Workers Comp Lawyers in Oakland

Oakland sits just a few minutes across the bay from San Francisco, and it’s not uncommon for people to compare the two … or confuse the two is probably more accurate.

The cities share a lot in common, and both (along with San Jose to the south) form the backbone of the ever-expanding Silicon Valley economic region.

However, some key differences distinguish Oakland and San Francisco from each other.

While there are plenty of tech jobs found throughout Oakland, the city’s industrial heart lies in the manufacturing and shipping industry. The Port of Oakland is one of the largest gateways on the west coast of North America and several manufacturing plants are dotted throughout the city. Oakland has often been billed as the blue-collar neighbor to the east with a cheaper — albeit barely — cost of living than both San Francisco and San Jose.

Among Oakland’s main industries include healthcare, manufacturing, and retail services. According to the Bureau of Labor Statistics, these three industries top the list for workers comp cases, accounting for nearly half of all private-sector workers comp cases in 2019.

Even after a lifetime of good health, an accident at work can put a wrench in your lifestyle and sideline your career.

Workers compensation is a complex field that can be hard to make sense of when you should be worried about getting back on your feet. Employers hire professional lawyers to manage their interests, which are often at odds with your own.

“They’re dealing with an opponent well versed in a very exotic area of law,” attorney Steven Birnbaum said.

Birnbaum has been practicing workers compensation law in the Bay Area for more than 40 years. He says knowing your rights is just the first step. The hard part is weaving through the system’s nuances to ensure you receive all the benefits you qualify for. This is where a workers compensation attorney can come in handy.

Reasons to Hire an Oakland Workers Comp Attorney

There are many parts to a workers compensation claim, including medical treatment, compensation payments, claim resolutions, and possible appeals. In some cases, you may not need a lawyer. For instance, if your insurance carrier moves your case through without delay and you’re receiving satisfactory treatment and benefits, you may be able to handle things on your own.

However, if your employer’s insurer puts up resistance, or you encounter an issue with medical experts, it can help to have someone on your side with knowledge of the system; ideally, someone who will represent your best interest.

Here are some signs that you should get in touch with a workers compensation lawyer in Oakland:

• You’ve been out of work two or three weeks after reporting the injury and you haven’t heard a word from your employer.
• Your employer threatens to fire you if you report the injury.
• Your employer says the injury happened at work.
• The insurance carrier denies your claim.
• Your employer or insurance carrier drags its feet with your claim.
• You suffer permanent disability, either partial or total, that will prevent you from ever fully returning to work.
• Your employer retaliates against you because you filed a claim.
• You are ready for a settlement.

What Does a Workers Comp Lawyer in Oakland Do?

A workers compensation claim is not the same as a lawsuit. According to the Alameda County Administrator’s office:

The workers’ compensation system is based on a trade-off between employees and employers. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries no matter who was at fault and, in return, are prevented from suing their employers over those injuries.

However, disputes may still arise that require professional help to resolve. Insurance companies are not always forthcoming with information, and your employer may not be eager to talk about accidents that happen on the job because it could lead to a rise in workers compensation insurance premiums.

That’s not to mention the indirect costs that come out of an employer’s pocket when a worker takes time off for recovery. Often a new worker needs to be trained, or an existing worker must be paid overtime to make up for the loss of productivity. Your employer may not be quick to agree with an outcome that could cost them money.

A workers compensation attorney can help protect a worker’s rights when these types of disputes arise.

“They’ll be familiar with an area of the law that general practitioners know little about,” Birnbaum said. “They can advise a client on the right decisions to make and take the right decisions for them.”

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

• Get a full understanding of the injury and how it impacts an employee’s ability to go back to work.
• Get a full understanding of prior injuries and claims and how that impacts the current situation.
• Depose doctors involved in the treatment.
• Depose claims adjuster representing the insurance company.
• Conduct settlement negotiations with the insurance carrier.
• Handle preparations and deadlines, if the case goes to trial.
• Know the grounds for appeals, if the case gets that far.
• Assume responsibility for filing your case and meeting deadlines.
• Prepare your side of the argument, giving you the best chance of a favorable outcome
• Cross-examine the insurance company’s witnesses.

How Much Does a Workers Comp Lawyer in Oakland Charge?

Workers compensation attorneys are paid on a contingency basis.

“In the state of California, workers compensation lawyers are paid a percentage up to 15% of the benefits gained by the workers, but it has to be approved by a judge and it has to be reasonable,” Birnbaum said.

An initial consultation with a workers compensation attorney shouldn’t cost you a thing. This is the first meeting between you and your lawyer, so he or she can review your case and determine how to handle it. You may not need a lawyer and if that is the case, he or she will let you know.

Some lawyers may have clients sign a fee agreement during consultation, but this too has to be approved by a judge.

The bottom line is, a workers compensation attorney only gets paid when they win your case. If you don’t receive a settlement, they don’t receive a payday.

How to Handle a Workers Comp Case on Your Own in Oakland, 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 Oakland

Employees injured on the job in Oakland 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 Oakland 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 Oakland Workers Comp Claims

There are multiple deadlines for all parties in an Oakland 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 Oakland

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 Oakland DWC office. You must serve the appeal to all other parties.

Phone: (510) 622-2866
1515 Clay Street, 6th floor
Oakland, CA 94612-1519

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).

“The panel QME process is very detrimental because it slows things down terribly,” he said.

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

It is illegal for an employer to run a business in Oakland 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.