The insurance company denied my workers' compensation claim, what do I do?

...If your workers' compensation claim or injury has been denied, you probably need legal help right away. You should immediately contact a lawyer or an information and assistance officer (I&A) at the Workers' Compensation Appeals Board (WCAB). Information and Assistance may be reached at 1-800-736-7401. You probably need to file an application right away at your local Workers' Compensation Appeals Board. Again, you should immediately follow up with either a lawyer or with I&A. If you are unable to work and are in need of monetary assistance, then you should contact your local Employment Development Department and apply for State Disability Benefits. Medical care will also be a problem if the insurance company denies your case. Your doctor may be willing to give you treatment on a lien basis. In such a situation the doctor would submit a lien in your case and attempt to recover his or her treatment costs when your claim is litigated. If you cannot find a doctor willing to follow the lien procedure, then you should consider any private health insurance you have.

How do I pay a lawyer if I hire one?

...A Judge at the Workers' Compensation Appeals Board must approve any fees paid to your attorney. The fees paid to lawyers in the workers' compensation system are rather strictly regulated. The fee is typically 12% to 15% of the benefits awarded. Usually the insurance company will pay your attorney directly at the conclusion of your case. You should never have to pay your lawyer directly. If your case is lost and you have no recovery, then the lawyer does not get paid and you owe your attorney nothing. If your attorney has also represented you for vocational retraining, there will also be a fee in conjunction with this representation.

My workers' compensation claim is accepted, but why isn't the insurance company paying me?

...This is perhaps the most common question we receive in workers' compensation litigation. To answer the question it is important to understand the basic monetary entitlements under the workers' compensation laws. There are three basic types of monetary obligations for the insurance company. The first is temporary disability, the second is vocational rehabilitation maintenance allowance (VRMA), and the last is permanent disability. These are the only monetary obligations the basic workers' compensation law provides for.

...If you are not working and your doctor is stating that you are too disabled to work, then you should be receiving temporary disability. The insurance company will only pay temporary disability if you have an accepted injury and your doctor is indicating that you are completely unable to work. Conversation is worth nothing in workers' compensation. Your doctor must document that you are completely unable to work due to your work caused injury. Your doctor must state this in writing. If you are not working and not receiving any temporary disability, then you need to get a note from your doctor immediately. The insurance company will likely stop paying temporary disability if any doctor releases you to return to work or declares your condition permanent and stationary. If your temporary disability checks have stopped it is very likely that some doctor has declared your condition stationary or released you to return to work. Again, the main player in establishing your right to temporary disability is your doctor. If there is a dispute with the insurance company about your entitlement to temporary disability, then you may consider applying for State Disability Benefits (SDI) through your local Employment Development Office (EDD) until the dispute is resolved.

If you have been receiving a vocational rehabilitation maintenance allowance, you should note that these payments will stop once the cap is exhausted, once the plan is complete, or once you return to work.

...If you have been receiving permanent disability, you should note that these payments will stop once the insurance company has paid approximately 80% of the expected value of your permanent disability. Please understand that all permanent disability payments are advances against your final recovery. For example, if at the conclusion of your case, the insurance company owes you $10,000.00, and they have previously advanced $6,000.00, then you would receive the balance of $4,000.00.

My workers' compensation claim has been accepted but the insurance company is denying my medical care, what do I do?

...If you have an accepted injury, then the insurance company must provide all medical care which is reasonable and necessary to cure or relieve the injury. Often the insurance company will object to the recommendations of your doctor. They may complain about the frequency, duration, type, or reasonableness of your doctor's recommendations. Typically the best approach to this problem is for your doctor to draft a clear report indicating exactly what the recommended treatment is and why it is important for you to receive the treatment. As with temporary disability, the doctor is the key player here. Again, conversation is worth nothing; your doctor must put his or her recommendations in writing.

...You do have the right to change your doctor. If the insurance company has provided you with a doctor, and you are unhappy with that doctor, then you can change to a doctor of your choice.

My employer fired me because of my work injury, what do I do?

...If you are fired or "laid off" because of your injury, you should follow up with a lawyer immediately. Discrimination against injured workers is prohibited by both State and Federal laws. Under the California Labor Code (Section 132a), your employer may not discriminate against you because of your work injury. In addition, the California State Department of Fair Employment and Housing administers the laws prohibiting harassment or discrimination in employment. They may be reached at 1-800-884-1684. The Federal Americans with Disabilities Act (ADA) prohibits discrimination against workers with physical or mental impairments. Under the ADA, your employer may be required to provide reasonable accommodations for your disability. For further information, call the Equal Employment Opportunity Commission at 1-800-USA-EEOC.

...Information about The Carlo Law Group, Workers' Compensation law and Social Security Disability can also be obtained by downloading our Information Publication for New Clients (PDF format).

...We urge all our clients to become members of VotersInjuredatWork.org, an organization of injured workers that is providing an independent voice and representation in Sacramento. Download their Membership Form (PDF format).

...Please note: The information presented on this web site is for general informational purposes only. Nothing contained in this site should be considered legal advice. You should speak to a lawyer to address any specific questions about your particular California workers' compensation or federal social security disability case.

...Law Notice: "Making a false or fraudulent workers compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine."