Being injured at work can be a distressing experience. In addition to the physical pain you’re facing, you may be worried about when you’ll be able to return to work or even whether you’ll be able to go back to your previous role at all. You may also be worried about your finances and whether workers’ compensation will cover all of your medical costs and lost wages. The outcome of your workers’ compensation claim may depend on the strength of the evidence you’re able to provide.
The two major things that you may need to prove are that your injury was work-related and that the injury is preventing you from working. How difficult it is to prove either or both of these will depend on the type and circumstances of your injury. Hiring a workers’ compensation lawyer can help you present the strongest possible case backed by relevant evidence.
If you fall while performing a work task and break your wrist, demonstrating that the injury was caused by work and that you qualify for workers’ compensation should be fairly straightforward. However, there are a number of circumstances that are less clear-cut. For example, you could be injured at your workplace during a break, have an existing injury that’s worsened by work, or have an injury that comes on gradually.
Ideally, you reported your injury to your employer as soon as it happened. In California, you’re generally required to report your injury within 30 days. This report can serve as valuable evidence of when your injury happened and what caused it. Other evidence that your injury happened at work can include:
If your injury involved malfunctioning equipment, maintenance logs for that equipment could also be useful evidence.
Medical records and reports from the doctor treating your injuries can also be valuable. If you’re dealing with a repetitive stress injury, your doctor can assess your injury and explain that they believe it was caused by your work. If you had a pre-existing issue that was worsened by work, your medical records could show the difference between your condition before and after a work-related incident. If your workplace injury occurs gradually, your medical records can also affect your reporting timeline. Your 30-day window to report your injury to your employer starts when you learned that work was causing the problem. In many cases, this happens at a healthcare appointment to investigate symptoms without an obvious cause.
Usually, you’ll need to describe your injury when filing your initial claim. You won’t need to provide further evidence unless there is a dispute or denial later on in the process. Your attorney can advise you on what evidence you should offer at what stages.
If your workplace injury requires a long recovery or results in a permanent disability, documenting that you’re not able to work will form a key element of your case. Usually, the doctor who is treating you will determine what types of work you can safely perform. In California, you can receive temporary disability payments for around two years or until your doctor says you can return to work, whichever happens first. There are some specific conditions and injuries that allow for a longer temporary disability timeframe.
As long as your primary treating physician agrees that you’re unable to work, you can continue receiving workers’ compensation disability payments. However, if you disagree with your doctor’s assessment or treatment recommendations, you can seek a second opinion. The process for seeing a different physician will depend on whether you’ve predesignated your own doctor or if there’s a medical provider network or healthcare organization managing your care. Which of these arrangements applies to you will depend on how your employee’s workers’ compensation insurance plan operates.
If there’s any kind of dispute over issues like whether your injury was work-related, how long you need to recover, or whether you’re permanently disabled, you may need to see a qualified medical evaluator (QME). QMEs are doctors or other healthcare providers certified by California’s Division of Workers’ Compensation (DWC) Medical Unit to examine and assess patients in these cases. The DWC chooses your QME from a randomly selected panel of three providers with the appropriate specialty experience. If the claims administrator and your attorney can agree on a doctor to do this assessment, you can see an agreed medical evaluator (AME) instead.
If you disagree with the QME’s report, you will have 30 days to dispute it or request more information. Depending on the nature of your injury, your attorney might recommend that you pursue a lump sum settlement instead of continuing to receive weekly benefits payments for an undetermined time period. When this happens, your medical records, including QME reports, can become essential in negotiations.
Navigating the workers’ compensation process can be difficult, especially when dealing with a long-term or permanent injury. You’re likely dealing with physical pain and uncertainty about your future along with bureaucratic complexity. This is especially true if you don’t agree with your primary treating physician’s assessment or treatment plan, the cause of your injury isn’t immediately obvious, or it’s unclear whether your injury was caused by your work. An attorney can help you demonstrate that your job led to your injury, negotiate on your behalf, and guide you through the multi-step process for getting a second medical opinion.
The workers’ compensation team at KCNS Law Group has the experience and knowledge to support you through the workers’ compensation process. Our expertise will increase your chances of getting the best possible outcome. Call us at 818-937-9255 or fill out our contact form to schedule your free consultation today.
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