Basics of the Workers Compensation System

Basics of the Workers Compensation System - A Primer

Introduction

Today, we'll delve into the fundamental principles of the workers' compensation system. This primer aims to provide a basic understanding that will prove useful as you navigate through your workers' compensation claim. We will cover the importance of immediate injury notification, the active and permanent phases of a workers' compensation claim, and the critical recommendations made by doctors during the process.

Overview of Discussion

Let's begin with a brief overview of the topics we'll cover today:

1. Importance of Prompt Injury Notification
2. The Active Phase of a Workers' Compensation Claim
3. The Permanent Phase of a Workers' Compensation Claim
4. Doctor's Recommendations and Their Impact

The Notification Door

Before delving into benefits and obligations within the workers' compensation system, it's crucial to address the initial step – notifying your employer of your injury. This is a legal obligation, and failure to do so promptly may lead to claim denial.

A visual aid: A diagram illustrating the active and permanent phases, with emphasis on the notification door.

Tips for Notification:

• Notify your employer immediately after an injury.
• Ensure you can prove the notification (e.g., written report, witness).
• Inform treating doctors and medical staff about the work-related nature of the injury.

Active Phase vs. Permanent Phase

The workers' compensation system comprises two phases – the active phase and the permanent phase.

Active Phase:

• Doctors actively work to improve your medical condition.
• Entitlement to medical care related to the work injury.
• Compensation at 66% of the average monthly wage prior to the injury.
• Litigation may occur over issues like recommended treatments or compensation disputes.

Permanent Phase:

• Begins after reaching Maximum Medical Improvement (MMI).
• Doctor's three recommendations: Supportive Care, Impairment Rating, and Compensation.

Supportive Care:

• Ongoing medical treatment to monitor rather than cure.
• Agreement to the adequacy of supportive care is essential within 90 days.

Impairment Rating:

• Determined based on the American Medical Association (AMA) guidelines.
• Essential to understand and potentially dispute if deemed inadequate.

Compensation:

• Varied based on the type of injury (scheduled vs. unscheduled).
• Scheduled injuries involve limbs and have a fixed compensation period.
• Unscheduled injuries require a loss of earning capacity analysis for lifelong compensation.

Workers Compensation Traumatic Brain Injury (TBI)

There are roughly 3 million traumatic brain injuries reported in the USA according to the CDC and the majority are seeking emergency medical treatment. With proper treatment, TBI patients can make full recoveries and go on to lead a normal and fulfilling life. 

If you have suffered from a head/brain injury while on the job, it is recommended to seek legal advice. If that's the route you go, you will want to find someone who is certified as a workers compensation attorney. There are no up front fees if you are pursuing a workers comp claim and all fees are paid out at the end of the settlement. They typical attorney fee is 15% of the case settlement value. 

Things to Note about traumatic brain injuries and the workers compensation system.

- Workers compensation claims typically do not move quickly. Depending on the severity of the injuries sustained, a claim can take between 2 and 4 years to completely settle. The case will remain open while your attorney sets medical appointments, builds up a log of all injuries sustained, and works on the case.

- Case settlements drastically vairy by both state, level of permanent disability and overall injuries. The average settlement for a workers compensation claim with a head or central nervous system injury is $93,942.

- Traumatic brain injuries are much more complicated than a typical workers compensation case. It is always recommended when screening attorneys to see if they have experience dealing with these types of cases. When dealing with TBI cases, there are special treatments and doctors you will want your attorney to setup in order to get the best outcomes.  

What is a Traumatic Brain Injury (TBI)

In short, a TBI is an injury that is directly effecting your brain. Typically these injuries fall under two general categories. Closed brain injuries and penetrating brain injuries. 

- A closed brain injury can happen when a worker sustains an injury and there is no direct penetration to the brain. This also includes injuries with no break in the skull. Some of the more common types of closed brain injuries are sports related, vehicle crashes and slip and falls.

- A penetrating brain injury happens when the injured worker sustains a more violent trauma to the brain with at least some type of fracture or break in the skull. Some of the instances include severe auto accidents, forklift injuries, blunt force traumas, assaults, and injuries sustained while working in law enforcement, firefighting, construction and in the oil industry. 

Common TBI Symptoms

The brain is the most complicated part of the body and unlike most bodily tissues, it cannot regenerate cells. Therefore, when you sustain a traumatic brain injury it is likely there will be permanent damage that will never fully recover back to a pre-injury state. The brain functions as the center for bodily function and can controls a range of bodily activity both psychologically and physically. Depending the amount of trauma from the injury, effects can be mild to severe. Here is a list of the most common traumatic brain injury symptoms: Vision Problems, Coma, Seizures, Slurred Speech, Sensitivity to Sound or Light, Difficulty Concentrating, Loss of Balance, Anxiety, Headaches, Fatigue, Vomiting/Nausea and Brain Fog. 

Early Treatment and Intervention

If you have experienced a traumatic brain injury, it's important to quickly seek medical treatment for the injury. Studies have shown, waiting to treat symptoms of a TBI likely result in a worse outcome for the injured worker. If you have a Traumatic Brain Injury and are looking for an attorney who specializes in this field we can point you in the right direction. 

Simi Valley Workers Compensation Lawyer

Simi Valley is a great city with a very tight knit community. Here is some information if you are looking for a Simi Valley Workers Compensation Lawyer. Picking an attorney to help you represent your case can be a challenging endeavor and most people have never been in the position of needing an attorney to help represent their needs. 

How do workers comp attorneys get paid in California? There is no money up front for a consultation and all payments/fees are taken from the final settlement. Typically, it's only 15% as opposed to other types of law such as personal injury which usually take 33% of the settlement. 

Why would I need and attorney and can I represent myself? As an injured worker, you can defiantly represent yourself. You will be handling all of your medical appoints and be comminating directly with the defense attorney handling your case as well as dealing directly with the insurance company. You will also be in charge of handling the final settlement of your case. 

What are the benefits of hiring an attorney? When you retain an attorney, the opposing defense and insurance company will no longer be commutating with you and will have to go through your legal representation. Your attorney will have your best interests in mind when providing guidance through your case. In most circumstances you will not only receive a higher settlement but will also have someone to guide you through the process and make sure you are receiving the best medical treatment and not being taken advantage of. 

How Long Do Cases Take to Settle? This is a tricky question but the typical answer depends on the severity of the injury you have sustained while working. The more medical treatment required to treat the injury, the longer the claim will stay open and active. The injured worker can keep the claim open as long as there is a medical necessity that still needs to be addressed. For something that is a minor injury (sprain, bruise, minor laceration), a typical case takes between 6-12 months. For more complicated injures that require more rehabilitation and treatment, the case may take 1-3 years in order to get the best medical outcome and settlement. 

From our research we have found the top Workers Compensation Lawyer in Simi Valley to be Erica Wise Law. Here are some of the reviews we found on both Google and Yelp. 

George K "I hired Erica after a back injury at work and my claim got denied by the insurance company. She was really responsive to all my questions and got me in with a really good doctor, surgeon and chiropractor and PT. We just signed the final settlement documents last week and are very happy. I would highly recommend Erica and have already sent over a couple of friends who are also happy with her help. A+ service. Thanks"

Ryan M "Erica Wise helped me on my workmans compensation case when others wouldn’t. She really stepped up to the plate and showed me how much she truly cared. She got my surgery approved after the lousy insurance denied it. She also got me paid while I was off work. When my work started messing with me, she put them in their place and they left me alone. She’s the real deal. Thank you Ms. Wise."

Katherine O "Ms. Wise is a very knowledgeable disability attorney. She was so patient and kind, and really went into depth to explain to me how the EDD state disability and workmans compensation system works. She really knows the laws and the system. I like that she is a very professional woman who can get the case settled. She has a kind heart and you can feel she really cares for her clients."

Bill H "I had great experience working with Erica and her firm. I had serious medical problems that were work related and it wasn't getting better. They helped me process my claim and set me up with a really good group of doctors. I'm slowly getting back to myself and livings a normal life again. I really appreciate all her help through the process."