Working for a living is just a way of life. It provides us with the funds necessary to take care of ourselves and our families, and pay for things like food, clothing, shelter, and entertainment. Everything costs money. And we often take our daily work routine for granted, assuming it will always be there. An on-the-job injury can change all of that in an instant and can result in a catastrophic turn of events that can become difficult to recover from – unless you know the laws surrounding workers’ compensation in California.
When you’ve experienced injuries caused by a workplace accident, it can seem as if your entire life changes. Physical injuries may keep you from doing even the most basic daily tasks or interfere with your activities of daily living. You might even find yourself having to rely on friends and family to provide for your most basic needs. During times like these, you can lose your independence, and the ability to work to earn the money you need to provide for yourself and your family. Maybe you’re out of work for a few weeks, or a few months while you recover from your injuries. In the very worst of scenarios, maybe you’re out of work longer or possibly for the rest of your life.
It’s not uncommon that workplace accidents can result in injuries so severe that you might not ever fully recover to the physical, emotional, or mental capacity you had before the accident occurred. Your injuries might also affect your future earnings or earning capacity. When this happens and you have permanent residuals from your injuries, you may be considered to be either partially or totally permanently disabled. California has very specific workers’ compensation laws that are designed to protect you in the event of an on-the-job injury. Workers’ compensation insurance (if your claim is found compensable or has been accepted) will provide compensation to you, often in the form of a settlement at the end of your case. It stands to reason that hiring an attorney who specializes in workers’ compensation law, such as attorney Todd Tatro, will be the key to obtaining the best result or in getting the greatest possible settlement in your workers’ compensation claim of any benefits to which you might be entitled.
Each employer in the state of California is required to either pay into a workers’ compensation insurance policy or in certain instances can provide this coverage through their own self insurance program. In either case, workers’ compensation insurance is usually there to cover the many costs associated with a workplace accident and resulting injuries. These costs can include medical treatments and either temporary and/or permanent disability payments.
After you’ve begun the claim process by filing your claim and have sought medical treatment for your injuries, your doctors will be able to give you a prognosis regarding your recovery. If full recovery from your injuries is ultimately not probable, once you reach a permanent and stationary status or as it is know known reach “maximum medical improvement”, your doctor normally will prepare a report addressing the nature of the injuries you’ve suffered,their prognosis, and any residual impairment you have related to your injuries under the AMA Guides, Fifth Edition. From a legal standpoint, this report is vital because it establishes the permanency of your disability, and that no further medical treatments will be of any benefit to improve your condition from an impairment/disability standpoint. Your doctor in this report will generally be required to provide the parties with his opinions on your whole person impairment under the AMA Guides in order to assist them with rating/valuing your case. The doctors opinions on your whole person impairment related to your injuries if found, will then be placed into a formula which also takes into consideration the part of the body involved, your diminished future earning capacity under the schedule, your occupational adjustment and age, resulting in a level of permanent disability on a scale of 1-100%. The higher your level of disability, the more you can expect to recover in your workers’ compensation claim.
However, if either you, your attorney or the workers’ compensation carrier object to the treating physician’s report and opinions, you may be required to go through either the Agreed Medical Evaluator process ( only available if you are represented by an attorney) or the Qualified Medical Evaluator process in order to have the issues or disputes addressed, including any impairment/disability you might have related to industrial injuries. Once the parties receive the report and opinions of the evaluating physician (AME or QME), their opinions on any related whole person impairment under the AMA Guides will be evaluated using the same formula to determine your level of permanent disability.
Once your injuries and the chance of a full recovery are known and the level of permanent disability has been determined and any issues of apportionment have been addressed, you and your employer’s insurance company will normally attempt to agree on the method of settlement (either a Stipulated Award or a Compromise and Release) and a settlement amount. It pays to keep in mind that a settlement is a voluntary process. You do not have a right to a settlement, but you do have the right to see your workers’ compensation claim adjudicated if necessary. You can view a settlement under either of the above methods as a compromise of sorts where both parties agree to give up their most beneficial position in exchange for avoiding the hazards of further litigation and potential negative results that might affect either party with adjudication of the case.
As referenced above, there are essentially two different types of settlement methods that are available in workers’ compensation claims: a settlement by Stipulations with an Award or a Compromise and Release (C&R).
A settlement by stipulations is an agreement where the parties agree to a level of permanent disability, and the permanent disability payments are sent to you on a bi-weekly basis, until the scheduled value of the permanent disability has been paid out. Both your level of disability and your salary at the time of injury will help determine the value of the level of permanent disability and how much bi-weekly your payments will be per week and for how long. With a settlement by stipulations, you normally retain the right to seek future medical treatments under the Award to treat only your industrial injuries for as long as you need them – or potentially for the rest of your life, if necessary. It is important to keep in mind that any treatment under the award would still be subject to any laws in effect at the time it is rendered, including currently Defendant’s Utilization Review (UR) process and Independent Medical Review IMR) as well as, the requirement for treatment within their Medical Provider Network if they have one. Also, if your case is resolved by a Stipulated Award, under this type of settlement, you still retain the right to try and Petition to Reopen your workers’ compensation case to secure further benefits. However, under the current statute of limitations, any petition to reopen must be filed within the applicable five (5) year statute which runs from the date of injury and not the date your case was previously settled.
On the other hand, a compromise and release means that you will receive a lump sum as compensation for your injuries. This lump sum will likely be more than you would receive through a settlement by stipulations, since it is to resolve all benefits, including any further rights to temporary disability, permanent disability, future medical treatment, right to reopen or any other workers compensation benefits to which you might be entitled to for your injuries. Again, the reason for this is because you are releasing the insurance company from any future obligation to pay workers’ compensation benefits, including medical treatment for your injuries. As indicated, in this type of settlement you also give up any potential right you may have to try and reopen your case in the future if your condition worsens and you experience any new and further disability related to your industrial injuries.
First and foremost, you have no obligation to settle your workers’ comp claim. Doing so is purely voluntary. If you choose not to settle, you can appear before an administrative law judge with the facts and evidence surrounding your case. If you do so, whatever decision the judge ultimately makes will be usually be final, unless either side has a basis for appealing and files a timely Petition for Reconsideration with the Workers Compensation Appeals Board.
Settling a workers’ compensation claim is a lesson in balance. Both sides to an average claim have an interest in settling, as well as an interest in adjudication. The art and science of the process of settlement is something best left to a professional in the area of workers’ compensation law, such as attorney Todd Tatro. Mr. Tatro is extremely knowledgeable with the settlement process, and this knowledge, coupled with his 30 years of workers’ compensation and personal injury experience can help you arrive at a settlement that is fair for your claim.
Make an appointment with Mr. Tatro now for a free consultation. During his consultation with you, he will take a look at the facts surrounding your claim, along with the issues involved in order to assess the likely outcome of your case. You can reach Mr. Tatro’s office by phone at (559) 431-0123, or through his website’s contact page.