Workers’ Compensation law is highly complex, multi-faceted, technical, and affected by statutory, regulatory, and case law. Defending workers’ compensation cases takes a great deal of skill, knowledge, experience and creativity. Certified Specialists in Workers’ Compensation participate in additional training and testing to achieve and maintain their status.
Workers’ compensation laws in the State of California, like many other states, require that employers take responsibility for injury or disability sustained in the course of employment regardless of fault. Therefore, benefits for work-related illness or injury are virtually always paid out through workers’ compensation. On one hand, this limits the employee’s ability to take action for extensive damages (with a few narrow exceptions). On the other hand, it means that every employer must pay to be insured against worker’s comp claims or secure a certificate to self-insure from the Department of Industrial Relations. The latter option is typically reserved for large companies with the resources to fund their own worker’s comp account.
In the event of a work-related employee injury that: (1) results in time lost beyond the day of the incident, and (2) requires medical treatment beyond first aid, the employee must provide a claim form and notice of potential eligibility within one working day. The employer or insurance company has 90 days to either accept or reject liability. If not rejected within the 90-day time-frame, the claim is presumed to be compensable.
If liability is rejected or if there is a dispute as to workers’ comp eligibility, the matter may be decided by the Workers’ Compensation Appeals Board (WCAB) and the case may then go as far as a Trial. Most cases are settled before Trial, but some are decided after witnesses and evidence are presented to the Judge.
Disputed workers’ compensation injuries may require the opinion of a qualified medical examiner who has met certain requirements to be eligible to perform workers’ comp injury examinations. Legal counsel for the employer or insurance company can ensure that the medical examiner is mutually agreed-upon, or that a Panel of 3 Qualified Medical Examiners (QME) is assigned. Each side may strike a doctor from the list, and the worker is seen by the remaining QME.
Declaration of Readiness and Findings
If a party desires a hearing before the WCAB, it must file a Declaration of Readiness to Proceed. That typically requires that an effort has been made to informally resolve the dispute, the necessary evidence has been gathered, and the requesting party is prepared for a hearing.
If one of the parties has good cause, they may object to the Declaration of Readiness. The Conference is usually still scheduled, but further conference may be precluded until the objection is satisfied. If a settlement isn’t reached, a Trial hearing is ultimately set, after which the judge will issue a “Findings and Award” or “Take Nothing” order, depending whether benefits are to be issued.
Allowing a worker’s compensation case to drag on is not to the benefit of our clients. The Law Offices of George E. Corson IV approaches workers’ compensation defense with creativity and an emphasis on seeking resolution as quickly and efficiently as possible. We want to close your file.