Frequently Asked Questions

What kind of Medical Treatment am I entitled to Receive?
If you have an accepted or admitted injury, you are entitled to all medical, surgical, chiropractic, acupuncture and hospital treatment that is reasonably required to cure or relieve you from the effects of your injury. However, recommended treatment in many cases must comport with the “ACOEM Guidelines” or other “scientific or evidence-based guidelines” and is subject to review and denial by the employer’s Utilization Review process. Appeals of denied treatment are often necessary. An experienced attorney is frequently crucial to your obtaining appropriate medical treatment for your work-related injury.

If your injury is in the “investigation” process within the first 90 days of the filing of your claim, you are entitled to reasonable medical treatment of up to $10,000 until the date the claim is rejected or accepted.

Do I have the right to a free-choice treating physician?
Probably not. Most employers or insurance carriers now have “Medical Provider Networks” (MPNs), of which you should be notified soon after filing your claim. The employer is required to arrange an initial medical evaluation and commence treatment. You must attend the initial examination, but can thereafter change to another physician within the MPN. There is no limit on the number of changes.

If the employer/insurer does not participate in an MPN, and you have not pre-designated a personal physician to treat you in the event of a work injury, the employer has the right to name the treating physician for the first 30 days from the date the injury is reported. After 30 days, you have the right to be treated by a physician or at a facility of your own choice within a reasonable geographic area.

There are some exceptions to these rules. Most importantly, an experienced attorney can be very helpful in selecting a sympathetic treating physician, even within the requirements of an MPN. Your treating physician plays a crucial role in the eventual outcome of your case, and this aspect of your claim should not be taken lightly.

What are temporary disability benefits?
Temporary disability payments are made to an injured employee who is unable to return to regular work, or a modified or “light duty” job, due to a work injury. This benefit is paid every two weeks and is generally computed at two-thirds of the employee’s average weekly wage at the time of injury, subject to statutory maximum and minimum rates.

Temporary disability benefits are now also subject to a cap of an aggregate two years or 104 weeks worth of payments. For this reason, it is helpful to have an attorney who can facilitate your prompt receipt of appropriate medical care to enable you to return to work, as well as one who is knowledgeable about and will assist you in obtaining other benefits outside of the workers’ compensation system, such as Social Security Disability Insurance (SSDI) and California State Disability Insurance (SDI).

What if I have a permanent disability?
You are entitled to receive permanent disability compensation, whether or not you return to your regular job, if you are found to have permanent impairment under the AMA Guides, which treating and/or evaluating physicians must now utilize to describe your disability. Disability based on work restrictions is, for all practical purposes, no longer recognized. This is among the changes in the workers’ compensation laws that were enacted in 2004 under SB 899, which has had a significant negative impact on the amount of financial recovery received by injured workers following industrial injuries.

An experienced and aggressive attorney is indispensable at this stage of the process in order to evaluate the treating physician’s findings and help you determine whether or not to proceed to an Agreed Medical Examination (AME) or a Qualified Medical Examination (QME), or to utilize the services of a vocational expert to rebut or supplement the value of the impairment found under the AMA Guides.

A permanent disability “rating” based on the identified impairment will be calculated. The final percentage that is derived from this formula will determine the number of weeks of permanent disability compensation you are entitled to receive.

How is my case settled?
Workers’ compensation cases are frequently resolved by way of Stipulations and Award based on the rating of your permanent impairment. This type of resolution allows you to receive future medical treatment paid for by the workers’ compensation carrier. Your Award is generally paid out over a certain number of weeks under this scenario.

A settlement of all issues, known as a Compromise and Release, may also be possible. With this option, you may receive a lump sum payment and more money than with a stipulated Award, but you will have to give up your right to receive future medical care.

Your attorney will be able to help you decide how to settle your case and to maximize your recovery under either option. We will negotiate with the insurance company or defense attorneys to achieve the best resolution possible in light of all potential issues and outcomes. Additionally, in the event that an agreement cannot be reached, your attorney can take your case to trial to receive a Findings and Award from a Workers’ Compensation Administrative Law Judge.

How are attorney's fees determined?
Attorney’s fees are contingent upon the amount of the settlement or Award received by the injured worker, and must be approved by a Workers’ Compensation Administrative Law Judge. Fees will generally be in the area of 15% of the net recovery by the worker, but may be higher in the event of an above-average complexity or time-consuming case. A Disclosure Agreement describing the potential range of attorney’s fees must be signed by the worker and the attorney when the attorney is retained.

Am I entitled to job retraining if I cannot return to my regular work?
No. Vocational rehabilitation is among the benefits formerly available to injured workers that have been eliminated in recent years.

There are incentives for the employer to return you to permanent alternate or modified work. However, if this cannot be provided, you are currently eligible to receive the Supplemental Job Displacement Voucher benefit, which provides a variable amount of funding based on your percentage of permanent impairment, payable to an accredited college or vocational school directly by the employer or carrier upon your enrollment.

Is the deck really stacked that heavily in favor of the insurance companies and against injured workers?
Unfortunately, yes. Recent statutory and case law have significantly eroded employee benefits in literally every aspect of the claims process. The system now is almost guaranteed to bewilder, frustrate and cause hardship to injured workers and their families.

As attorneys, we cannot change the laws. However, we can work within them to ensure that you receive your maximum entitlements, and can fight for you if any benefits are unjustly denied or reduced. If you feel as though you need someone on your side, please call us to schedule a free consultation.

Additional Questions:

Financial Safety Nets for Your Workers' Compensation Claim (click here, or see below for specific topics)

State Disability Insurance (S.D.I.)

Social Security Disability Insurance (S.S.D.I.)

Long Term Disability Insurance

Disability Retirement Pensions for Safety Employees

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