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Public Employees and Workers' Compensation

Working for the government as a public employee puts you in a separate set of regulations regarding worker's compensation. As a state or local government worker, you have state regulations or special state statutes governed by the state where you work. Federal employees are under federal law guidelines. Other employees such as railroad workers and seamen are under separate regulations from either state or federal employees.

Railroad, Seamen, and Other Special Occupations

Unique occupations are protected under different worker compensation benefit acts run by the federal government.  One of these is the Federal Employer Liability Act that provides recovery for injuries sustained by interstate transportation employees such as railroad workers. Employees who work on defense bases or public works projects not within the United States are protected under the Death on the High Seas Act, Defense Base Act, or the Outer Continental Shelf Lands Act. Seamen and longshoremen and others involved in maritime activities of navigable waters are protected by the Jones Act and the Longshore and Harbor Workers' Compensation Act.

Local and State Employees

Your state workers' compensation statutes determine if you are covered under the state's program or another provision if you work as a state or local employee. Most states require there be a poster displayed in your workplace explaining the details of your coverage. In California, the sign will provide contact information and details of your coverage.

If you work in California and are a state employee, you would contact the California Department of Human Resources. If you work for a city or local government agency, you will contact the human resources department if you have claims or questions. If these offices do not solve your problems, you should contact a Workers Compensation Attorney to protect your rights.

Federal Employees

Employees working for the federal government have the protection of workers' compensation under four separate acts. A federal employee who has been killed or disabled as the result of a disease or injury they received while in the performance of duty are protected by the Federal Employee's Compensation Act (FECA). FECA protects federal employees no matter how long they've been on the job or their position. These employees are entitled to compensation for lost wages and coverage of their medical expenses. They are also entitled to vocational rehabilitation if partially disabled. Federal Benefits are paid through the Employees' Compensation Fund through the Office of Workers' Compensation Program (OWCP).

What is Workers' Compensation

Workers' compensation or workers' comp is paid by your employer and is an insurance program that will pay your expenses if you are injured while working at your job. Your employer does not take any amount from your paycheck for this coverage. The plan covers your medical expenses and your wage-loss compensation if you cannot work due to work-related illnesses or injuries sustained while on the job.

Not every employee is covered by a state workers' compensation program; some are covered by compensation laws governed through the United States Department of Labor. The office in charge is called the OWCP(Office of Workers' Compensation Programs) which handles four disability compensation programs.

Problems with the Workers' Compensation Program

The workers' compensation program is one of the oldest programs in the United States providing social insurance to the workforce. Nearly 130 million people are working in the U.S. that are covered by workers' comp. Each state governs its own program without any federal minimum standards. Over the past twenty years, it has become increasingly difficult for workers to receive full benefits from this program due to changes made. If you find your claim is not being handled fairly, contact a Workers' Compensation Attorney to ensure you received the benefits you've earned.

Your employer's workers' compensation insurance should cover any workplace injury you suffer. Most state laws require employers to cover their employees according to the average level of risk involved in the industry of employment. Not all claims filed under this program are honored, in fact; many worker comp claims get denied. These are some of the common reasons for workers' compensation claims to get turned down:

  • Not enough proof that your injury occurred due to your work. It is sometimes hard to determine if an injury happened in the workplace. Having a couple of medical exams along with supporting evidence should solve a denial of claim issue. You may want to consult with a Workers' Compensation Attorney to help you with this process.
  • You missed the deadline for filing. There is typically a thirty to a ninety-day deadline on filing claims, depending on the state where you live. If you file after the specified period, your application can be denied.
  • You did not report the injury in time. You have a specified time in which an injury must be reported depending on the state where you live. Usually, there are a few days allowed for you to tell your employer or supervisor that you have been injured performing your job.
  • You did not seek medical attention. Most workers' compensation claims must be supported by medical evidence. If you have not been to a doctor for your injury, you can be denied on your application.
  • Your employer can dispute your injury. There are incidents where the employer denies your injury is work-related, or that it happened at the workplace. They can also claim that it occurred due to your recklessness and not associated with the type of work you do in the workplace. These forms of disputes may require you to have legal counsel. Your place of employment and the government have attorney's working for them, and you deserve representation as well.
  • Workers' compensation insurance does not cover the injury. Some injuries or illnesses are denied as not being compensable under the program. Stress-related injuries are one of the major illnesses that are denied often; however, California specifically lists stress-related injuries are one that should be covered as workers' compensation claims.

There are many other reasons for workers' compensation claims getting denied; these are some of the more common. If you or someone you know has filed for compensation and been denied for any reason, you need to contact a Workers' Compensation Attorney to make sure your rights and your future are protected.

Appealing a Denial of Workers' Compensation Claim

When a denial is sent to you on your workers' compensation claim, it will state the deadline for appealing the decision. Deadlines are set by state guidelines and are strictly enforced, so it is important to talk with your Workers' Compensation Attorney as soon as possible to ensure you file on time.

The first step you should take is talking with your employer or their insurance carrier and determine what the reason is behind the denial. Make sure it is not a clerical error that is easily and quickly fixed before launching into the appeal process. If it is not an easy correction, remember appealing can be a complicated legal process and having legal counsel working with you will help you get a more favorable outcome.

Appealing a workers' compensation denial for benefits is different state to state, but generally begins with a meeting in front of an administrative law judge. This meeting is arranged through the labor department or state workers' compensation board. Since each state has different laws, it will be to your advantage to have a Workers' Compensation Attorney working with you who understands the legal system and knows their way through the courts.

Preparing for your appeal, you will need to collect all documentation regarding your injury. Have all the information you gathered for the initial claim including medical reports, time sheet that proves you were working at the time injury occurred and any other records that verify your injury or illness is a result of your work. Bring all these documents along with the letter you received denying the claim.

Workers' Compensation Claims in California

Under California Workers' Compensation laws, you are guaranteed coverage for any injury or illness that has been caused by your employment. Any time an accident occurs when an employee is doing his or her duties; their injuries are guaranteed to be covered for any medical attention needed. If an employee suffers conditions resulting from repetitive actions or exposure to dangerous substances, or even if their injuries are stress-induced, California Workers' Compensation laws state they are entitled to benefits. There are a few exceptions; however, if you are able to demonstrate the illness or injury is a direct result to your work, you are entitled to compensation.

A significant change that has occurred with workers' compensation claims in California is that you can no longer treat with any doctor of your choice. You are required to see a doctor who is a member of the employer or their insurance company's MPN (medical provider network). You are able to choose any doctor who is a member of this network. There is an extensive list of doctors for you to pick from.

The doctor may ask for diagnostic tests, medical appliances or procedures, and medical treatments. The insurance company may then request the results of these tests be sent to a utilization reviewer. The utilization reviewer does not talk or examine you as part of the claim process and typically does not even consult with the doctor who has performed the tests. The reviewer will go by the results sent to them by reading all notes and reports and then make a conclusion for treatment based on the information provided them.

If after looking over the material, the reviewer decides to decline your claim, you will then have to begin the appeal process to receive the treatments needed for your injury.

How to Handle a Denial of Workers' Compensation Benefits in California

If you live in the state of California and have filed a workers' compensation claim to receive medical care and been denied, you need to act right away. You want to protect your rights and receive the treatment you deserve and need to heal after you've been injured in a work-related incident. Working with a Workers' Compensation Attorney will speed the appeal process so you can begin recovery sooner. An attorney will also fight for your rights and ensure you a successful outcome.

Some injuries or illnesses require attention immediately. If you have to seek medical care right away, the doctor cannot legally bill you as an employee of a work-related injury or illness. You may have to sign a lien form, agreeing to the doctor waiting for payment of services until your claim has been filed and processed.

If you end up paying for medical treatment, medications, or any other medical expenses related to your injury while awaiting the decision of the appeal process, you need to keep all receipts. Make sure your receipts clearly state the reason you were treated medically as it relates to a work-related occurrence and the date you took medicines or received treatments. Your attorney will need all this documentation to file for all the appropriate reimbursements you are entitled.

If you do not have the proper evidence when filing for reimbursements, you can be denied credit for these expenses. If you have been denied workers' compensation benefits through the program and your own insurance provider, you need legal representation to help you receive the compensation you deserve under the law.

Finding Work Injury Attorney Near Me

If you or someone you know has been denied a workers' compensation claim in California, you need to contact an attorney as soon as possible. Call 949-423-3212 to speak with experienced legal counsel who understands the complicated legal process involved with denial of claims.

Orange County Workers Compensation Attorney has the knowledge and experience needed to gain you the benefits you deserve. You can stop in and talk to a representative and find out how to start your appeal process now. Check out our website further and discover the services we have available to handle all your legal needs.


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