While some injured workers can navigate their claim without the assistance of an attorney, many can benefit from hiring an attorney. Skilled Workers’ Compensation attorneys can help in the following ways:

• They can assist you in reporting/processing your claim correctly

• In the event of a denied or delayed claim, they help to prove the accident or illness is work-related

• They can help find a primary treating physician that is more patient-oriented and sympathetic compared to the employer’s designated doctors/clinic.

• They work with your physicians to help you attain medically necessary treatment.

• They contest efforts by the employer or the employer’s insurance company forcing you to return to work when it is not medically feasible

• They help verify what level of disability you have and make sure you are compensated accordingly

• They appeal medical denials and advocate for medical needs

• They help you navigate the complex QME process in an effort to get the best possible evaluator, which is critical to the final PD award

• Experienced Attorneys will guide you through each step of the claims process and ensure the best results are achieved both medically and in your overall case outcome.

WC attorneys are paid on a contingency basis, which means that the injured worker does not have to pay a retainer or otherwise pay the attorney out-of-pocket. Per the Labor Code, the WC attorney is paid based on a percentage (9-15%) of the final settlement. In most cases the attorney’s fee is 15% of the final award. Once the fee is established (and approved by a Workers’ Compensation Judge), the attorney is paid directly by the claims administrator out of the final settlement.

No, workers compensation benefits are not considered to be income by either the IRS or the State of California.

Once the injured worker is declared to be a maximum medical improvement (MMI), they are evaluated by the PTP or QME to determine the extent of any permanent residuals (impairment or disability); if the evaluator finds permanent impairment, the injured worker is assigned a whole person impairment (WPI), which is adjusted based on occupation, age, etc. to derive a permanent disability (PD) percentage. Once the parties agree (or a WC judge decides) on the final PD percentage, the case is then finalized one of two ways:

• Stipulations with Award of Future Medical Benefits

When the case finalized by “Stip/Award” the insurance company pays out the PD compensation on a biweekly basis (usually at the rate of $290/week) until the full award is paid out; meanwhile, the injured worker is awarded “lifetime” medical, which remains subject to MPN/UR constraints. This method of finalization is generally used when the injured worker returns to the same employer.

• Compromise & Release (Lump Sum) Settlement

When the parties agree to a “C&R” settlement, the PD compensation is paid out in a lump sum (rather than biweekly) and additional monetary consideration is paid by the insurance company to “buy out” the injured worker’s future medical benefit. Thus the insurance company is released from any further liability. This can be a preferred means of settlement for injured workers who do not return to their previous employment and, to the extent they require further medical treatment for their industrial injuries, have adequate health insurance outside of WC. Neither party can be forced into a C&R settlement - both sides must voluntarily agree on a lump sum settlement with a future medical buy out.

Medical Treatment: The employer is required by law to offer medical treatment (initially at the place of the employer’s choosing) upon being notified of a workplace injury. This requirement continues unless the claim is denied within 90 days of the employer’s knowledge of injury. Once 30 days have passed the injured worker can potentially transfer their care to another medical provider as long as the desired doctor/facility is included within the employer's Medical Provider Network (MPN). Critically, all requests for authorization of treatment is subject to Utilization Review (UR), meaning that the claims administrator can deny treatment at any point during the life of the claim (even when the claim is accepted). The injured can seek reimbursement for expenses associated with obtaining approved medical treatment, to include the cost of transportation, parking, tolls, etc.

Temporary Disability (TD): This is a wage loss indemnity benefit payable when the injured worker is certified by an MPN doctor as unable to work OR when the injured worker is given work restrictions that the employer does not accommodate. The TD rate is calculated by multiplying the workers’ gross average weekly wage by ⅔, up to a maximum rate ($1,619.15 per week for dates of injury after 1/1/23). Eligibility for TD ends when (1) the injured worker is declared to having reached maximum medical improvement (MMI) by their primary treating physician (PTP) or a Qualified Medical Evaluator (QME); (2) the 104-week TD cap is reached; or (3) the injured worker is released to return to work without restriction by their doctor.

Permanent Disability (PD): This is an indemnity benefit that is supposed to compensate the injured worker for an injury’s permanent effect (or impairment), measured on a scale of 1-100 percent. PD is calculated at the time the injured worker is declared as having reached MMI by either the PTP or a QME.

Supplemental Job Displacement Benefits (SJDB): If an injured worker is deemed by the PTP or a QME as unable to return to their usual and customary occupation (and the employer does not offer permanent modified duty or an alternate job), the injured worker is entitled to the SJDB, which includes: (1) a $6,000 voucher that can be used to pay for educational retraining or skill enhancement at state-approved or accredited schools, computer equipment, etc. and (2) through the Return-to-Work Supplement Program (RTWSP), a check for an additional $5,000 from the State of California.

• What is SDI?

State Disability Insurance (SDI) replaces a portion of employee income when they can’t work because of an illness or disability. It provides wage replacement benefits that cover, on average, up to 60% of employee earnings.

• What to have ready when starting an application for SDI:

Filing for SDI (State Disability Insurance) can be a supplementary income to what you are already receiving or an available income when your WC benefits have come to an end. Below is a link taking you to step-by-step instructions for filing for SDI which is done through EDD (Employment Development Department). You'll see that first, you need to register with EDD. This requires filling out basic contact info and then selecting and answering a number of security questions to protect your EDD account. It’s important that you save your login info in a safe place as it will be very difficult to retrieve if lost. After registering you will receive an email from EDD asking you to verify your EDD account. After you have verified your account you can login to EDD and follow the steps for applying for SDI.

https://edd.ca.gov/Disability/How_to_File_a_DI_Claim_in_SDI_Online.htm

You will need:

• Date of injury

• Claim number

• Date of last day worked

• Date you expect SDI to begin (typically the day following the last day worked unless is falls on day you would not typically work such as a weekend day of you work/ed M-F) ie, the next work day following the DOI (date of injury)

• Employer address

• WC PTP doctor name: This is your Workers Compensation Primary Treating Physician assigned to treat just your work related injury. They will complete the SDI application in the final step.

A QME or Qualified Medical Examiner is a physician who is certified to provide an unbiased and truthful opinion about work-associated injury claims. The QME will do a detailed medical analysis of the workers' medical documentation related to the injury or illness. They will also carry out a physical exam to determine the degree of functional limitation the affected body part has suffered. This physician can also advise vocational rehabilitation if it is determined that the worker can not return to work because of the disability.

A report is issued within 30 calendar days from the date of the exam though sometimes the QME may request for an extension.

A deposition is a recorded meeting in which the opposing attorney asks the “deponent” questions about facts regarding the case. It’s less formal than a court hearing and often takes place at the insurance company’s lawyer’s premises.

However, with Vincent Marletta as your attorney, depositions are often held either at our office or via Teleconference with an hour of preparation before the deposition start time. During the preparation, Vincent will meet with you to help prepare you for what to expect and answer any questions you may have so you go into the deposition feeling prepared.