Acupuncture, Chiropractors, and Workers’ Compensation

After an employee sustains a work-related injury, there are many steps that will need to be taken, ranging from paper work to reporting the injury to insurance company to reporting certain injuries to state and federal entities.  One of the most important steps is making sure that an employee receives proper medical treatment.  Although some medical treatment may involve addressing acute and emergent injuries, such as a broken arm, other treatment plans may include more long-term types of treatment, such as physical therapy.  Some workers may elect to pursue alternative treatments.  Two of these treatments are acupuncture or going to a chiropractor.

Acupuncture is a form of alternative medicine with roots in China.  With acupuncture, tiny needs are inserted into the patient’s skin at very particular, key points.  Practitioners of acupuncture believe that proper practice can alleviate stress or pain.  Under the California Labor Code 4600, acupuncture is recognized as a valid treatment for work-related injuries. The labor code provides that an authorized practitioner of acupuncture may apply to become certified as a health care organization to provide treatment to injured employees.

Chiropractic care is based on manipulating and realigning joints, especially those in the spine.  Practitioners believe that proper chiropractic care can help address disorders affecting nerves and muscles.  As with acupuncture, California Labor Code 4600 provides that chiropractic care is a valid treatment course for workers’ compensation.  Unfortunately, many employers have reported negative experiences with some chiropractors.  In the past, some unscrupulous chiropractors would continue to make sure the injured worker came back for as many treatments as possible to maximize the money he or she could make from the patient.  In response, California law now provides that chiropractic visits shall be capped at twenty four for each industrial injury, unless the employer authorizes additional visits.  This law was passed in response to the fact that past studies revealed that workers’ compensation cases involving chiropractic care often paid out more than thirty percent more than other cases, and tended to last longer.  The law is intended to address the fact that many chiropractors often recommend chiropractic care as a life long course of care, and some were attempting to draw out treatment far after was actually needed for the work related injury.

If you have questions about what type of care is appropriate or available for your injured worker, call us today.  We have extensive experience helping business owners understand their rights and responsibilities under California law

Causation, Lung Disease, and Workers’ Compensation

Workers’ compensation is designed to cover a wide variety of work related injuries that your employees may sustain during the course and in the scope of their employment.  Most people tend to think of physical injuries, such as a broken arm or even an amputated foot, but workers’ compensation covers many other injuries, including those from repetitive stress, psychological injuries, or illnesses that may be caused by work place conditions.  One type of illness commonly seen in the workers’ compensation system is lung disease.

Lung disease may happen as a work related injury where a worker has been exposed to certain contaminants that cause lung disease while at work.  There are many different roles that may expose a worker to dangerous fumes, dust, or gases.  For an injured employee to be eligible to receive workers’ compensation benefits as a result of lung disease, he or she will need to prove industrial causation.  Proving industrial causation will require proof of three things: 1) that the contaminants alleged to have caused the lung disease are actually present in the work place; 2) the worker was exposed to the contaminant in the work place; and 3) there must actually be a disease that the contaminants can cause, accelerate, or aggravate.

A worker can prove which contaminants are in the work place in one of two main ways.  The first is eyewitness testimony.  Other workers or even clients or customers can testify that particular materials or conditions were observed in the workplace.  The other way is through the Material Data Safety Sheet.  Federal law requires that employers ensure that these safety sheets are “readily accessible to employees for all hazardous chemicals in their workplace.”

Whether the worker was actually exposed to the chemical is a factual issue.  The employee or other workers can testify that the employee was exposed to the contaminant.  For example, testimony can be introduced which states the employee was observed inhaling fumes from dangerous chemicals.  In other cases, particular tests can help prove exposure.  These tests would be commonly used where the employee has been injured by, for example, mold or asbestos.

Finally, a physician will have to examine the employee.  The medical professional will need to determine that the lung disease was actually caused by exposure to the contaminant.

If you have questions about what industrial injuries are covered by the workers’ compensation system, let us answer them.  Contact us today for an appointment to talk about your business.

Beltran v. Structural Steel

Although many may think of the workers’ compensation system as quite adversarial, like other civil law suits, workers’ compensation has some unique features which require that employer and employee work together.  After an employee is injured on the job, he or she will visit a treating physician, who may then determine the worker can only return to work with particular physical restrictions and limitations.  When a worker is determined to be permanently disabled, the employer is obligated to provide accommodations to the injured worker so he or she can return to work.  Where returning to the same position is not possible, the employer will offer the injured worker another position that will pay at least 85% of the salary the injured worker was making in the position he or she was working at the time of injury.  If the employer is unable to make such an offer or the employee refuses the job, then the employee may receive supplemental job displacement benefits (SJDB).  These benefits are given in the form of providing a voucher to the injured worker.  The voucher can then be used by the employee to pay for education, retraining, or skill enhancement at particular accredited schools.  Recent case law from the Workers’ Compensation Appeals Board (WCAB) discusses whether the employer and employee may agree that the employee should receive a SJDB voucher during a settlement.

In Beltran v. Structural Steel Fabricators, the worker Juan Pablo Beltran sustained cumulative trauma injury to his head and back due to heavy work over the course of a year while employed by Structural Steel Fabricators.  After initially denying the claim because Structural Steel alleged Beltran did not submit his workers’ compensation claim until after he was fired from the job, the parties eventually entered into a settlement.  The settlement included language that Beltran was not entitled to a SJDB voucher.  The WCJ rejected the settlement, stating that the parties were not entitled to settle the issue of whether Beltran was entitled to the voucher.  The WCAB disagreed.  The WCAB held that when the parties have a good faith dispute as to whether a worker is eligible for a voucher, the parties may agree on eligibility and include that agreement in a settlement.

We have extensive experience helping our clients with reaching favorable workers’ compensation settlements.  Contact us today and we can talk about your business.

Structured Settlements and Workers’ Compensation

The legal system is often thought of by lay people as being complicated, and legal cases may take months or even years to resolve a case.  Unfortunately, workers’ compensation is not always an exception to this, as the nature of the cases often include injuries that take time to heal before it can be determined whether a worker is permanently or temporarily disabled, the type of accommodation the worker requires, or whether the worker can even return to work at all.  Both sides are often looking for ways to shorten the process and come to a settlement.  With a settlement, the parties can avoid the time and expense of a court case that drags out and costs both sides dearly.  One way to complete this in a workers’ compensation case is a structured settlement.

A structured settlement is a settlement agreement wherein the employer or its insurance provider agrees to make a series of periodic payments to the injured worker (or the surviving family) over a period of time.  Some structured settlements provide that each payment amount will be exactly the same, but other settlements can provide additional flexibility.  In some cases, the settlement may provide for a lump sum to be paid up front before the regular payments start.  This lump sum may be to assist with housing, transportation, or medical needs.  In addition, the settlement can take future cost of living expenses increase or inflation rates into account, and provide for future increases at specific times.  It should be noted that a separate account is often set up to handle the injured workers’ future medical expenses, and that the periodic payments are meant to represent the lost wages.

One advantage for the employee in accepting a structured settlement is that the periodic payments are not subject to federal income taxes.  An employer will often benefit from a structured settlement in cases where there has been a catastrophic injury that is likely to result in a finding of permanent partial or total disability, especially where the injury is so severe that the worker is unlikely to be able to return to meaningful employment.

We have extensive experience helping our clients understand what types of settlements may be best for their business.  Call us today to talk about what we can do to help you.

Global Assessment of Function Score

The workers’ compensation system is designed to help workers get medical treatment and get back to work as soon as possible after they sustain a work-related injury.  The system also provides protection for employers, as the workers’ compensation system provides that the worker is typically required to seek compensation through this system and cannot sue the employer in civil court.  A worker can seek recovery for a large variety of injuries, including psychiatric injuries.  As with a physical injury, workers who have sustained work-related psychiatric injuries will need to undergo examination by a medical professional.  Part of the examination will result in a Global Assessment Function Score.

A Global Assessment Function (GAF) score must be obtained by any injured worker who is seeking to obtain permanent disability benefits through workers’ compensation.  In the workers’ compensation system, only psychiatrists or psychologists can evaluate an injured worker and make this evaluation.  The GAF score will be based on whether there is a permanent psychiatric disability and the degree or amount of that disability.  The GAF score is a numeric scale used by appropriate mental health practitioners.  The practitioner will provide a subjective rating for the social, occupational, and psychological functioning of the injured worker.  For this rating, the lower the number, the greater the degree of permanent disability.  For example, someone with a GAF score of 1 would be considered not disabled at all, and fully functioning, whereas someone with a score of 1 would be highly impaired.

There are a variety of issues used to evaluate psychiatric functioning.  These include:

  • Participating in activities including keeping a job, completing hygiene related tasks, and socializing with friends;
  • Social effectiveness, including whether the worker can make and keep friendships and other community contacts;
  • Family interactions, such as whether the injured worker neglects family relationships, has issues with domestic violence or frequent arguments;
  • School performance, including grades and truancy; and
  • Performance at work, including whether the worker can interact effectively with clients and coworkers, regularly attend work, and complete appropriate tasks.

The mental health professional will also look at different issues when evaluating symptom severity.  These include anxiety, insomnia, suicidal ideations, or depression, just to name a few.

We have experience assisting our clients understand the role of GAF scores in workers’ compensation cases.  Call us today to talk about your business.

Communications Between an Injured Worker and Their Physician

The confidentiality between a patient and doctor is well established in the United States, and California is no exception.  Confidentiality is strict to make sure that the patients can fully disclose all symptoms and potential sources of illness or injury without fear that embarrassing conditions will be on display for others to read.  Although employees can typically be secure in the knowledge that their medical conditions are private and protected from their employers, this can change in the case of a workers’ compensation case.

During a workers’ compensation case, the injured employee will need to seek medical attention.  Even after urgent conditions have been addressed, the worker may require ongoing treatment or physical therapy.  The worker will definitely need to be evaluated by a physician or medical professional to determine whether he or she is temporarily or permanently disabled, the degree of the disability, and whether he or she requires limitations or work restrictions upon returning to work.  Clearly, these will be medical conditions that are assessed by a medical professional.  Employers and employees alike should have an understanding of what types of communications remain privileged between the injured employee and his or her treating physician.

The Confidentiality of Medical Information Act contains strict rules and prohibitions on when a health care provider can release information.  There are exceptions, however in the workers’ compensation system.  Communications between the patient and the physician concerning the work related injury will be turned into reports that will be submitted by the physician to insurance adjusters, attorneys, and even the employer.  The employer, attorneys, or an insurance adjuster may also request copies of the actual medical records.  When the treating physician has been the worker’s treating physician for other conditions in addition to the work related injury, however, these medical records will contain information that is completely irrelevant to the work related injury.  In that situation, the physician is restricted from releasing more information than is necessary.  In other words, an employer or insurance adjuster is not entitled to receive a complete copy of the employee’s entire medical record.  The physician is required only to release the information relevant to the injury and whether the employee is able to return to work.

We have extensive experience with the workers’ compensation system and all types of associated litigation.  Contact us today for a consultation.

Workers’ Compensation and Medical Marijuana

Healthcare is a major industry in the United States, and advances are frequently made in medical technology, genetics, and pharmaceuticals.  Medical Marijuana is one area where there have been many recent advancements.  These advancements include not only medically and understanding how marijuana can help treatment a variety of conditions, but also in the law.  When an employee sustains a work-related injury, he or she may be prescribed medical marijuana to address their injury.  As an employer, it is important for you to understand how medical marijuana fits in the workers’ compensation system.

California Labor Code section 4600 states that any treatment that is reasonably required to cure an injury or relieve the employee from the effects of the injury will be covered under workers’ compensation.  The Workers’ Compensation Appeals Board has determined that this can include medical marijuana.  Naturally, a worker must receive prescription from a doctor for the costs to be covered.  Moreover, if the treatment plan includes medical marijuana, the plan is subject to independent medical review and utilization review to make sure that independent providers agree the marijuana is medically necessary to address the work related injury.

There are some other important issues to be aware of.  First, although California has passed law legalizing the use of medical marijuana, marijuana remains illegal under federal law.  Although these federal laws are not typically enforced in terms of medical marijuana dispensaries, this does not change the fact that the possession and sale of marijuana – even for medical use – remains illegal  under federal law.

In addition, just because an employee is using medical marijuana, that does not mean he or she is not subject to certain restrictions.  Just as an employee taking prescribed opiates may not be a suitable person to continue to operate heavy machinery, an employee may not be able to use medical marijuana during the work day.  Employers also need to keep in mind that there are rules about when an employer can require drug testing.  In addition, firing an employee for testing positive for medical marijuana can run afoul of regulations under the Americans with Disabilities Act.

We have extensive experience with the workers’ compensation system and explaining an employer’s rights and responsibilities.  Contact us today for a consultation.

Acupuncture, Chiropractors, and Workers’ Compensation

After an employee sustains a work-related injury, there are many steps that will need to be taken, ranging from paper work to reporting the injury to insurance company to reporting certain injuries to state and federal entities.  One of the most important steps is making sure that an employee receives proper medical treatment.  Although some medical treatment may involve addressing acute and emergent injuries, such as a broken arm, other treatment plans may include more long-term types of treatment, such as physical therapy.  Some workers may elect to pursue alternative treatments.  Two of these treatments are acupuncture or going to a chiropractor.

Acupuncture is a form of alternative medicine with roots in China.  With acupuncture, tiny needs are inserted into the patient’s skin at very particular, key points.  Practitioners of acupuncture believe that proper practice can alleviate stress or pain.  Under the California Labor Code 4600, acupuncture is recognized as a valid treatment for work-related injuries. The labor code provides that an authorized practitioner of acupuncture may apply to become certified as a health care organization to provide treatment to injured employees.

Chiropractic care is based on manipulating and realigning joints, especially those in the spine.  Practitioners believe that proper chiropractic care can help address disorders affecting nerves and muscles.  As with acupuncture, California Labor Code 4600 provides that chiropractic care is a valid treatment course for workers’ compensation.  Unfortunately, many employers have reported negative experiences with some chiropractors.  In the past, some unscrupulous chiropractors would continue to make sure the injured worker came back for as many treatments as possible to maximize the money he or she could make from the patient.  In response, California law now provides that chiropractic visits shall be capped at twenty four for each industrial injury, unless the employer authorizes additional visits.  This law was passed in response to the fact that past studies revealed that workers’ compensation cases involving chiropractic care often paid out more than thirty percent more than other cases, and tended to last longer.  The law is intended to address the fact that many chiropractors often recommend chiropractic care as a life long course of care, and some were attempting to draw out treatment far after was actually needed for the work related injury.

If you have questions about what type of care is appropriate or available for your injured worker, call us today.  We have extensive experience helping business owners understand their rights and responsibilities under California law.

Beltran v Structural Steel

Although many may think of the workers’ compensation system as quite adversarial, like other civil law suits, workers’ compensation has some unique features which require that employer and employee work together.  After an employee is injured on the job, he or she will visit a treating physician, who may then determine the worker can only return to work with particular physical restrictions and limitations.  When a worker is determined to be permanently disabled, the employer is obligated to provide accommodations to the injured worker so he or she can return to work.  Where returning to the same position is not possible, the employer will offer the injured worker another position that will pay at least 85% of the salary the injured worker was making in the position he or she was working at the time of injury.  If the employer is unable to make such an offer or the employee refuses the job, then the employee may receive supplemental job displacement benefits (SJDB).  These benefits are given in the form of providing a voucher to the injured worker.  The voucher can then be used by the employee to pay for education, retraining, or skill enhancement at particular accredited schools.  Recent case law from the Workers’ Compensation Appeals Board (WCAB) discusses whether the employer and employee may agree that the employee should receive a SJDB voucher during a settlement.

In Beltran v. Structural Steel Fabricators, the worker Juan Pablo Beltran sustained cumulative trauma injury to his head and back due to heavy work over the course of a year while employed by Structural Steel Fabricators.  After initially denying the claim because Structural Steel alleged Beltran did not submit his workers’ compensation claim until after he was fired from the job, the parties eventually entered into a settlement.  The settlement included language that Beltran was not entitled to a SJDB voucher.  The WCJ rejected the settlement, stating that the parties were not entitled to settle the issue of whether Beltran was entitled to the voucher.  The WCAB disagreed.  The WCAB held that when the parties have a good faith dispute as to whether a worker is eligible for a voucher, the parties may agree on eligibility and include that agreement in a settlement.

We have extensive experience helping our clients with reaching favorable workers’ compensation settlements.  Contact us today and we can talk about your business.

Structured Settlements and Workers’ Compensation

The legal system is often thought of by lay people as being complicated, and legal cases may take months or even years to resolve a case.  Unfortunately, workers’ compensation is not always an exception to this, as the nature of the cases often include injuries that take time to heal before it can be determined whether a worker is permanently or temporarily disabled, the type of accommodation the worker requires, or whether the worker can even return to work at all.  Both sides are often looking for ways to shorten the process and come to a settlement.  With a settlement, the parties can avoid the time and expense of a court case that drags out and costs both sides dearly.  One way to complete this in a workers’ compensation case is a structured settlement.

A structured settlement is a settlement agreement wherein the employer or its insurance provider agrees to make a series of periodic payments to the injured worker (or the surviving family) over a period of time.  Some structured settlements provide that each payment amount will be exactly the same, but other settlements can provide additional flexibility.  In some cases, the settlement may provide for a lump sum to be paid up front before the regular payments start.  This lump sum may be to assist with housing, transportation, or medical needs.  In addition, the settlement can take future cost of living expenses increase or inflation rates into account, and provide for future increases at specific times.  It should be noted that a separate account is often set up to handle the injured workers’ future medical expenses, and that the periodic payments are meant to represent the lost wages.

One advantage for the employee in accepting a structured settlement is that the periodic payments are not subject to federal income taxes.  An employer will often benefit from a structured settlement in cases where there has been a catastrophic injury that is likely to result in a finding of permanent partial or total disability, especially where the injury is so severe that the worker is unlikely to be able to return to meaningful employment.

We have extensive experience helping our clients understand what types of settleemnts may be best for their business.  Call us today to talk about what we can do to help you.

Ratings and Reviews

CBLS