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.

Why You Need Workers’ Compensation Insurance

Any business owner can tell you that there are many laws that need to be observed when setting up and running a business.  These laws range from federal tax laws all the way down to local ordinances about signage.  Mindful business owners will need to have a grasp on all the major laws and rules that could impact their business.  The laws surrounding workers’ compensation is no exception.  Although business owners work hard to reduce the likelihood that their employees will be injured on the job, it is likely that at some point, one of the employees will sustain some sort of injury in the course and scope of employment.  Once this occurs, the employee has the right to file for workers’ compensation benefits.  Once that occurs, it will quickly become obvious why you need to carry workers’ compensation insurance for your business.

The first and most prominent reason that your business needs workers’ compensation insurance is that California law requires almost all business owners to carry workers’ compensation insurance.  California labor code section 3700 provides that a business must carry workers’ compensation insurance as long as it employs one or more employees, with very few exceptions.  The penalties for failure to adhere to this law are severe.  A business owner can be charged with extensive civil fines for this.  In egregious cases, an employer could even be criminally charged for the failure to carry the proper insurance.

Another essential reason why you want to make sure to carry workers’ compensation insurance is that if you do not have insurance, your business will be directly liable for any costs for workers’ compensation benefits incurred by the employee.  Your employee will be entitled to the same type of benefits regardless of whether you carry insurance.  Especially where your worker is severely or permanently injured, he or she may require extensive medical treatment and lifetime benefits.  These types of costs can be enough to benefit a small company.  There are ways to obtain assistance in making those payments through the state.  However, this is not a gift; the employer will be responsible for repaying the benefits paid by the state on the employer’s behalf.

We have extensive experience with helping business owners understand their obligations with regard to workers’ compensation insurance.  Call us today to discuss your business and what we can do to help.

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.

Do I Have a Right to My Employee’s Medical Records?

Workers’ compensation can be a confusing process for both the injured employee and the employer.  Like other civil litigation, workers’ compensation requires a large amount of paperwork.  There are many forms that need to be filed in a timely manner, the employee will have to file paperwork starting the claim with the court, and doctors will need to fill out and return forms concerning the employee’s injury.  Medical conditions can be just as complicated and confusing for laypeople as the workers’ compensation claim itself.  If your business is facing a workers’ compensation case, you may be wondering if you can get a copy of your employee’s medical records.

The short answer to this question is “yes.”  Although employees may balk at this as it seems like an invasion of privacy, it is important for employees and employers both to understand that medical records can be crucial to the workers’ compensation process because an employee’s claim can be impacted by the existence of a pre-existing injury.  For example, if your worker is claiming he or she has developed carpal tunnel syndrome during the course and scope of employment, the employee can be forced to disclose medical records that show that he or she has sought treatment for the same or similar condition in the past.

Employers should keep in mind, however, that an employer cannot force an employee to provide copies of all medical records, despite the lack of connection between the work-related injury and records of past medical conditions.  Taking the same example of the employee claiming he or she has developed carpal tunnel syndrome, the employer could not likely require the employee to provide copies of medical records concerning skin cancer treatment.  Employers should also keep in mind that the Health Insurance Portability and Accountability Act (HIPAA) also applies to workers’ compensation cases.  The purpose of HIPAA is to help protect the privacy and security of medical records.  In most situations, a person would need to sign a release for another entity to receive a copy of health records. Workers’ compensation cases have a limited exception, allowing relevant medical information to be released without individual authorization from the injured employee.  However, the medical records will only be disclosed to meet the minimum required information.

We have extensive experience helping our clients understand the type of information they may have a right to during a workers’ compensation case.  Call us today for a consultation.

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.

How Workers’ Compensation Can Protect your Business

Workers’ compensation is an important system in California.  The system makes sure that workers receive medical treatment after receiving a work-related industrial injury.  Injured workers can receive payment for medical costs as well as a portion of replacement wages.  Clearly the worker receives protection from the system, but it is important to remember that business owners and their business structures are also protected by the workers’ compensation system.

One essential way that businesses receive protection is through the “no-fault” system under workers’ compensation.  This means that the employee is not required to prove that the business owner committed any type of negligence in order to receive compensation.  While at first blush it may seem that this is a protection for the employee, it is also a protection for the employer.  This Is because the no-fault system also prevents the injured worker from bringing a lawsuit in civil court to recover for the work-related injury.  In a civil suit, the employee would need to prove that the employer committed negligent or intentional conduct leading to the injury.  The amount of damages could be unpredictable.  By contrast, under workers’ compensation, there are specific fee schedules set out for how much an employee will be able to recover.  This system could save the employer substantial time in court as well as money for damages that employee could not recover in the workers’ compensation system.

Another important way that the workers’ compensation system protects your business is by requiring workers’ compensation insurance in almost every situation.  Workers’ compensation insurance protects your business because if your worker is injured in the course and scope of his or her employment, your business will be on the hook for the medical costs and replacement wages, regardless of whether you were actually carrying insurance.  In other words, if you do not carry the required insurance, having to pay all of these costs straight out of the business could create a significant and even detrimental impact on your business.

Finally, the workers’ compensation system helps businesses by making business owners and managers more aware of potential dangers and how to take action to help prevent injury.  Forming safety committees, keeping equipment up to date, and providing the latest safety training for employees are all ways businesses can reduce their liability, and could even reduce their insurance premiums.

We have extensive experience helping our clients understand how their business fits in the workers’ compensation context.  Contact us today for a consultation.

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.

The Role of the Qualified Medical Examiner

There are many important steps during the workers’ compensation process.  The employee and employer will both be required to file particular paperwork and may have to attend court.  The employee will also need to receive medical treatment.  The medical attention will be not only for the purpose of treating the injury, but also for assessing the employee’s injury and assigning a disability rating.  One of the medical care providers the employee will likely need to meet with is a qualified medical examiner (QME).

The qualified medical examiner is a doctor that is licensed to practice medicine in California.  The QME is also certified by the Division of Workers’ Compensation Medical Unit in his or her area of expertise.  The QME is meant to be able to provide an unbiased opinion about the injured employee’s injury.  The opinion of the QME can have a serious impact on the outcome of your case.  The QME provides an opinion on the disability rating of the injured employee, which in turn has a direct impact on the length and amount of workers’ compensation benefits an employee may receive.

The most common way that an employee will need to be assessed by a QME is after the injured employee has been given a permanent disability rating by his or her treating physician and you and your workers’ compensation insurance provider disagrees with the rating.  You and the insurance company can then request that the employee submits to a QME examination.  The employee will be given a choice of three different QMEs in the area that he or she can choose from.  The relationship between the employee and the QME is different than a typical physician-patient relationship.  The examination by the QME is a  “medical-legal” evaluation.  Before the employee arrives at the QME’s office, the file will have already been sent over to the QME for review.  The insurance company will have sent over a list of questions to the QME that they want answered based on the treatment the employee has already received.  The QME will discuss the injury and the treatment received with the employee.  The QME will then complete a report about the injury, detailing his or her findings.  The QME is required to send a copy of the report to both the insurance company and the employee.

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

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.

Helping Your Employees with Occupational Illnesses

Employers take many measures to make sure their workplace is as safe as possible.  Keeping the workplace free from hazards is an essential step to keeping your customers and employees safe.  When making your business safe, you likely think about dangers such as a slippery floor or heavy machinery with outdated safety updates.  Unfortunately, many employers overlook the very real danger posed by occupational illnesses.  These include conditions such as carpal tunnel syndrome, ulcers, or back injuries.  Conscientious employers should take measures to help their employees avoid occupational illnesses.  As an employer, there are measures you can and should take to help your employees avoid and deal with their occupational illnesses.

One of the best ways to identify and avoid occupational illnesses for your employees is to create an injury and illness prevention program.  The focus of an injury and illness program is to identify potential sources of injuries, and then making a plan to help manage and control those dangers.  For example, if your business requires employees to perform repetitive motions, such as lifting boxes and turning to put them away, an illness and injury program can help provide training to employees on how to properly lift boxes to avoid injuries as well as making sure employees take breaks at regular intervals.

Another way to help your employees is to provide information and awareness information about occupational illnesses.  While employees are likely aware of the dangers of carpal tunnel or even repetitive motion injuries, they may be less familiar with how to prevent other injuries, such as developing asthma or even certain psychological injuries.

Encouraging your employees to stay healthy and take appropriate breaks from work can also help to reduce the incidences of occupational illnesses.  Keeping your employees healthy and fit can help keep them strong, making it less likely they will develop those injuries.  Breaks are also extremely important.  For example, taking regular breaks from typing can reduce the chances of an employee developing carpal tunnel or exacerbating prior nerve damage.  Although some employers may feel frustrated at frequent breaks, making sure the employee never develops the injury in the first place will save time in the long run, as the employee will not need to miss work for treatment of the injury.

If you have questions about what measures you should take as an employer, contact us today.  We can talk to you about your rights and responsibilities

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