Workmans Comp Procedure and Law

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You really should not have to start a claim.  Labor Code 5401 says that the employer must send you to a work comp doctor if you need help.  The employer should offer a claim form to be filled out.  All you should have to do is tell them that you are injured and they should call their workers compensation insurance company who will pay for medical treatment for injured workers.  The employer should turn everything over to the insurance company and the insurance company actually pays for the medical treatment and replacement wages if needed.  So a work comp claim is really against the insurance and is more like asking your car insurance company to fix your car after being damaged.

Unfortunately, most employers do not provide claim forms or send an injured worker to the doctor.  Many employers tell injured workers to go to their own doctor instead of filing a claim for workmans comp benefits.  If this happens you will need the help of a workers comp lawyer to find the proper insurance company and a doctor in the network for that insurance company.  This network is called the Medical Provider Network.  Knowing the doctors in the network is important because the doctors make all decisions on what an injured worker will receive through the workers comp process.

If an employer does send an injured worker to see a doctor it is usually with a doctor that is working for the insurance company, usually at industrial clinics like Concentra.  If you are stuck seeing a doctor that you did not choose they will usually try to save money for the insurance companies and send you back to work even if you are really injured and need some time off to heal.  

At Workers Comp Lawyer, we know the doctors that are real doctors looking out for injured workers and the doctors looking out for the insurance company.  We first look through the Medical Provider Network to find the work comp doctor that is most friendly with injured workers.  We usually have to go to court to get the judge to tell the workmans comp insurance to allow the injured worker to see a different doctor.  If you are stuck at Concentra, Immediate Medical or any other industrial clinic that is on the side of the work comp insurance company and not the injured worker, then you should call Workers Comp Lawyer, PC and we will get you switched to a real doctor. 

There are two types of money benefits.  There are short term benefits to replace an injured workers wages while they recover from a work injury, and then there is money to compensate an injured worker for the damage done to the body after suffering a work injury.

Temporary Disability benefits are available when the work comp doctor says the injured worker is unable to work because of the injury.  That is why the insurance company will send you to their doctor that they pay.  They know their doctor will say that an injured worker is okay to work and the insurance will not have to pick up Temporary Disability payments.

If the work comp doctor says that you can work modified, or restricted duties, then you have to work those light duties if the employer can provide the work.  However, if the employer cannot accommodate the light work that was prescribed by the work comp doctor, then the insurance company should pay to replace the injured worker's pay.  It is often necessary to go to court to get those payments.

Permanent Disability payments from the insurance company are paid after the doctor says that the injured workers injury has recovered as much as possible.  They call this reaching a point of Maximum Medical Improvement.  When the worker has reached this Permanent and Stationary status the insurance will start paying based on the doctor's opinion as to how much damage was done to the body.  If the opinion is coming from a work comp doctor chosen by the insurance company it will be a smaller amount of money, if any at all.  

For the Temporary Disability benefits the work comp insurance will determine the rate of pay by looking at all the money earned over the last year prior to the work injury and then divide the total amount earned by 52 to determine the gross average wage.  The insurance will pay 66% of the gross average weekly pay.  Taxes are not figured into this so the work comp payments should come out to be around the amount an injured worker would have received after getting taxed on the pay check.

For Permanent Disability benefits, the work comp settlement is based on damage to the body.  The doctors will use the AMA Guides to follow the charts for each body part involved in the injury.  Those charts are then rated out and combined based on body parts.  It is very important to be sure to acquire the evidence needed to show that the injuries did cause injury and damage to the body to get these benefits.  Even if the work comp insurance is being nice to an injured worker and providing treatment, they are always trying to limit the amount of money an injured worker gets in a settlement.

This can include buying out future medical care or keeping future medical care available from the workers compensation insurance.  Every case is different but there is an option to keep medical care open in case future treatment is needed.  Workers Comp Lawyer, PC can explain the different settlement options.  Call for answers to your questions.