to discuss your business and what we can do to help.

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