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.

What Does Workers’ Compensation Not Cover?

Workers’ compensation is crucial to help make sure that employees receive medical treatment after sustaining a work-related injury.  Workers’ compensation allows an employee to recover medical costs related to the treatment of the injury. It also provides temporary or permanent disability payments to help take the place of lost wages.  Workers’ compensation will cover a wide variety of injuries, ranging from post-traumatic stress disorder, carpal tunnel syndrome, or a broken arm, just to name a few.  While workers’ compensation certainly covers a lot of different injuries, there are definitely some things that workers’ compensation will not cover.

One thing that workers’ compensation will not cover is injuries sustained during a car accident that happened during the employee’s normal commute.  Getting to and from work is not generally included, but there can be some exceptions.  For example, if the employee is driving between two different work sites, or is commuting to a distant work site that is not the employee’s typical workplace, then injuries sustained during that drive could sometimes fall under workers’ compensation.

Another class of injuries that would not be included in workers’ compensation benefits would be injuries that were intentionally inflicted by the employee himself.  An employee cannot recover for injuries if he or she purposefully sustains that injury.  This makes sense, as it is clearly unfair to allow an employee to receive financial benefit for purposefully throwing himself off of scaffolding or slicing her arm with a kitchen knife.

Third, injuries that were sustained during horseplay or fighting are likely not covered.  Even if  the employees are “on the clock” when they were horsing around, if either sustains an injury while this was going on, they likely will not be covered by workers’ compensation.  As with most other issues, there are exceptions to this.  If the employer regularly permitted or even encouraged horseplay, it is conceivable that the injuries would be covered.  Similarly, fighting in the workplace may end up not being covered.  That said, while a personal altercation between two employees may fall outside of coverage if one employee is attacked by another after a poor job performance review, the injuries to the employee who did not instigate the fight may be covered.

If you have questions about what types of injuries are covered by workers’ compensation, call us today.  We can talk with you about workers’ compensation and your business.

How Long Will the Case Take?

The legal system is notorious for being cumbersome and slow.  The workers’ compensation process is no exception.  Workers’ compensation cases, like any other legal proceeding, has many different steps that need to be completed before the case can be resolved.  How long the case will take depends on a variety of different factors.

Any workers’ compensation case begins when the worker who sustained a work related injury files a claim.  The case cannot start until the worker takes this step.  Following the filing of the petition, the claim administrator has ninety days to investigate the claim of injury or illness.  While the investigation is ongoing, the employee does not have to wait for benefits.  Medical benefits must be authorized within one day.  Temporary or permanent disability payments must be made within fourteen days of when there is knowledge of the injury.  However, if the employer offers the employee a job that pays at least 85% of the compensation he or she was making at the time the injury occurred, the fourteen-day timeline does not apply.

Next, some cases require a Qualified Medical Evaluator.  A QME will review the employee’s medical file and make an independent assessment about the injury and the disability.  The QME may need to be deposed by both sides, and scheduling the deposition can take weeks.  After the QME completes his or her assessment, he or she will have thirty days to issue the initial report.  The QME will determine the percentage of disability that the employee has suffered, which will directly impact the amount and duration of benefits the employee will receive.  The employee can dispute the conclusions in the report, and can present a case to the workers’ compensation administrative law judge to ask the rating be adjusted.

The parties will also likely go through a process called “discovery.”  During discovery, the parties will exchange documents and information that may support their respective positions.  Discovery can sometimes be relatively quick, ending after just thirty days, and sometimes can take months if the parties disagree about the process or need to do multiple rounds of discovery.

If you and the other side cannot come to an agreement on a settlement, the case will go before a workers’ compensation administrative law judge.  The judge will then make the ultimate determination of disability rating.  Other issues may also be presented to the judge, such as whether the worker is an independent contractor who would not be eligible for workers’ compensation benefits.

These are just a few examples of the hurdles that must be cleared before a workers’’ compensation case can be completed.  Contact us today for a consultation to discuss the process and how we can help you.

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