Workers Comp in Los Angeles

When disasters strike, people call first responders for help. These include firefighters, nurses, police officers, and paramedics. Large cities couldn’t exist without them.

Los Angeles, a metropolis in every sense, relies on a lot of first responders. Naturally, these first responders rely heavily on workers compensation benefits to help them deal with their own injuries and illnesses picked up on the job.

“I would say 80% of our clientele are first responders,” said Lawrence Stern, a Certified Specialist in Workers’ Compensation Law with the firm Mallery and Stern.

Workers compensation is not limited to disabling or even severe injuries. In 2019, around 60% of injuries reported by firefighters were categorized as Report or First Aid only. However, minor injuries can develop into major ones down the line, so it’s always a good idea to report everything so there is a record of it.

Some people assume that it’s not worth filing a workers compensation claim over a minor injury. They may be tempted to follow the guidance of their employer, who needs them back on the schedule and doesn’t want his premiums for workers comp coverage going up because you made a claim.

In truth, you have more options than simply sucking it up and going back to work.

Workers compensation isn’t reserved for heroic occupations. In California, every employer must carry workers comp insurance regardless of industry or occupation. Bankers, porters, teachers, flight attendants — virtually all jobs are covered under workers compensation.

Workers comp attorneys offer free consultations so that you can discuss your case with an expert before making any further decisions.

Reasons to Hire a Los Angeles Workers Comp Attorney

Having an attorney means having a trained professional in your corner to combat the trained professionals representing the other side.

“You should have some idea of what to expect and what the law is because the other side — i.e. the insurance company and the employer — absolutely knows the law,” Stern said.

You can file a workers compensation claim on your   own, and depending on the case, things might work out.  But it makes more sense to contact an attorney for a free consultation. Most attorneys will tell you during the free consultation if your claim could benefit from legal aid or if it is something you can complete on your own.

Here are some signs that you should hire a workers compensation attorney in Los Angeles:

 Employer gives you the runaround when you bring up the injury.

• Employer does not provide information on what doctor or clinic to go to for treatment.
• Your employer or insurance carrier says the injury didn’t happen at work.
• The insurance carrier denies any part of your claim.
• Your employer threatens to fire you if you report the injury.
• The insurance carrier denies medical treatment ordered by your doctor.
• You receive written notice from the carrier that they are disputing the claim.
• You haven’t received any wage benefits.
• The calculations for wage compensation are incorrect

What Does a Workers Comp Attorney in Los Angeles Do?

A worker’s compensation attorney does more than file paperwork. “The first thing is getting medical care,” Stern said.

Injured workers must navigate a system known as the Medical Providers Network (MPN) to receive specialized medical treatment. This process alone can be long and frustrating. “Unfortunately, these are very restrictive,” Stern said, “and the doctors are very limited.”

The Medical Provider’s Network refers to doctors and medical facilities contracted by the insurance company. Healthcare providers charge lower fees in exchange for being a part of the network.

The workers compensation system was meant to protect workers injured on the job. Unfortunately, the language has grown so complicated, it can be hard to decipher what you qualify for. That is why an attorney will go down many avenues to utilize the system to your full advantage.

“Do you have an extra job or side job and has that been counted into your temporary disability rate?” Stern said. “Assuming that you do require medical care, you’re going to be off to look for other sources of income. Do you have any disability insurance? Do you have any payments for which there is a disability policy associated with it?”

A workers compensation attorney offers guidance throughout the claims process. He or she can act as a reliable advisor to ensure your claim doesn’t get lost or misplaced. This is someone in your corner who knows the law and can hold employers and insurance companies accountable.

“Guidance is the key,” Stern said in talking about what a workers compensation attorney should provide. “What is the insurance company is required to do? If they don’t do those things, how do you determine the amount of disability? How do you determine if you can go back to work? What are the obligations of the employer? There’s a myriad of things that make contacting the attorney very important.”

Here are some things a workers compensation attorney can do for you in Los Angeles:

• Depose doctors involved in the treatment.
• Depose claims adjuster representing insurance company.
• Conference with doctors treating the injury.
• Know the doctors involved. Some are insurance-oriented. Some look out for the patient first. Do you know the doctors well enough to know the difference?
• Conduct settlement negotiations with the insurance carrier.
• Handle preparations and deadlines if the case goes to a trial.
• Know the grounds for appeals, if the case gets that far.
• Call expert witnesses and cross-examine opposing witnesses.

How Much Does a Workers Comp Lawyer in Los Angeles Charge?

Workers comp attorneys are paid on a contingency basis. This means lawyers don’t receive a dime unless they win your case. In fact, the only way for an attorney to get paid is by winning your case. If you don’t receive a settlement, you won’t owe them any compensation.

California law puts attorney’s compensation at between 12% and 15% of the settlement. This means if you were awarded $100,000, your attorney’s fee could range from $12,000 to $15,000. There’s no need to stress over how you can afford a worker’s comp attorney since you’ll probably earn a larger settlement if you hire one.

“In my experience, if you have an attorney, the settlement or resolution is always higher,” Stern said.

How to Handle a Workers Comp Case on Your Own in Los Angeles, CA

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 Los Angeles

Employees injured on the job in Los Angeles should notify a supervisor immediately to ensure receiving benefits, including medical care. If the injury or illness developed gradually, it should be reported to the employer as soon as you believe it was caused by your job.

To protect your rights, 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.

Once you have the claim form, fill out the “employee” section, sign and date it, and send it to your employer right away. Always keep a copy. The claim form should be returned to the employer in person or by mail. If you mail the claim form, use certified mail (“return receipt requested”) so there is a record of the date it was mailed and received.

Failure to return the completed form to your employer puts you at risk of losing your right to benefits. If your employer does not give you a claim form, contact an information and assistance officer.

Employers Responsibility in Los Angeles Workers Comp Claims

Employers are responsible for completing the “employer” section of a claims form and forwarding the completed claim form to the insurance company. Employees should receive a copy of the completed claim form from their employer; if you don’t, request a copy and keep it for your records.

Deadlines for Los Angeles Workers Comp Claims

There are multiple deadlines for all parties a Los Angeles workers comp case and following them is essential to make sure your claim is processed efficiently.

The most important deadline for injured workers is reporting an injury or illness within 30 days of when you believe it incurred on the job. For most workplace maladies, determining when the injury occurred is simple enough, but repetitive-stress injuries or occupational diseases that occur gradually, can make that determination 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
• You knew or should’ve known that it was caused by your work, generally because the doctor explained that to you.

Once your injury is reported and your completed claim form submitted to the insurance company, your employer must authorize medical treatment for you within one day, to a maximum of $10,000, while your claim is investigated. If that authorization is not provided, you should immediately contact California’s Information and Assistance Unit for help.

When the claim is submitted, the insurer has 14 days in which to mail you a letter with the status of your claim. Contact the insurer if you don’t receive a letter within 14 days.

If your employer does not deny your claim within 90 days, you can presume that your injury is covered. 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 Los Angeles

If your workers comp claim is denied, you can file an appeal with the state Division of Workers Compensation Appeals Board using this form.  After completing the form, you must file it at the Los Angeles DWC office. You must serve the appeal to all other parties.

Phone: (213) 576-7335
320 W. 4th Street, 9th floor
Los Angeles, CA 90013-1954

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.

What to Do If Your Employer Does Not Have Workers Comp Insurance

It is illegal for an employer to run a business in Los Angeles without carrying workers compensation insurance. Those that fail to do so are subject to steep fines, having their business shut down, criminal charges, and even jail time for the employer.

If you believe your employer is not insured, contact your local Department of Industrial Relations Division of Labor Standards Enforcement (DLSE) office and make a complaint. Go to www.dir.ca.gov/dlse to find a local office.