Workers compensation is an important safety net for every worker in Encinitas, but sometimes old worn out nets have holes.
When the workers compensation system works as intended, an injured worker simply needs to notify his/her employer and the process takes care of itself. Claims get filed, medical bills taken care of, and lost wages get paid.
However, workers comp attorneys exist for a reason – the system is old, worn out, and doesn’t always work as it was intended.
We’ll go over reasons why you might need a workers comp attorney in Encinitas, how they can help, and how much they charge. We’ll also cover how to navigate the system on your own.
The goal of this article is to give you the information you’ll need to make informed decisions about your workers compensation case.
Reasons to Hire an Encinitas Workers Comp Attorney
Workers compensation is a no-fault system. That means the employer and the injured worker don’t have to argue over who was at fault for the accident. If the injury happened at work, the employee is entitled to workers comp benefits.
The decision about consulting an attorney will come down to how your employer and their insurance carrier handle your case.
If any of these situations sound familiar, you should get a lawyer involved:
- Your employer or their insurance carrier says the injury did not happen at work.
- Your employer refuses to file your workers comp claim.
- Your injury is serious enough that you expect to miss more than two weeks of work.
- You have a permanent disability, either partial or total, that prevents you from returning to work.
- The insurance carrier denies your claim.
- You have a pre-existing condition in the same part of your body that was injured.
- The insurance carrier approves part of the claim but rejects another.
- The insurance carrier denies medical treatment ordered by a doctor.
- Your employer retaliates against you for filing a workers comp claim.
- Your employer or their insurance carrier offer a settlement.
- You plan to file for Social Security disability benefits.
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What Does a Workers Comp Lawyer in Encinitas Do?
To put it simply, a workers comp lawyer does all of the things injured workers don’t have the time or knowledge to do. From filing paperwork to calculating a fair settlement, their expertise can be a valuable ally in your fight for compensation.
Here are some of the things a workers comp lawyer does for their clients:
- File petitions and meet deadlines.
- Develop sufficient evidence to carry the burden of proof.
- Conference with the physician.
- Get workers second and third medical opinions from good doctors when necessary.
- Depose the claims adjuster representing the insurance company.
- Call witnesses and cross-examine opposing witnesses.
- Use experience with doctors, opposition attorneys, insurance carriers and judges to reach a favorable outcome for the client.
- Conduct the settlement negotiations with the insurance carrier.
How Much Does a Workers Comp Lawyer in Encinitas Charge?
Workers compensation lawyers in California are paid on a contingency basis regulated by the state. That means if they win your case, they will receive a percentage of the benefits. Judges typically award attorneys 9-15% of the settlement amount.
“If they win” is the operative phrase here. They don’t get paid until you get paid.
And remember, the consultation is free, so it doesn’t hurt to give an attorney a call to see if you would benefit from their legal expertise.
Other lawyer fees, such as an hourly rate for your deposition or out-of-pocket costs for proving medical issues, are covered by the insurance carrier.
Bottom Line: Yes, you’ll have to give up some money in your settlement for an attorney, but studies show that injured workers receive higher payouts when they are represented by an attorney. Plus, judges agree that an injured worker is better off with a lawyer on their side – the insurance carrier will certainly have a team of their own.
How to Handle a Workers Comp Case on Your Own in Encinitas
Most claims do not require the help of a workers comp attorney. When the system works as intended, you simply have to notify your employer to kickstart the process of filing a workers compensation claim. If things do not work out in your favor, you have the option to appeal a claim denial. This will require the help of a workers comp lawyer, but for reference, the step-by-step guide is detailed below.
How to File a Workers Comp Claim in Encinitas
Any worker injured on the job in Encinitas should immediately notify a supervisor. If the injury or illness developed gradually, it should be reported as soon as you learn or believe it was caused by your job.
To start the workers comp claims process, file a claim form as soon as possible. Your employer must give or mail you a claim form within one working day after learning of your injury or illness. The California claim form can be downloaded online. Workers also can contact the Department of Industrial Relations’ Information and Assistance Unit online or by calling 1-800-736-7401.
Fill out the employee section of the claim form, sign and date it, and give it by hand or mail it to your employer as quickly as possible. Keep a copy for your records. If you mail the claim form, use certified mail (“return receipt requested”) so you have a record of the date it was mailed and received. If you don’t return the completed form to your employer, you could lose your right to benefits.
Employers must complete the “employer” section of the form and send it to their insurance company. You should receive a copy of the completed claim form from your employer; if you don’t, request a copy and keep it for your records.
Deadlines for Encinitas Workers Comp Claims
The workers comp process in Encinitas includes multiple deadlines for employees, employers and insurers.
For injured workers, the most important deadline is reporting your injury or illness within 30 days of when you believe it occurred on the job. For most workplace maladies, determining when the injury occurred is simple enough: it’s the date that you sprained your ankle, wrenched your back or suffered whiplash in a car crash.
However, for repetitive-stress injuries or occupational diseases that occur gradually, making that determination is more complicated.
For those cases, the timeline for reporting and filing your workers comp claim starts when the following happen:
- You first missed work or saw a doctor for the injury or illness, and
- You knew or should’ve known that it was caused by your work, generally because the doctor explained that to you.
Once the claims form is submitted, the insurance company generally has 14 days in which to mail you a letter with the status of your claim. If you don’t receive a letter within 14 days, contact the insurance company to inquire about the status.
If your employer does not deny your claim within 90 days, you can presume in most cases that your injury is covered under workers comp. If the injury or illness forces you to miss work, you should begin receiving temporary disability benefits within 14 days after the insurer learns about the injury and your temporary disability. If the insurer doesn’t start the payments by then or respond to the claim by denying it or asking for more information, it will be required to pay a 10% late penalty on the disability payments.
How to Appeal a Claim Denial in Encinitas
If your workers comp claim is denied, you can file an appeal with the state Division of Workers Compensation Appeals Board by filling out this form. You must file that form at the DWC office nearest to you, and present that form to the claims administrator.
Contact information for DWC offices nearest you:
Anaheim DWC District Office
1065 N Link Suite 170, Anaheim CA 92806-2131
Bakersfield DWC District Office
1800 30th Street, Suite 100, Bakersfield, CA 93301-1929
Fresno DWC District Office
2550 Mariposa Mall, Suite 4078, Fresno, CA 93721-2219
Long Beach DWC District Office
1500 Hughes Way, Suite C203, Long Beach, CA 90810
Los Angeles DWC District Office
320 W. 4th Street, 9th floor, Los Angeles, CA 90013-1954
Marina del Rey DWC District Office
4720 Lincoln Boulevard, 2nd floor, Marina del Rey, CA 90292-6902
Oakland DWC District Office
1515 Clay Street, 6th floor, Oakland, CA 94612-1519
Oxnard DWC District Office
1901 N. Rice Avenue, Suite 200, Oxnard, CA 93030-7912
Pomona DWC District Office
732 Corporate Center Drive, Pomona, CA 91768-2653
Redding DWC District Office
250 Hemsted Drive, Second Floor, Ste. B, Redding, CA 96002- 9040
Riverside DWC District Office
3737 Main Street, Suite 300, Riverside, CA 92501-3337
Sacramento DWC District Office
160 Promenade Circle, Suite 300, Sacramento, CA 95834-2962
Salinas DWC District Office
1880 N Main Street, Suite 100, Salinas, CA 93906-2037
San Bernardino DWC District Office
464 W. Fourth Street, Suite 239, San Bernardino, CA 92401-1411
San Diego DWC District Office
7575 Metropolitan Drive, Suite 202, San Diego, CA 92108-4424
San Francisco DWC District Office
455 Golden Gate Avenue, 2nd Floor, San Francisco, CA 94102-7014
San Jose DWC District Office
100 Paseo de San Antonio, Suite 241, San Jose, CA 95113-1402
San Luis Obispo DWC District Office
4740 Allene Way, Suite 100, San Luis Obispo, CA 93401-8736
Santa Ana DWC District Office
2 MacArthur Place, Suite 600, Santa Ana, CA 92707-7704
Santa Barbara DWC Satellite Office
130 E Ortega St, Santa Barbara, CA 93101-7538
Santa Rosa DWC District Office
50 D Street, Room 420, Santa Rosa, CA 95404-4771
Stockton DWC District Office
31 East Channel Street, Room 344, Stockton, CA 95202-2314
Van Nuys DWC District Office
6150 Van Nuys Boulevard, Suite 105, Van Nuys, CA 91401-3370
The DWC office will send you a notice confirming that it has been filed. The notice will include your assigned case number, which will begin with the letters “ADJ” followed by a sequence of numbers. Use the assigned case number on all documents and correspondence.
Next, you must file a Declaration of Readiness to Proceed to request a hearing before a workers compensation administrative law judge. Your case will be scheduled for a hearing called a mandatory settlement conference (MSC). At the hearing, workers will want an experienced workers comp attorney in their corner.
The judge will discuss the case with you and your claims administrator and try to assist the both of you in reaching a settlement. If your case is not settled at the MSC, you will need to prepare documents that outline the dispute, identify the items each party will present at trial and the names of the witnesses that each party will ask to testify.
The trial will be held before another judge, and you will be required to attend. The judge will issue a written decision after the trial and send it to you by mail, usually 30-90 days after the trial. If either you or the claims adjustor disagrees with the judge’s decision, a Petition for Reconsideration can be filed.
If there is a disagreement between you and your claims administrator over the diagnosis of your injury by your treating physician or treatment plan, you most likely will need to request a qualified medical examiner (QME) to review your case and issue a medical-legal opinion. These are doctors that meet additional educational and licensing requirements
If the worker is represented by an attorney, the attorney may try to convince the claims administrator to agree to a doctor to review the case, known as an agreed medical examiner (AME). This can be a quicker more efficient process than a QME.
About The Author
The Workers Compensation Experts have had the privilege of interviewing attorneys, judges, insurance reps, government officials, and experts from every corner of the workers compensation system. We use their knowledge to help you understand how to navigate the mine field of workers comp after you've suffered an injury at work. We can be reached at email@example.com.
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- N.A. (ND) How to File a Workers’ Compensation Claim Form. Retrieved from https://www.dir.ca.gov/dwc/iwguides/IWGuide01.pdf
- N.A. (ND) If My Claim Was Denied. Retrieved from https://www.dir.ca.gov/dwc/MyClaimWasDenied.htm
- N.A. (ND) Answers to Frequently Asked Questions about Workers’ Compensation for Employees. Retrieved from https://www.dir.ca.gov/dwc/WCFaqIW.html