San Jose Workers’ Compensation Attorneys
A workplace injury will place countless obstacles before you. If you’re like most people, you go to work each day and put your health at risk. If you get injured, you may need an enforcer to ensure that your employer or insurance company pays up. Ratto Law Firm is the official enforcer for San Jose, CA. We give our clients a real path to recovery.
It will help if you speak with a workers’ comp attorney as early as possible. If you’re located in San Jose, ensure that you speak to an attorney licensed to practice law in California. Doing so will afford you a better chance you of getting a positive outcome.
You deserve the best representation. We serve San Jose residents in the following workers’ comp categories:
- Construction injury
- Denied workers’ comp claims
- Head and brain injury
- Knee and shoulder injury
- Traumatic heart claim
- Uninsured employer workers’ comp claims
- Work-related death
- Work-related motor vehicle accident
City of San Jose Benefits
Each state – not the federal government – operates and regulates a compensation program. In San Jose, and in all other cities, California employers must provide workers’ compensation insurance to employees. They can buy it from one of the many licensed insurers in the state.
Alternatively, they can get it from the State Compensation Insurance Fund (SCIF). The California Legislature created the SCIF in 1914. They wanted to ensure that all organizations with employees could provide workers’ compensation coverage. The SCIF is a state-operated body that operates in competition with private insurers. Some employers cannot get workers’ comp coverage from private insurers. The SCIF acts as a last resort insurer for these employers.
Let’s outline the difference between Workers’ Compensation and State Disability Insurance. If your injury or illness is NOT work related, Disability Insurance will pay you a weekly benefit, but if an employee gets injured at work in San Jose, he or she can receive workers’ compensation benefits. An employee can also claim for an accumulative medical condition due to his or her occupation. Workers’ comp also covers existing work-related medical conditions.
The employee gets these benefits in exchange for a waiver of the right to sue the employer. With workers’ comp, you’re unlikely to receive punitive damages or compensation for pain and suffering. The law also limits to the amount an injured employee can recover. They also protect coworkers by eliminating their liability in most accidents.
You can get injured by a single event. For example, you can get burned by a chemical that splashes on your skin or hurting your back in a fall. You can also get injured in a vehicle accident while making deliveries. Alternatively, you can get injured because of repeated exposures at work. For example, you can develop carpal tunnel syndrome from doing the same job over and over again. Alternatively, you may lose your hearing due to constant noise.
Carpal tunnel syndrome has become prevalent. It is the result of compression of the median nerve as it goes through your wrist inside the carpal tunnel. This compression causes tingling, pain, numbness, or weakness in the wrist and hand. Workplace related risks include repetitive, forceful tasks. Vibration or extended use of the hands or wrists in an uncomfortable posture can also cause you to develop CTS. The fabric finishing, textile, and coating mills industries have high rates of CTS. Animal slaughtering and processing also have high CTS rates.
In San Jose and other cities in the state of California, state and private sector employers must offer workers’ compensation benefits. Workers must report injuries or illnesses to their employers as soon as possible. If your medical condition developed over time, report it as soon as you learn or believe that your job was the cause of it. The employer has to arrange treatment. It’s important to tell the physician that the employee’s injury or illness is work-related. The incapacitated worker must update the employer of the treating physician’s advice. It’s critical that the employer knows about the employee’s ability to resume work.
Your employer’s insurance company has to pay for your treatment once you report the injury and file a claim. It must cover all treatment “reasonably required to cure or relieve” the effects of the injury. You don’t have to bear any deductible or out-of-pocket cost.
Filing the claim opens your case for workers’ compensation in San Jose. The insurer has 90 days from the date of filing to accept or deny your application. If they do not respond within 90 days, the law presumes that your work was the cause of your illness or injury. You are eligible for up to $10,000 in medical treatment while the insurer considers your claim.
The following workers’ compensation benefits are available in San Jose:
- Temporary disability and lost wages
- Medical and hospital benefits
- Permanent disability
- Supplemental benefits
- Death benefits
Injured workers in San Jose are entitled to two-thirds of their pre-tax gross wages, as set by state law, up to the maximum allowable. The maximum rate in 2018 was $1215.27 per week for a total disability, while the minimum paid was $182.29. Many private companies and self-insured public entities make up the salary difference so that a worker still gets his or her regular income after sustaining a work-related injury.
Workers’ Compensation for High-Risk Occupations
Nurses, police officers, firefighters, and construction workers are in high-risk occupations. For these jobs, workers’ compensation is critical for protection. Nurses and doctors sometimes have to treat patients with contagious diseases. Construction workers often fall from scaffolds or get hurt by heavy equipment. Police officers can sustain gunshot wounds or assault injuries, and firefighters sometimes suffer burns and the effects of smoke inhalation. Workers in San Jose still face pushback from employers, despite the known dangers of these occupations.
Self-employed people only need workers’ comp if employed in a hazardous line of work. If you’re self-employed, check with the California Department of Industrial Relations. They will determine whether you’re carrying enough insurance.
Failure to carry workers’ compensation insurance is a criminal offense in San Jose and the rest of California. An employer can face a penalty of $10,000 if an employee sustains an injury and the employer is not insured. Moreover, employers cannot make employees pay for or offset the cost of the policy. Benefits must cover all workers. It is unlawful to penalize or fire an employee for filing a workers’ compensation claim.
Employers’ insurance companies in San Jose have the tendency to deny workers’ comp claims. Alternatively, sometimes they don’t award full benefits. You should be aware that missing the reporting deadline can lead to denial of your application. File a report of your illness or injury to your employer within 30 days of your injury date. For an illness that develops over time, report as soon as you realize that it is work-related.
Your insurance company may deny your initial workers’ comp claim as a matter of routine. Their thinking is that most injured workers will not continue with the matter if their claim does not get approval. Also, your insurer may think that your employer’s policy does not cover your injury. In such a case it will deny your claim.
The insurer can deny that you worked for the insured employer. For example, a cleaner might work for XYZ Janitorial Services. She cannot claim from ABC Corporation, even if she cleans their San Jose branch offices every day. The insurer can also deny that the injured worker was an actual employee. They can use this argument if you’ve signed an Independent Contractor Agreement. Another common defense is that the injury is not work-related.
It is essential that you get medical attention after an injury at work. You’ll need medical records for your workers’ compensation claim. Also, getting medical care is the right thing to do for your health. Do not miss your medical appointments. If you do, the insurer may think that you no longer need care.
You can challenge the decision to deny your claim. There are deadlines for filing the relevant papers, so don’t delay. You can represent yourself, but the best course of action is to hire a workers’ comp attorney, San Jose. You will need a hearing from your local Workers’ Compensation Appeals Board judge. After the hearing, the judge will decide if the insurance company has to accept your workers’ comp claim. If the judge’s decision favors the insurance company, you can appeal this decision.
The insurance company can use the post-termination denial under Labor Code 3600(a)(10). Under this code, the employee files a claim for after getting laid off or terminated. The general course of action in such situations is for the insurance carrier to deny the application. The insurer will not pay compensation unless:
- The employee has medical records dated before the notice of layoff or termination. These records should contain evidence of the injury
- The employer received word of the injury before the notice of layoff or termination
- Toxic exposure on the job led to the development of the injury after layoff or termination
- Injury occurs after the employee receives the notice, but before the effective date
The workers’ compensation system tends to drag out medical care. The delays are making it difficult to recover and get back on the job. Doctors and injured workers have shown that denials are at an all-time high. However, the California Workers’ Compensation Institute says that the system is working well. According to them, the majority of medical requests submitted by workers gain approval.
Ratto Law Firm knows better. We know the process inside out and will ensure that you get a positive outcome.
Workers’ Compensation Appeals in San Jose, CA
In California, the Workers’ Compensation Appeals Board has full judicial power. It offers leadership and guidance to the workers’ compensation community. The governor appoints the seven-member board, and the Senate confirms it. Its major functions include adjudication of the appeals process. Another function is the reexamination of decisions by workers’ compensation law judges.
Sections 110 through 138.2 of the Labor Code set forth the statutory scheme for the WCAB. The governor designates a chair from its membership. The chairman can select a secretary and two assistant secretaries, who must be lawyers admitted to the bar in California. The WCAB consists of one workers’ compensation judge, three deputies, and 12 attorneys.
Either side can appeal the judge’s decision. Three board members review appealed cases. Either party can also appeal the decision of the three board members to the full membership of the WCAB. You always have the right to legal representation. The WCAB also offers virtual hearings. These hearings give you the opportunity to attend hearings online. This option may be more convenient for you
You might need a hearing even if your insurance company accepts your workers’ comp claim. For example, your disability payments may be too low given your average weekly wage. Or, the insurance company may refuse to approve surgery. You only have 20 days from the date you received your decision or award to appeal it.
For federal workers in San Jose, the Employees’ Compensation Appeals Board has final authority. The ECAB determines the liability of the federal government when employees sustain injuries. The Board makes its decisions under its statutory mandate, based on a thorough review of the case record. The Office of Workers’ Compensation Programs compiles these records.
Did You Know?
- Part-time or temporary workers may also be eligible for benefits
- Your employer has to pay for medical care if you’re injured on the job – whether you miss time from work or not
- You don’t have to be a legal United States resident to receive most workers’ compensation benefits
- Workers’ comp may cover you as an employee even if you’re an “independent contractor”
- You receive benefits regardless of who was at fault for your job injury
- It’s illegal for your employer to fire or punish you for having a job injury. They also cannot penalize you for filing a claim for workers’ compensation benefits.
If you’re having trouble accessing your workers’ comp benefits, call the Ratto Law Firm at (408) 293-9300 for a free consultation. Or, you can complete the intake form at the bottom left hand corner of our Contact Us page. We are located at 1871 The Alameda Suite 425, San Jose, CA 95126 near the Hotel Rose Garden and the Central YMCA. Other nearby landmarks include College Park and Planned Parenthood San Jose Health Center. Call or visit us today!
Injured? Denied Benefits?
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