Frequently Asked Questions
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Frequently Asked Questions

Caution: Workers Compensation Law is dynamic and changes almost monthly. The information below is intended only to give a general description of the workers compensation law and the benefits available. It is not intended to provide specific legal advice with regard to any particular case. You are advised to consult an attorney with regard to any specific legal matter.

Workers Compensation is a policy of insurance that is paid 100% by your employer for your benefit in the event you are injured while working. This form of insurance has no deductibles, no co-pays and no maximums. However it does have limits which are listed below.

Any one who is injured while working for another person or company may be entitled to workers compensation benefits. This includes undocumented workers who are in the country illegally. It also includes housekeepers working in a home. Contact us and we can let you know immediately if you are covered by this insurance.

Workers compensation is a “no fault” system. This means that you don’t have to prove any one was negligent in causing your injury. Since fault is not an issue in workers compensation you are entitled to benefits even if you cause your own injury accidentally. You can not intentionally cause your own injury and obtain benefits. For example,  if you forget to tie your shoe (accidental) and you trip on your show lace and fall and get hurt,  you caused your own injury but you are still entitled to receive  workers compensation benefits. Even a suicide can be covered by workers compensation in certain situations.

The law requires every person or company that has at least one employee to buy a policy of Workers Compensation Insurance. When an employer does not buy this insurance, the State of California will pay the benefits to you. These cases require special knowledge and are handled differently than cases where there is insurance and many attorneys don’t handle this type of case. At the work injury law offices of Jackson & Jackson we know how to handle a case when there is no insurance and we have handled many such cases over the years. In fact other Workers Compensation attorneys send their uninsured cases to us! See our Recent Cases section for some examples.

If your employer willfully fails to buy workers compensation insurance the law allows you to file your claim in civil court or the workers compensation court. While the civil court claim will enjoy certain advantages over other types of civil claims it is not always your best option to file your claim there. It may be better to file your claim at the workers compensation appeals board. The choice of venue is very important and an attorney who has experience with these types of claims should be consulted. If you think your employer is willfully uninsured contact us and set an appointment to discuss your situation with one of the knowledgeable attorneys at Jackson & Jackson.

The Law requires that you provide written notice to your employer of your work injury within 30 days of your injury. While there are many exceptions to this rule, you should notify your employer ( a supervisor, someone in management or human resources) of your injury as soon as possible after it happens. In the event of a repetitive trauma injury you should notify your employer as soon as you become aware that your symptoms may be due to your work activities.

It is very important that you know about Labor Code Section 3600(a)(10). This law states that if you are injured at work and fail to get medical attention or notify your employer of the work injury before a notice of termination or layoff, you will not be allowed to file your claim and obtain your workers compensation benefits.We have handled many cases that were initially denied by the insurance company under this law. However our in depth investigation nearly always results in turning a denied claim under this section into an accepted claim and then benefits are paid to our client.

a) Medical Treatment: You are entitled to all “Reasonable and necessary treatment to cure or relieve you of the effects of your work injury”.

In addition, if other symptoms arise after your initial injury, they are covered also so long as the new symptoms are connected to the original injury. For Example, Joe feels a pop in his back while lifting a heavy box. Initially the injury is only to his back. Two months later he begins having upset stomach and heart burn due to the medications he is taking. This stomach problem is covered. He is also having difficulty sleeping due to pain and wakes often during the night or doesn’t sleep much at all. During the day he is more irritable, depressed, sad and angry because he is not able to work and is in pain all the time. The sleep disturbance and depression are also covered by Workers Compensation Insurance because they arise from the original injury. For this reason it is very important to always let your treating doctors know of all symptoms, aches, pains and discomfort you are experiencing as well as how your doing emotionally each time you see him or her. You and your doctors are creating a record of your injuries and disabilities and it needs to be as accurate as possible so you get all the treatment and monetary compensation which you are entitled to receive. An attorneys job is to make sure that you are aware of what is included in your claim and how to obtain the best evidence documenting all your injuries.

“We understand that you are not just a knee, an elbow or a spine but a whole person who deserves to be treated with respect and dignity,  by the insurance company, their attorneys and the doctors who have pledged to provide medical care.”

— Gary Jackson, Esq.

b) Temporary Total Disability: This is your lost wages which are payable to you when a doctor declares you to be completely unable to work for a period of time. It is generally paid at a rate of 2/3rd of your average weekly wages, averaged over the 52 weeks prior to your injury. Wages from other employment can be combined to determine your average weekly wage if you have more than one job.There are minimum payments and maximum payments which change every year. Also your payment may be entitled to an increase every January first. Call us and we can let you know how much you would be entitled to on a weekly basis.

c) Temporary Partial Disability: This is the same wage loss payment as Temporary Total Disability but is paid when your doctor indicates you can work limited duty and you are earning less than your regular full pay. For example, your doctor allows you to continue working after your injury but light duty only. If 2/3rds of your average weekly wage is $400 per week and now you are making $200 per week on light duty, the insurance company would pay you Temporary Partial Disability payments of $200 per week. So you can see that your income while working on limited duty is the same as if you were not working at all. If your employer paid you at least 2/3rds of your average weekly wage while on light duty then the insurance company would not be obligated to make any payments to you.

d) Permanent Disability: This is money to compensate you due to the effects of the injury. How this is determined has undergone a major change since April 19, 2004 when the Governor signed SB 899 into law. For injuries occurring before January 1, 2005 in which there is a medical report which addresses permanent disability, you may be entitled to a permanent disability rating under the old law. The State of California reports that the governor’s reform laws have cut benefits to injured workers by approximately 60%. Therefore it is very important that those older injury claims that are still open be looked at closely to determine if there is any way to keep them under the old law.

For injuries on or after January 1, 2005 you are subject to the governors axing of your benefits. The determination of the percentage of your Permanent Disability under the reform law is very complex and there are many factors that your doctor needs to consider including how your injury is effecting your ability to engage in Activities of Daily Living, known as ADL’s. At Jackson & Jackson we educate our clients how Permanent Disability is determined so they know what the doctor needs to know and why it is important. This results in a more comprehensive and persuasive medical report on your behalf and helps to reduce delays in getting your case settled.

“One of the things that makes Jackson & Jackson unique is how we work together as a team with our clients and their doctors to be sure the doctor has all the medical records and a complete history of the client’s injury and how it is affecting them as a whole person.”

— Derek Jackson, Esq.

e) Medical Mileage Payments: The insurance company is required to pay you on a per mile basis for driving to your doctors visits and to pharmacies and other places to pick up medical equipment.  They must also pay any associated parking expenses.  Currently the rate of reimbursement is determined based on the rate in effect when the expense was incurred and tends to change each year.

f) Self-Procured Medical Treatment: The insurance company is required to reimburse you for any expenses actually and reasonably incurred to obtain medical treatment. This often occurs when an injured worker reports an injury and the employer simply tells the injured person to go to a doctor and use their own health insurance, rather than the workers compensation insurance. There is often a co-pay that the injured person must pay up front to receive the medical care they need. This expense is reimbursable and should be submitted to the insurance company with a proper demand for payment within thirty days.

No. Attorneys are not allowed to ask for or receive any money up front to represent an injured worker. Workers compensation attorneys only get paid after a workers compensation judge orders an attorney fee payment to be made. This order is made in writing at the time your case is settled or at the time the workers compensation judge makes a decision in your case after trial.

It costs you nothing up front or “out-of-pocket” to hire an attorney to represent you. Attorneys are normally awarded between 12% to 15% of the benefits awarded to you. Attorneys are paid at the end of the case after a Judge approves your settlement or a judge Awards you benefits after a Trial. In most other types of cases attorneys are able to get 30% to 40% so in workers compensation it is very cheap for an injured worker to hire an attorney. However, injured workers need to be cautious what attorney they hire due to the fact that the small amount of attorney fees paid on any one case means that some attorneys are more concerned with having a high volume of cases than the quality of representation on any one case. Such is the case with most attorneys who advertise on television and radio. They often have large offices with a large staff of non-attorneys who are actually handling the cases. The attorney claims he is overseeing the non-attorney work, but he is often not involved in the day-to-day handling of the claim. At the work injury law offices of Jackson & Jackson we don’t use non-attorneys to handle your claim. We believe that is unfair to the injured worker who is seeking real help in a bad time and thinks he or she is hiring an attorney to handle the case. Don’t be fooled. A hearing representative or paralegal does not have the same level of education or experience as an attorney licensed by the State Bar of California. At the Work Injury Law Offices of Jackson & Jackson your case will be handled by a member of the State Bar in good standing and we work hard to maximize our client’s benefits in every case, every time.

Regardless how big or small the case, our attention to detail, highly efficient office staff and years of experience results in consistently higher case settlements and judicial awards.

Yes. Anyone can act as their own attorney with regard to their work injury case. In fact as soon as you are hurt at work, you are acting as your own attorney until you hire a licensed attorney to represent you. You need to understand that you are at a great disadvantage if you are your own attorney because you will have to talk with an insurance person who handles workers compensation cases everyday and has been trained by an insurance company how to defend against such claims. Everything you say to an insurance adjuster can be used against you.

At the work injury law offices of Jackson & Jackson we have dedicated ourselves to knowing the Workers Compensation Law better than the insurance company representatives. This is how we make our living. We Spend many hours every month going to seminars as well as reading and discussing the latest changes in the Workers Compensation Law. Yes you can represent yourself but it will most likely cost you more than the 15% you would pay an attorney. Not to mention the peace-of-mind of knowing that you are getting the maximum compensation under the law. The last thing you need after a work injury is to be left wondering “can they do that to me?” For this reason our clients tell us that hiring us is a win-win proposition.

Generally speaking you can not choose your own doctor. You will have to pick a doctor from the Insurance company list of doctors. There are legal exceptions to this rule such as when you have predesignated your own doctor, when the employer fails to post notice of your rights to workers compensation on those large posters you often see in lunch rooms or near the time clock. Or when the insurance company list does not have certain specialists in your area, as well as some other specific situations. Most often you are stuck with the insurance company list of doctors. For this reason you should consult an attorney who handles a lot of workers compensation claims and is familiar with the doctors on these lists. Everyday we are involved in helping clients to pick the right doctor for their particular needs as well as one that is knowledgeable in writing a medical report that will meet the legal requirement of substantial medical evidence. Just because a doctor is on an insurance company list does not mean he or she has a good reputation of that he or she is good at writing medical reports. Keep in mind that the medical reports are used to determine what benefits you will or will not get and some doctors are more insurance company minded that on the side of the injured worker. In today’s workers compensation system the last thing you need is to go to a doctor who is skeptical of work injury claims and discounts your symptoms. Unfortunately we see this occur all too often with doctors who get most of their patients through insurance company referrals. You don’t need a doctor who claims he or she is “neutral” either. A workers compensation claim is a fight for benefits and good medical care no matter how nice a claims adjuster may seem. You need a doctor who is on your side and fighting for your right to good and fair medical treatment. We can help you pick a doctor who is not only a good report writer but an excellent physician.

No. It is illegal for an employer to fire a worker because he or she is hurt at work or because he or she has reported the injury or because he or she has filed a claim for Workers Compensation Benefits. However although it is illegal, some employers are willing to violate the law. Workers Compensation law provides for an increase of 50% in your regular benefits if your employer fires you, demotes you or does anything act to discriminate against you just because you are injured at work. If you feel this has happened to you, you should contact us right away because there are short time limits to bring such a claim for 50% increase in benefits due to employer discrimination.

Your employer is required by law to investigate whether there is any modified or alternate work you can do in the event you are unable to perform your usual and customary job. They must search for modified work, which is your regular job with some minor changes or alternate work, which is a completely different job, at the time your doctor determines you can return to work with restrictions of any kind. The law does not have much teeth to it because the courts have been unwilling to question the adequacy of the employers “investigation” of the availability of modified or alternate work. So long as the employer can show that they have searched for modified or alternate work, their decision will usually be what you are stuck with.

There are situations however where your employer can be in violation laws which are outside the scope of the workers compensation act. The Americans with Disabilities Act(ADA) and the Fair Employment and Housing Act (FEHA) can be violated by an employer when making return to work decisions for an injured worker. We can help determine if you have other claims under these other Federal and State laws.

Permanent and Stationary (also called P&S”) is determined by a doctor. When your treating doctor believes that your condition has stabilized to the point that more medical treatment is not going to cure you of the effects of your injury he or she should declare your condition to be “P&S”. It does not mean that you no longer require medical treatment, but that medical treatment after P&S is no longer provided for the purpose of curing you but to provide temporary pain relief and/or to maintain you from getting worse. So at the time of “P&S” your doctor is saying that your condition will not get substantially better from that point forward and that any impairment or disability you have is permanent.

Another term that is used is “Maximum Medical Improvement” (also called “MMI”). This is a good term because it describes that your condition is as good as it is going to get and more medical treatment from that point forward is not going to make you better.

P&S and MMI don’t mean that all medical treatment must stop at that point. It only means that the purpose of any medical treatment after that point is to be keep down the pain and inflammation and symptoms and to keep you from getting worse, with the understanding that the treatment is no going to cure you.Another term that is used is “Maximum Medical Improvement” (also called “MMI”). This is a good term because it describes that your condition is as good as it is going to get and more medical treatment from that point forward is not going to make you better.

The short answer is because the P&S report will form the basis for a settlement demand to resolve your case.

At the time of P&S your doctor will write a final detailed report covering all the medical and legal issues in your case. This final report will detail how the injury is causing impairment in your activities of daily living, any functional limitations in the use of the injured body part or parts and any work activity restrictions.

An injured worker attorney has a very difficult job of evaluating the medical reporting to determine if it meets the legal definition of SubstantialMedical Evidence so that the report will be admissible in court. You or your attorney will also have the challenge of trying to obtain a medical report which is better than the medcial report which the insurance company wants to rely upon.

The settlement offer made by an insurance company is often determined by the quality, not the quantity of medical evidence in a case. For this reason it is vital to consult with an attorney at the beginning of your case to be sure the right doctor is assigned to oversee your medical care. A doctor that is very good not only at the practice of medicine but also in writing the required reports that a judge can rely upon. At Jackson & Jackson we have access to get you the best medical care, paid 100% by the insurance company, and know which doctors can write a good report and which can’t.

This is the special court that has been set up to hear only work injury cases. These courts are in separate locations from the county and state courthouses and are usually located in office buildings. They are also known as the WCAB, the Appeals Board or just the Board.