Workers Compensation Benefits Archives - UELG https://www.california-labor-law-attorney.com/category/workers-compensation-benefits/ California Labor Law Attorney Wed, 01 Jul 2020 11:09:06 +0000 en-US hourly 1 https://www.california-labor-law-attorney.com/wp-content/uploads/2019/05/img-logo-150x113.jpg Workers Compensation Benefits Archives - UELG https://www.california-labor-law-attorney.com/category/workers-compensation-benefits/ 32 32 CALIFORNIA UNEMPLOYMENT BENEFITS https://www.california-labor-law-attorney.com/california-unemployment-benefits/ Wed, 01 Jul 2020 11:07:19 +0000 https://www.california-labor-law-attorney.com/?p=6285 Unemployment benefit in California is an initiative jointly handled by the State and the federal government to provide financial support […]

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Unemployment benefit in California is an initiative jointly handled by the State and the federal government to provide financial support to Californians who are out of work through no fault of their own. As of June 2020, California’s Employment Development Department EDD has processed over 6.3 million claims and paid $30.3 billion in benefits since the coronavirus pandemic started. Of that amount, $797 million is paid out to claims under the Pandemic Emergency Unemployment Compensation program.

As the number of applicants continues to increase, many Californians still have not received any benefits, and are running out of cash to live on. There is one particular roadblock – eligibility. According to the EDD, the unemployment benefits will only be given to applicants who meet the eligibility criteria and can prove they are who they say they are.

This article provides general information about the various unemployment benefits in California, how they are calculated, including the eligibility requirements needed.

COLLECTING UNEMPLOYMENT BENEFITS IN CALIFORNIA

California employees that have been laid off due to the COVID-19 pandemic or for other reasons may be eligible for unemployment benefits. The regular unemployment benefits in California provide eligible applicants with 26 weeks of insurance benefits.  The EDD determines your weekly benefit amount by dividing your wages for the highest-paid quarter of the base period by 26, up to a maximum of $450 every week.

While the State provides most of the benefits to employees based on the employment taxes collected from California employers, the federal government has also approved some benefits as a response to the surging unemployment triggered by the coronavirus pandemic.

Apart from California’s 26 weeks of unemployment benefits, applicants are entitled to an additional 13 weeks of benefits through the federal Pandemic Emergency Unemployment Compensation to make a total of 39 weeks coverage. Employees that are eligible for the regular California UI benefit will receive an additional $600 benefit weekly on top of the State-provided benefits. The extended relief is available until December 31, 2020.

There is another 20 weeks of benefits from the Federal Emergency Benefit Program, including the 7 extra weeks of benefits in California’s new budget plan. This is needed so that California residents can get access to more weeks of unemployment benefits. The Legislators will decide on measures to implement the supposed “trailer” bill law with the unemployment provisions. The trailer bill law is an expression of the fact that COVID-19 coronavirus will likely remain for a long time, and that Californians need the extension of unemployment benefits. At the time of writing, there are no state-operated benefit extension programs given in California.

I am not qualified for the regular UI benefits. What can I do?

If you are ineligible for the regular unemployment benefits in California, you may apply for the following unemployment benefits:

  • Disability Benefits

An employee who files for California unemployment must be available for work, physically able to work, willing to start work immediately, and must fulfill all other eligibility requirements. An employee or applicant who, however, becomes ineligible for unemployment benefits due to an injury or sickness can file a claim for the California Disability Insurance program. The program offers short-term benefits to a qualified applicant who suffers wage loss because they are unable to work due to pregnancy or childbirth or any non-work-related illness or injury. The payment is dependent on meeting all the basic eligibility requirements.

  • California Paid Family Leave

If you are at home because you need to look after a family member who is ill, you can apply for California Paid Family Leave (PFL), but it requires medical certification. An employee does not currently qualify for PFL if they have to stay at home with their kids because the schools are closed.

  • Pandemic Unemployment Assistance Benefits

The Pandemic Unemployment Assistance program is intended to be an alternative benefit for applicants who are not qualified to collect regular California Unemployment Insurance (UI) benefits. It covers applicants that are unemployed or partially unemployed for reasons related to COVID-19. Likewise, self-employed Californians who did not have any regular employment or did not earn sufficient earnings as an employee during the 2019 calendar year are eligible to apply for the Pandemic Unemployment Assistance benefits. Applicants that can work from home or on leave and being paid or receiving other paid leave stimulus are not eligible for the PUA benefits.

ELIGIBILITY REQUIREMENTS FOR UNEMPLOYMENT BENEFITS IN CALIFORNIA

To be eligible for California unemployment benefits, applicants must satisfy the three criteria according to EDD. These include minimum earning, the reason for unemployment, and maintaining eligibility.

  • Minimum earnings requirements

Your past earnings are expected to meet a predetermined amount. You must have earned a minimum of $1,300 in the highest-paid quarter of the base period, or $900 in the highest-paid quarter of the base period, not less than 1.25 times their earnings in the highest-paid quarter in the entire base period.

  • Reason for unemployment

You must prove that you are out of work for reasons beyond your control. You must show that:

  1. You became unemployed at no fault of their own
  2. You were not involved in any fraudulent, unethical, or criminal activities in their former workplace, which led to being fired
  • You did not quit the job for a lack of interest
  1. You are fired or your work hours were reduced for lack of work

Note that EDD would verify the reason you provided for separating from your previous employer. They will contact your previous employer to validate the reason provided and if there are discrepancies, you may not be eligible for benefits. You may file an appeal against the decision of EDD if you are not pleased with the response,

  • Maintaining Eligibility

Meeting the minimum earnings and the reason for unemployment will qualify you for unemployment benefits in California. However, you are expected to certify for unemployment benefits every week. Otherwise, it will disrupt the payment of your weekly benefits. The information on the certificate will show whether or not you meet all the requirements for the week.

HOW UNEMPLOYMENT BENEFIT IS CALCULATED

California’s unemployment benefits are calculated using your earnings during a 12-month base period. The base period is divided into four consecutive quarters, and it begins about 15 months before the date you filed for a claim. The EDD has two types of base periods used to calculate employee’s earnings for an unemployment claim. They include:

  • Standard Base Period – the first four of the last five calendar quarters before the date that you apply for benefits is used to determine if you can establish a claim.
  • Alternate Base Period – The alternative base period consists of the last four calendar quarters before the start date of the claim. The EDD will only consider this method when you do not have enough wages in your standard base period, but you have sufficient wages in the alternative base period to establish a claim.

APPLYING FOR UNEMPLOYMENT BENEFITS IN CALIFORNIA

Employees in California can apply for unemployment benefits via online, phone, mail, or fax.

  • ONLINE

The most convenient way to apply for unemployment in California is through the EDD online portal. Applicants can visit https://www.edd.ca.gov/Unemployment/UI_Online.htm to register their claims online. The registration time differs by days as shown below:

  1. Monday – 4:00 AM to 10:00 PM
  2. Tuesday to Friday – 2:00 AM to 10:00 PM
  • Saturday – 2:00 AM to 8:00 PM
  1. Sunday – 5:00 AM to 8:30 PM

Applicants can also certify for continued benefits, open new claims, update their phone number & address as well as view, request, and print their copy of form 1099G.

  • PHONE

This is another way to file for unemployment benefits in California. Applicants can call EDD designated numbers from Monday to Friday. The time is 8:00 AM to 12noon. Applicants with hearing disabilities can reach the TTY line on 1-800-815-9387.

  • FAX OR MAIL

Applicants may also choose to apply for unemployment benefits in California through mail or by fax. The first step is to download the UI Application form from the EDD website and complete the forms. You can either mail it or fax it to the EDD using the provided address on the forms.

Once you have successfully filed for an unemployment claim, you will start to collect the benefit on a weekly basis. However, you would need to obey all the eligibility rules throughout the benefit period.

VACATION PAY AND UNEMPLOYMENT BENEFITS

Vacation pay may be subtracted from an employee’s benefits. However, it will depend on whether the employee has been given a specific date to return to work when they were laid off. If the employee has not been given a precise date to return to work, any vacation payment made to the employee will not be deducted from their weekly benefit amount when their job ends.

Any vacation pay made to an employee that has been given a specific date to return will be deducted from their unemployment benefits for their period of a temporary layoff. According to the California Employment Development Department (EDD), vacation pay will be allocated to the number of days an employee requested vacation or to the number of days their employer required the employee to use as vacation during the temporary layoff.

OVERPAYMENTS OF UNEMPLOYMENT BENEFITS

It is possible that an applicant collects excessive benefit amounts that they were illegible to receive. This is called an overpayment. In this case, the applicant will receive a “Notice of Overpayment” through the mail from the EDD. The notice generally contains information on the nature of the overpayment transferred to the applicant, the excess amount the applicant will have to pay back, and penalties (if any) levied against the applicant. It will also contain information about the applicant’s right to appeal the imposition of the overpayment as well as the appeal procedure. California’s employment development department categorizes overpayment into Fraud and Non-Fraud.

  • Non-Fraud Overpayment

This is when applicants receive benefits they were not entitled to, through no fault of their own. The applicant will receive a notice from EDD stating that they have received an overpayment and that they will need to pay back the excessive amount. In this case, there will not be any interest or penalties levied against the applicant.

  • Fraud overpayment

This occurs when an applicant intentionally deceives the EDD into paying more unemployment benefits than they qualify for. If an applicant holds back some important information, lie about the wages earned during the base period, or provide fake or false documents to prove eligibility, and other related misleading tactics are regarded as a fraud in California. If a fraud overpayment is confirmed, the applicant will not only refund the excess amount but also pay an additional 30% of the amount of the overpayment as fine. If the applicant fails to pay back the excess amount and the specific penalty, the EDD may deduct the money from the applicant’s future weekly benefits, a process referred to as “offset”. Depending on the decision of the EDD, the applicant may be disqualified from receiving unemployment benefits for up to 23 weeks. The EDD may also file a lawsuit against the applicant in the law court.

How Long Does It Take To Get Unemployment Benefits In California?

It usually takes two to three weeks for EDD to process an unemployment claim and send payment to most entitled applicants. When the first benefit payment is available, the applicant will be mailed an EDD Debit Card. Once the card is activated, you can begin to use, track, and transfer your benefit payments.

How much of my earnings will I get with unemployment?

The amount of benefits an employee may receive per week is their weekly benefit rate (WBR). The amount will be at least 60 to 70 percent of the average weekly wages during your base period.

When will I be credited for benefit?

If you submit certifications by phone or online and you are eligible, your unemployment benefit will be posted to your EDD Debit Card in 24 hours. For fast claim processing, ensure you submit certifications online.

Are California’s unemployment benefits tax-free?

California’s unemployment benefits are not tax-free. Any fund you get from the State or the federal government is included in your gross earnings and taxed at your regular income rate. Moreover, applicants do not have to pay Medicare taxes and Social Security on your benefits, but you must report them on your tax return as income.

Final Thought

Receiving unemployment benefits may not be a comfortable way of living. While California’s EDD has said they will begin to automatically file extensions for those with exhausted claims (provided they first started receiving benefits on or after June 2, 2019), some applicants may have to wait until even July, before their payments start to arrive.

For more details on California’s unemployment benefits or you want to make inquires about your eligibility and specific facts, experienced employment attorneys at United Employees Law Group are always available to help. Get in touch through the contact form below.

Photo Credit

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YOUR EMPLOYMENT RIGHTS DURING COVID-19 https://www.california-labor-law-attorney.com/your-employment-rights-during-covid-19/ Tue, 09 Jun 2020 18:32:13 +0000 https://www.california-labor-law-attorney.com/?p=6246 The COVID-19 coronavirus has caused far-reaching changes to normal life in California and other parts of the globe. In addition […]

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The COVID-19 coronavirus has caused far-reaching changes to normal life in California and other parts of the globe. In addition to health fears, the pandemic has led to dramatic changes at work, which may cause California employees to feel uncertain and worried about their employment. Such feelings are reasonable considering the different unique challenges everyone is facing. Likewise, it can be difficult to stay up to date with employment rights during this time when employment laws are being changed.

Furthermore, the tendency for employers to misuse their power has been a familiar problem for employment lawyers. But it is an important issue, which is highlighted and exacerbated by the current pandemic. Many employers are responding to COVID-19 either by (i) keeping their businesses open and running as far as possible and (ii) cutting costs by any means available. Even though these actions are legitimate, they both come with increased risks of employers abusing their power with the aim to shift the burdens and costs of the COVID-19 pandemic on their workers.

It is understandable that employers want to keep their business open and operating as close to normal as possible. Despite introducing a general lockdown, the California labor law expressly permits people to leave their homes to work where it is not ‘reasonably possible’ to work at home, and the ban on gatherings of two or more people does not apply where these are essential for work purposes. In this time of crisis, it is important for all California employees to understand their rights in the workplace and to know where to turn to if those rights are violated. This post, therefore, focuses on the employee’s employment rights during COVID-19 beyond the statutory health and safety obligations.

 

EMPLOYEE RIGHTS

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It is generally a breach of an agreement for an employee to fail to turn up at their workplace and perform their job, as they would do normally. It may lead to dismissal or corrective action. However, the COVID-19 coronavirus pandemic has altered this basic position in quite a lot of ways. California employers who require their employees to come to work may themselves be breaching the implied duty of confidence and trust owed to their employees, or their duties of care in the contract provided there is one. Whichever way, employees can resign and pursue a constructive claim for dismissal, partially because of the difficulty they may face in finding new work during the crisis.

 

RIGHT TO A SAFE WORKPLACE

Subject to the California Occupational Safety And Health Act, employees have the right to a safe workplace. Your employer is required to take reasonable steps to ensure your workplace is free from any serious and imminent danger during the Covid-19 coronavirus pandemic, and that includes:

  • Performing a COVID-19 risk evaluation
  • providing and enforcing the use of face masks, hand sanitizer and other PPE suitable for your workplace
  • Introducing social-distancing measures like work station rearrangement, staggering schedules; and thoroughly cleaning and disinfecting the workplace, particularly high-touch objects and equipment.
  • Regular adherence to guidance issued by the government.

If you belong to the vulnerable groups of employees, or your employer cannot guarantee most of the safety measures mentioned above and you believe you are in great danger if you return to work, then you have the right to stay at home. You are also free from reprisals or any disciplinary action or pay cuts, which are illegal under the California labor law.

 

RETURNING TO WORK AND EXPOSURE TO COVID-19

shutterstock/David OdishoAs California is gradually easing the lockdown, most businesses are also putting things in place for employee’s safe return to work. Employees that return to work to comply with their employer’s instruction may be exposed to catching COVID-19, and the employers to a criminal sanction.

 

What if an employee gets COVID-19 coronavirus on their job and believes it was their employer’s fault. Is it possible for the employee to sue their employer for compensation? With just a few exemptions, California workers who contracted COVID-19 at work cannot sue their employer for the losses arising from their illness (including suffering and pain) in any civil court. Often times, the employee will only be restricted to pursuing relief through a workers’ comp claim.

EXCEPTION TO WORKERS’ COMPENSATION CLAIMS

The exceptions to the workers’ compensation claim are when you were injured or ill because of your employer’s deliberate wrongdoing, severe and willful misdemeanors, contrary to mere negligence. In this case, you may sue your employer outside of the workers’ compensation system.

To prevail on such a claim, the infected worker would have to prove that the employer maliciously engaged in such misconduct. Mere opening up for business after the California government has said it’s okay may not amount to willful misconduct – but opening before that might. Furthermore, employers may face a greater liability risk under such a claim if they carelessly and maliciously fail to provide necessary protective equipment or enforce social-distancing or hygienic guidelines.

 

THE EXECUTIVE ORDER

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In the Executive Order N-62-20 signed on May 6, 2020, California Gov. Gavin Newsom mandated a conjecture that “a worker’s COVID-19-related illness or injury shall be assumed to stem out of the workplace for the purpose of awarding workers’ compensation benefits if some requirements are satisfied”. Under the executive order, the presumption only arises if the worker tested positive for COVID-19 coronavirus or was diagnosed by a qualified doctor as having the disease within 14 days of resuming to work as directed by the employer or at the employee’s place of employment. The presumption does not arise if the employee works from home during that timeframe, or if the worker was otherwise off duty on or after March 19, 2020.

The existence of a presumption does not mean the source of the employee’s infection is undisputable. On the contrary, the executive order confirms that the presumption “may be refuted by other evidence”. Although there probably won’t be a rash of employee lawsuits related to COVID-19, it can be very tricky to establish the basic causative links between the employers’ breach and the employee catching the virus. Therefore, most claims related to the coronavirus may be covered by workers’ compensation, but would usually specify that the employee was exposed to the virus at the workplace and became sick, unable to work, and require medical attention and treatment. Moreover, employees can receive benefits for a work-related illness or injury quickly without having to prove that their employer was at fault. If the employee has paid sick leave benefits exclusively available in response to COVID-19 coronavirus, those benefits should be used before any workers’ compensation benefits are collected.

If you contracted COVID-19 at work or you feel you have good reasons to sue your employer because of their conduct about the COVID-19 pandemic, I would suggest that you consult an experienced employment attorney. United Employees Law Group will explain your options for seeking compensation for the losses you have suffered—whether from contracting the disease at the workplace or from taking steps to prevent it.

 

WRONGFUL TERMINATION FOR “WHISTLEBLOWER”

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Employees that are concerned about safety in their workplace have the right to speak up without fear of retaliation. This is known as whistleblower protection. But if an employee is fired or dismissed due to circumstances where they have raised a health and safety concern or complaint, for instance;

  • On the lack of Personal Protective Equipment (PPE) that they consider appropriate for your role (to limit the spread of COVID-19),
  • On working in hazardous conditions,
  • In violation of stay at home orders or of physician’s orders – then this may be an automatic wrongful termination.

The California labor law prohibits an employer or any person acting on behalf of your employer from wrongful termination or retaliating against their employees for acting as a whistleblower. If having raised a health and safety concern the employees are subjected to unfair treatment from their employer or any person acting on behalf of the employer leading to discrimination/harassment and employment termination, then the employee may have a right of action.

 

LAYOFF

Laying off an employee is different from firing an employee. Subject to the California labor law, employers are prohibited from firing an employee because they are sick or have COVID-19 or other medical conditions. However, if the employer has no work for the employee, or there is less work than usual or wants to cut costs, the employer may decide to lay off some employees (both sick and healthy).

Laying off workers is one of the toughest decisions for a company and most likely to land an employer in legal trouble. Before laying off workers, employers must have carefully considered different alternatives and set criteria for which employees to lay off. To ease the pain for employees that have been relieved of their employment, they have the right to apply for the new COVID-19 Pandemic Unemployment Benefit.

 

SICK AND LEAVE PAY

Employees showing symptoms of COVID-19 have the right not to go to work. While they are sick with COVID-19 coronavirus, the employee may be entitled to statutory sick pay from their employer. This is also paid to employees who are self-isolating because someone in their home displays symptoms of COVID-19, or they decide to stay at home due to a high risk of severe illness from COVID-19. The statutory sick pay takes effect from the first day that an employee is self-isolating, provided it is part of the employee’s contract of employment. Otherwise, employers are not mandated to pay their employees if they cannot come to work because they are sick with coronavirus. In such a situation, the employee should apply for the COVID-19 unemployment claim.

If, on the contrary, the employee is not sick, but could not return to work because they have kids or other relatives to cater for, they can ask their employer for paid leave. If the employer denies the paid leave, the employees can ask for statutory leave as specified in the California labor law.

 

Can An Employer Request to Take The Temperatures Of Their Employees At Work?

Of course, yes. Because of the present pandemic crises, employers can request information from their employees about symptoms, and this includes taking your body temperature at work – and requiring that you stay home if you are sick.

 Do Employees Have To Tell Their Employer About Their Medical Condition(s)?

The California Occupational Safety And Health Act allows employers to ask their employees about medical conditions ONLY if it is to protect other workers from infection. Employers may not ask an employee who is asymptomatic (not displaying symptoms of an illness) if they have any medical conditions that might increase their vulnerability to the coronavirus.

For instance, the symptoms of COVID-19 coronavirus include cough, fever, and shortness of breath. Employers may not ask their employees who are not showing those symptoms about any medical condition that may make them more vulnerable to the virus. Employers should, however, inform their workers about the risks of infection. This way, employers may encourage their employees to present any personal medical information, but that depends on the decision of the employee.

 

WHAT CALIFORNIA EMPLOYERS CAN DO

Employers also have to be careful of this new presumption that a worker’s COVID-19 infection may be an industrial sickness protected by workers’ compensation laws. To protect themselves against possible claims that a COVID-19 infection was caused by willful misconduct, California employers should consult a competent attorney while they prepare to reopen for business.

 

FINAL THOUGHT

This post is not calling for employees to refuse to work during the COVID-19 pandemic, but that the crisis should also not deny employees (including essential service workers) of their basic right to safe working conditions. United Employees Law Group understands that these are challenging times for both employers and their employees, and we are particularly concerned about helping to protect employee’s jobs, wages, and livelihood as mandated by the “Equal Employment Opportunity Commission” and “California Department of Fair Employment and Housing”.

CONTACT US

If you are concerned about your rights as an employee or you feel your rights have been violated by your employer during this pandemic period, do not hesitate to contact United Employees Law Group. We are here to answer your questions, and help you understand what you can do to protect you and your job during this time.

 

Photo Credits

shutterstock/David Odisho
Shutterstock/Sam72
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Shutterstock/shutteratakan

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Can I Be Compensated For Workplace Hearing Loss? https://www.california-labor-law-attorney.com/can-i-be-compensated-for-workplace-hearing-loss/ Mon, 30 Dec 2019 22:15:57 +0000 https://www.sanfranciscoemploymentattorneys.net/?p=2079 Your hearing is one of the 5 senses that you really rely on in life and at work. But, what […]

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Your hearing is one of the 5 senses that you really rely on in life and at work. But, what a lot of people don’t realize is that if they are consistently exposed to noises at work, they could be causing hearing loss. While a lot of the issues that can happen are not permanent, if they go untreated, you could face hearing loss forever.

How Many People Experience Noisy Work Conditions?

According to the CDC somewhere around, 30 million people experience noisy workplaces. But, hearing loss doesn’t just involve noisy workplaces – it can also deal with chemicals, metals or solvents that you use in the workplace, that can damage the inner ear.

What Types Of Jobs Put Workers At Risk?

When talking about noisy workplaces or dealing with chemicals, these are the top jobs that put people at risk for hearing loss.

– Construction
– Mining
– Nightclub Jobs
– Auto/Motorcycle Manufacturing or Testing
– Carpentry
– Airline Maintenance
– Manufacturing and Factories

Man using saw on wood

Noises louder than 80DB can damage the inner ear permanently. Unfortunately everyday things like tools, engines, and music – are all 120DB or louder!

Help Reduce The Risk Of Hearing Loss

If you work in a noisy place you can help reduce hearing loss by wearing protective equipment. Here are a few tips to take into consideration while you are on the job.

– Wear Protection: Even if your boss doesn’t provide ear-wear, you should be wearing it, so get yourself earplugs or muffs that would reduce the noise.

– Schedule Hearing Tests: When you schedule a hearing test on a regular basis you can become aware of if your job is causing more of a hearing loss or not.

– Take Breaks: When possible, take breaks away from the noisiness going on around you. Even if you are wearing protective equipment, you still should be taking breaks. Taking breaks away from the equipment doesn’t mean you’re safe at a few inches. You should be placing yourself a few feet away from the equipment and the noise!

– Be Aware Of Loud Equipment: Make sure that you stay away from loud equipment when possible. Jackhammers, for example, can really increase your chances of hearing loss because of how loud they are. A Jackhammer can emit 120DBs even if it’s 3 feet away from where you are!

While that is a typical distance for people walking by it, it doesn’t account for workers that have to hear it at a much closer distance for a much longer time.

Can You Get Workers Compensation?

If you are going for regular visits to your audiologist and they suspect that your hearing is getting worse due to your job and prolonged workplace noise, you should know that you could have a case for workers compensation to help cover your medical costs.

Group of nurses and doctors standing with arms crossed

In fact, if the hearing loss is really bad, you might even be able to qualify for social security disability benefits IF you can’t return to work because of the hearing loss. If you are seeking workers comp, seeing a lawyer that deals with employment laws or workers comp is going to be in your best interest.


Photo Credit: Shutterstock Bogdanhoda/Blue Planet Studio

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5 Reasons Why a Workers’ Compensation Claim Can Be Denied https://www.california-labor-law-attorney.com/5-reasons-why-a-workers-compensation-claim-can-be-denied/ Mon, 07 Oct 2019 08:26:22 +0000 https://www.sanfranciscoemploymentattorneys.net/?p=2055 After you’ve had a workplace accident, the very last thing you want to hear, is that your workers’ compensation claim […]

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After you’ve had a workplace accident, the very last thing you want to hear, is that your workers’ compensation claim has been denied. Unfortunately, it happens all the time. Instead of trying to recuperate and get better, you’re left asking yourself questions about why it was denied, what happened, how you are going to pay your bills – and if it will get fixed.

It’s almost impossible to say why it got denied for sure, but there are common reasons why a compensation claim has been denied.

The Application Was Too Late

Every state in the US has guidelines and deadlines for filing the compensation claim. If you don’t report it on time, you could get denied. There are usually 2 types of deadlines:

– The deadline for you reporting the injury to your employer
– The deadline for filing the compensation claim for your benefits.

If you miss either of these it’s most likely the reason you were denied benefits!

Questionable Accidents

While people get hurt on the job every day, if you don’t have a witness – or even a camera showing what happened, it’s hard to prove that it did happen. If you don’t have any witnesses, the insurance company will be hard-pressed to believe that the accident happened the way you said it did.

It’s important to remember that the insurance companies aren’t working for you – they want to pay out as little money as they possibly can! Because of this, it’s better for credibility, if you did have a witness for your compensation claim.

Man hurt at construction site with other worker kneeling over him trying to help

If you did not have any witnesses you still should be reporting to your boss, manager or supervisor and you should be writing down as much detail as possible. When it happened, where it happened, how it happened, etc. You should also seek medical attention because this is a report that will back up the facts and details you made in the report to your boss.

You Were Liable!

If you were found liable in any way and caused the accident, this will get your compensation claim denied. This means that if you were at your job, or on the clock and were using any substances; drugs or alcohol and they were the reason for your accident, you are at fault – not the company.

Inconsistencies In Your Story

When your story is inconsistent this raises red flags to the insurance companies. For example, if you told your boss one thing and tell your doctor another thing entirely, this could cause a denial in your compensation claim. Make sure that when you are telling your story, that you are being consistent with what you say!

You Didn’t Go To The Doctors

When people are hurt, they usually go to the ER, the hospital or to their doctor. When people are hurt at work, for some reason, they decide to skip medical attention. Not smart! Going to see a doctor when you get hurt at work is going to do 2 things.

1- It shows that you were hurt enough to go to the doctor to get checked out.

2- Everything that happens from the time your doctor sees you until the time you leave the room is going to be documented. This document can and usually will be used as proof to the insurance company – and the employer, that you were hurt, you had these injuries, you were given these treatments/surgeries/instructions and how much everything cost.

Doctors standing with arms crossed

If your employer denies the report or does not want to pay for your compensation claim, you can hire a lawyer. When you hire a lawyer, they will collect all the evidence – including the report from the hospital and it will be used in court for your compensation claim.

Worker compensation claims either go really well and everyone gets along nicely and you get the compensation and benefits you need to recoup and get better. Or they go really bad and you have nothing but issues along the way.

If you do have issues, it’s in your best interest to hire a worker compensation lawyer to make sure that your claim is properly prepared and submitted. Not only that but you’ll have someone by your side that will stand up for you and your rights.


Photo Credit: Shutterstock Halfpoint/Blue Planet Studio

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Common Mistakes Made When Filing a Workers Compensation Claim https://www.california-labor-law-attorney.com/common-mistakes-made-filing-workers-compensation-claim/ Mon, 18 Sep 2017 07:26:19 +0000 https://www.sanfranciscoemploymentattorneys.net/?p=1482 There are common mistakes made when filing a workers compensation claim which you should avoid. First, you should fill the […]

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Man and woman filling out workers Compensation forms on a laptop

There are common mistakes made when filing a workers compensation claim which you should avoid. First, you should fill the compensation claim with an open mind knowing nobody will report to the workplace while expecting to be injured.

There are different forms of compensation which you can access after you file for the compensation claim. If you are injured, then you should file for compensation so that you can access funds which you will use to pay for treatment services. If mistakes are made while filing for compensation, then you may face challenges when trying to file for compensation.

Failing to report the injury

You cannot access workers compensation if you decide not report the injury. If you have been faced with an incident, then the first step you should take is to report the injury to your employer. There are two ways you can report the injury. You can either report in writing or report in person. If you fail to report to your employer, there will be no records to your injury which will compromise your process of trying to file for the compensation.

Reporting your injury to the doctor first

If your injury is not a medical emergency, then you should consider reporting to your employer. It is necessary to report your injury to the employer before you proceed to report to your doctor. Even if you feel like you should see your doctor as fast as possible, but you should ensure you report to the employer first.

Seeking coverage through your private health insurance

An employer’s workers compensation will cover your medical bills as well as other disabilities which can arise out of the injury. It is unlike your personal health cover which will only pay for your medical bills. Some private insurance providers can even deny you the claim if they discover you were injured in the workplace.

Failure to report injury because you are not sure of the cover

Even if you don’t have enough information about areas where your cover can help, it is necessary for you to report all cases of injury ion your workplace so that you can access compensation if the employer has any cover.

Failure to provide accurate and complete injury report

The insurance cover will provide to you compensation based on the injury report which you will provide. It is necessary for you to provide details about your injury so that you can access the compensation.


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