Workers Comp Lawyers in San Francisco

There are a lot of surprising things about San Francisco and one of the most surprising might be: “San Francisco is a union town!”

California has the highest number of union members in the United States with more than 2.4 million workers and San Francisco’s 309,644 members rank second in the state behind Los Angeles (659,426).

That can sometime be an issue when there is an accident on the job site and the injured worker goes looking for help receiving benefits.

“Sometimes, union members get lulled into a false sense of security about what their union can do,” Bernhard Baltaxe, a workers compensation attorney in San Francisco, said. “I try to help them understand that, for the most part, the union isn’t going to have much power over workers compensation issues.

“You need competent, qualified representation if you’ve got a dispute with workers compensation and that means getting a lawyer.”

Baltaxe, who has been working in the Bay Area since 2000, deals with all facets of the labor industry in San Francisco, which primarily has been focused on service jobs like hotels and restaurants or positions in the technology industry. He said he sees San Francisco’s workforce gradually changing in recent years, but no matter what jobs are created, there is always going to be the possibility of injuries at the workplace.

“The workforce is going through a transition right now,” Baltaxe said. “You can see it down on the waterfront where a few industries are being phased out and new ones coming through.

“But even though this isn’t the San Francisco it used to be, there are still plenty of jobs that put you in dangerous positions.”

Reasons to Hire a San Francisco Workers Comp Attorney

The workers compensation system in California is “no fault” meaning the employer and employee don’t have to argue over who was at fault for an accident. If it happened in the workplace, the injured worked gets his medical care paid for and receives compensation for lost wages during the recovery period.

Ah, if it were only that simple!

Employers and their insurance carriers don’t automatically agree that an injury happened at the job site or that the medical treatment a worker receives is necessary and disputes over how much compensation a worker receives are ongoing. The carriers are looking for a reason to reject parts or all of your claim and that’s when you definitely should at least consult with a lawyer.

Some of the signs your claim might be disputed or completely rejected include:

• Your injury is serious enough that you expect to miss more than two weeks of work
• The insurance company delays or denies medical treatment ordered by a physician
• You had prior injuries to the same body part
• The insurance company admits one injured body part claim, but rejects another. For example, accepts shoulder injury, but rejects neck injury
• Doctor treating you doesn’t speak the same language and misunderstands when you describe accident and/or injuries
• Delays reporting the injury lead to questions over whether it occurred on the job site
• Your employer retaliates against you for filing a workers comp claim
• Employer or carrier makes a settlement offer

“Anytime you think the injury is serious enough that there will be long-term effects on your ability to do your job, you should call a lawyer,” Baltaxe said.

What Does a Worker Comp Attorney in San Francisco Do?

The laws, rules of procedure, regulations and deadlines for workers compensation claims in California are so confusing – and often times penalizing – that you might think hiring a lawyer to wade through the mess for you is a nice summary of what a good lawyer should do.

And it is.

But Baltaxe said if that’s all you get, you missed out.

“The most important thing a lawyer does for his client is determine how this injury is going to affect the workers earning capacity for the rest of his or her life,” Baltaxe said.

A good lawyer will have the experience, judgment and contacts with experts to determine, based on medical evidence, how much an injury impacts the workers ability to compete for a job on the open market.

“That’s not all an attorney does,” Baltaxe said, “but that should be right at the top of the list.”

Other “lawyerly” things you should expect when you hire an attorney include:

• Know what needs to be included in filing a claim to assure it is accepted
• Know filing deadlines and paperwork required for each deadline
• Know how to steer client to the right doctor a second opinion
• Know medical experts needed for testimony if case reaches a court hearing
• Know the rules of evidence and how to introduce things that lead to a positive result
• Be prepared to argue successfully if the case goes to court
• Know the rules to follow if the claim is denied and an appeal is needed

“And know what a case is worth,” Baltaxe said. “Every insurance company puts aside a reserve – the amount of money they expect the case will cost them – and a lawyer should know how much that is … and get it.”

How Much Does a Workers Comp Lawyer in San Francisco Charge?

When California workers ask themselves whether they can afford a lawyer for their workers compensation case, the answer is simple.

“We work on a contingency basis, which means we have to win to get paid,” Baltaxe said. “It doesn’t cost anything to consult a workers comp lawyer and we don’t get paid unless the worker is awarded money for their injury.”

The contingency laws for California put the payout for workers compensation attorneys at somewhere between 10% and 15%. Compare that to the 33% cut that personal injury lawyers receive for doing the same thing – trying to get a positive judgment for their client.

Baltaxe said the 15% that most workers compensation attorneys charge is easily covered by the insurance reserves.

“When the insurance company knows a lawyer is representing the worker, the amount they set aside in reserves goes up, almost automatically,” he said.

Workers comp lawyers evaluate all cases and determine whether their services are really needed.

“If the case settles for a reasonable number and there really is nothing for us to do, we don’t try to make a lot of money off that case,” Baltaxe said. “We get paid when we provide a service that provides real benefits to the client.”

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

Employees injured on the job in San Francisco 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 San Francisco 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 San Francisco Workers Comp Claims

There are multiple deadlines for all parties a San Francisco 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 San Francisco

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

Phone: (415) 703-5020
455 Golden Gate Avenue, 2nd Floor
San Francisco, CA 94102-7014

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 San Francisco 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.