Proving Workers’ Compensation Claims

Workplace accidents and injuries take many forms. Each one has a different set of causes, circumstances, and outcomes. But there is only one way to be sure you get the financial compensation you need to cover your costs and lost income: workers’ compensation. This article dives deep into what makes for a strong California workplace compensation claim and how to prove it, including:

• The elements you will need to prove to get workers’ compensation.
• The evidence needed to prove a workers’ compensation claim in California.
• How to handle a qualified medical evaluator form without making costly errors.

In an ideal world, workers’ compensation insurance providers would take one look at the bill from your doctors and your salary and pay you the full amount you deserve for all your losses and costs, including future ones.

Sadly, that is not the world we live in. Instead, a workers’ compensation claim can be an uphill battle against your employer, their insurer, and sometimes even a judge or jury – but it is a fight that can very much be won if you have the right tools and evidence.

In addition to an experienced workers’ compensation attorney, you will need the following pieces of evidence, explained in more detail below:

1. Date, time, and location of the injury. The more proof of this you have, the better.
2. Details about your employer and whatever insurance policy they have.
3. Details about your injury, including the body part(s) affected and medical treatment required and recommended.
4. Your occupation at the time of the injury, both the job title and the responsibilities and duties you perform.
5. The benefits you have already received, including any temporary disability.
6. The consequences of the injury on your work as well as your life outside work.
7. Any additional injuries you suffered after or as a result of the initial injury/incident.
8. Any medical treatments required or undergone already, including surgeries, with the costs.
9. (For cumulative trauma injuries only) the duration of the work that caused the injury, and under whom you have done such work for the last 2 to 3 years.
10. Prior injuries to the same body part or with similar consequences, especially if you were previously awarded any compensation or disability for them.

How Should I Document My Accident Or Injury?

Immediately after your injury, or as soon as it is safe to do so, you want to gather as much evidence as possible about what happened. Make sure you record the date, time, place, and any other pertinent details, as well as evidence to back up your claim.

From the contact information of witnesses to your accident to photographs of what happened and what injuries you suffered, everything you can get is valuable towards proving that things happened the way you are claiming they did.

What Medical Evidence Do I Need For A Valid Workers’ Compensation Claim?

It is crucial to visit a doctor as soon as possible after your injury or as soon as you notice any symptoms. Not only will immediate medical attention be in the best interest of your health and recovery, but their report will go a long way towards proving your claim is valid, and your disability is connected to your workplace injury.

You should also keep careful records of any future and all past injuries, as these can quickly become extremely relevant.

They might be used by insurance providers to dismiss or diminish your claim, or they could be used by your attorney to enhance your claim, arguing compensable consequences for those which were caused by your initial injury, or subsequent injuries trust fund benefits for repeated injuries and disabilities caused by work (this is often claimed by police officers, firemen, and other professionals in dangerous lines or work).

Why Are My Current Job And Role Important To My Workers’ Compensation Claim?

Your job, both in terms of your official title and all duties and responsibilities, is vital to establishing several aspects of your claim for compensation.

• First, it is important to demonstrate that your injury happened within the scope of your employment and duties.
• Second, it will be necessary to establish how badly the injury affects your future work and how much the injury will prevent you from working.
• Finally, the value of your claim depends in large part on how much work you have or will miss, which makes everything from your current salary to your promotion potential relevant.

How Will The Type And Location Of The Injury Affect My Compensation Claim?

Some injuries are obvious and clearly connected to your work. If you lose a hand to a machine you were asked to use as part of your job, no one will question the connection to your work.

Unfortunately, not all injuries are so evident, but they still deserve to be compensated for. The above case is an example of a specific injury connected directly to an event or incident. But there is another kind: cumulative trauma injuries.

Cumulative trauma injuries are those that are caused by ongoing stresses, repeated motions, or long-term exposure to certain chemicals. These can be very serious and disabling injuries that are connected to your work but not to any specific instance. A typist develops carpal tunnel syndrome not because of a single fateful keystroke but after millions of them year after year.

Sometimes, these will even stretch over a time period with multiple different employers, of whom only those from the last 12 months of exposure need to be filed against.

How Are Repeated Injuries Taken Into Consideration In Workers’ Compensation Law?

Repeated injuries to the same location can be the cause of your disability, with cumulative trauma injuries, which could strengthen your claim. Unfortunately, insurance companies could also use repeated isolated injuries against you in any individual claims.

Fortunately, if you have had prior disability awards for that body part, a skilled lawyer may be able to get you access to subsequent injury benefits. Roughly speaking, this means that by pointing out the combined effects of the injuries and disability, you can gain access to more consequential compensation.

Do I Need A Workers’ Compensation Attorney?

In addition to gathering evidence and seeing a doctor to get the medical training you need, it may be important to consult with an attorney. For one thing, the workers’ compensation filing process is complicated and easy to make mistakes on. For another, it is highly time-consuming and stressful, which is the last thing you need when dealing with an injury.

You might not technically need an attorney if everything seems to be going smoothly. If your case is unopposed or your disability or compensation claim has already been accepted, you might be able to manage it all on your own. On the other hand, everything going too well could also be a sign that your insurance is trying to get away with paying you less than you deserve.

Obviously, if things are not going well, if your employer is contesting the facts, or the insurer is refusing to pay out what you need, or trying to get you to negotiate down, you need an attorney. You might also need an attorney if your doctor has said you can only return to work on modified duty, but your employer argues that none is available, though in that case, what you need is a disability attorney, not a workers’ compensation attorney.

For example, you will absolutely need an attorney if the insurance has sent a letter asking you to choose a qualified medical examiner.

What Is A Qualified Medical Evaluator (QME)? Why Is My QME Choice So Important?

Sometimes, you will reach a crossroads in your case where a seemingly simple decision can have a huge impact on the outcome of your claim. A Qualified Medical Evaluator request letter is one of those times.

If you have been hurt on the job, and your doctor sent instructions for you to take time off work, your employer’s insurance is supposed to pay you roughly two-thirds of your normal wage. But they might not want to do that. So they will send you a letter contesting the opinion of your doctor with regards to the disability or to some aspect of the treatment he is requesting.

In this letter, they will enclose a blank “request for a qualified medical evaluator” form. They will leave it up to you to fill it out, but you might be entirely lost as to how to do that or why doing it quickly is incredibly important.

There are several traps for the unwary in a QME request form. For one, you only have ten days to fill out the form. If you fail to do so, the employer or the workers’ compensation insurance adjuster gets to pick the specialty of the doctors on the three-doctor list that the state will send out.

Unfortunately, there are a lot of unsympathetic doctors out there who are more than happy to get paid to come and take a very skeptical look at your situation and claim. The insurance company knows exactly who to call if you give them the chance to choose the doctors. They come in, do a very rapid evaluation, and then write a report that is technically correct, but fails to appreciate the nuance of your case and injury. They will strictly apply rules to your detriment.

How Can A Workers’ Compensation Attorney Help Me Choose A Qualified Medical Evaluator?

An attorney can either represent you and obtain that evaluation directly or, at the very least, be able to advise you on how to navigate the examination process, including your right to choose the specialty of the doctors that get sent.

Indeed, when the list of three gets sent, you will get to choose one. There may be one that is considerably more favorable, competent, sympathetic and, familiar with workers’ compensation rules. Your attorney will help you choose that doctor within the extremely limited ten-day time frame.

Because if you blow that 10-day deadline, the workers’ comp adjuster gets the right to pick and schedule the doctor, and you can bet they will choose the least favorable one.

This is a watershed moment because the labor code, unfortunately, means there is very little your attorney can do to get that evaluation contested or obtain a new one after you have already been through one evaluation.

For more information on Proving A Worker’s Compensation Claim In CA, reach out to a qualified workers’ compensation attorney near you. Get the information and legal answers you are seeking by calling (530) 287-6674 today.