According to Labor Code Section 3352 you are exempt from Workers’ Compensation Benefits if you are employed for fewer than 52 hours or earn less than $100 within 90 days of the calendar year while working in a home-related or personal services type job.

So the next time Mrs. Smith asks you to hang her Christmas Tree Lights for $50 and you fall off the ladder, look to your private insurance for coverage.

We can still be reached at the same phone number and facsimile.

Ouch! You have just suffered an injury while at work, and therefore may file a workers’ compensation claim.  You are in your mid-40’s and the injury is to your back.  You had noticed your back hurting a bit before the injury (probably from just getting older) but it was nowhere near the pain that you are now experiencing since the work injury.  Not to mention you had that old embarrassing lower back injury that you suffered during a picnic whiffleball game a few months ago, which you have since pretty much fully recovered from.  But what should these other aches and pains have to do with your new injury?  After all, if it wasn’t for the new work injury, you would still be able to work!

That is absolutely true.  However, when it comes time to determine the amount of Permanent Disability associated with your back injury, the doctor will attempt to determine just that:  how much of the disability was caused by the work injury and not other contributing factors.  This is called apportionment in workers’ compensation.

The doctor will attempt to apportion your Permanent Disability.  Using the example above, the doctor could determine that 80% of your disability is a result of your work injury, while 10% is due to “degenerative changes” (the back pain you noticed before) and 10% to your whiffleball-related injury.  This is when you say, “But that isn’t fair!  If it wasn’t for the work injury I wouldn’t have any noticeable disability!”  You’re right, but that is just the way the law and the labor code are written at the moment, and we’re stuck with it.

Insurance companies are also beginning to try to apportion an injured worker’s inability to get back to work after the injury to other factors besides the injury itself.  Again, you will correctly shout from the rooftop that “but if it wasn’t for my work injury I would still have my job!”  However, insurance companies are increasingly making the argument that not all of someone’s inability to find a job is related to the work injury.  They put forward that the economic climate is even preventing healthy people from finding work, that the injured worker may not be looking at all available jobs, that the job the injured worker was employed in is now more and more rare for anyone who is looking for work, injured or not.  Simply put, they are looking for other things to blame your inability to find a job on than your work-related injury.

Rodman J Martin

For our younger clients who do not have health insurance, it is important to discuss coverage options with your parents. Changes to the Workers’ Compensation Laws have made it difficult to get much needed medical care on a timely basis. Sometimes coverage through private health insurance is necessary to obtain treatment. The Health Care Reform Legislation may make a difference.

Lisa E. Ivancich

Stipulations (a fancy word for “agreements”) with a Request for Award is a settlement that allows for the future medical care associated with your work injuries to remain open.  In other words, the workers’ compensation insurance carrier still has to pay for your medical after you sign the settlement.  In fact, they will be on the hook for it as long as you need it (it’s lifetime medical, but only on the work injury).  However, they can still send treatment requests from your doctor through Utilization Review (UR), which is where they determine to reject or deny a particular treatment based on their determination of the treatment’s “medical necessity.”  In other words, even though the medical care is left open, they can still review it and deny it if they don’t think it’s necessary.  Also, with a Stip settlement you can re-open your case within 5 years from the date of injury if you feel that your work injury has gotten worse and has resulted in new and further disability since the settlement.

The Compromise and Release (C&R) is where the insurance company issues you a tax free lump sum check in exchange for being relieved of liability (taken off the hook) for future medical care associated with the work injury.  In other words, the benefit to you is that you receive all of the settlement money at once, while the benefit to the insurance company is that they no longer have to worry about paying your doctors.  The lump sum check often takes into account the benefits associated with your permanent disability, the estimated cost of your future medical care, and the value of giving up the right to reopen your case.  Lastly, if you are still working at the job you got injured at, the employer most likely will not be agreeable to settling by way of C&R.  The reason is because of you settle by C&R and go to work the next and injure the same body part, they are on the hook again for medical treatment of that body part.  It defeats the purpose of them agreeing to enter into that type of settlement; not having to be liable for the medical care in the future.

Which one you choose is of course ultimately your decision to make.  If you know that you are going to require a lot of medical treatment because of the injury and do not have any other type of insurance, you will probably lean toward leaving the future medical open.  If you do not get a lot of treatment or are getting by without it and don’t anticipate it being a problem in the future, you might want to settle with a C&R.

By RODMAN J MARTIN, esq

Some things to look forward to are:

1. Fenton’s ice cream is sponsoring and is serving ice cream at a hole.

2. The Raiderets will be hanging out with us at dinner after the tournament.

3. Complimentary wine at dinner and the auction.

3. Many prizes for our silent auction and raffle including: an iPad, digital camera, television, and gift certificates.

If you are interested in participating in a day of fun to benefit East Contra Costa County Youth and Lend-A-Hand Foundation please email us at pegnimandivancichgolf@gmail.com or call 925-776-4500!

It is not uncommon these days to be employed at more than workplace.  After all, the cost of living is high in the Bay Area, and supporting a family on one income is not an easy task.  These issues make it even more difficult when someone suffers a work-related injury that renders them Temporarily Totally Disabled, unable to earn the money that he or she so desperately needs.  The person is not only usually precluded from being able to perform the job that is related to the injury, but also is prevented from returning to work at the other job(s).  When this happens, it is important to make sure that the Workers’ Compensation Insurance Carrier is paying you the right Temporary Disability rate.

If you are injured at work and you are temporarily unable to return to work right away because of that injury, you will receive Temporary Disability (TD) benefits.  These are calculated per the Labor Code of California to be 2/3 of your average weekly wage.  You should receive TD payments every two weeks.

However, if you have more than one job, those wages should be included in calculating your TD benefit amount as well!  Let’s say you work at 2 different retailers.  If you are injured on the first job and cannot immediately return to work, you most likely cannot return to the second job either.  The first job alone does not reflect your average weekly earnings, so it is important to make sure the insurance company is including the earnings from the second job as well!

The downside is that if you were getting paid more at the second job (where you weren’t injured), that hourly rate does not apply in determining the TD amount, only the rate of pay at the job you were injured.  The hours from the second job will be added at the hourly rate of the first job.    The big thing to remember is that if you were working more than one job when you were injured, be sure to let the adjuster on your claim (if you don’t have an attorney) or your attorney know, and provide them with the pay-stub/tax-information that can help them determine what the TD rate should be.

Rodman J Martin

You have been through endless medical treatments, been to a QME or AME evaluation, and then a reevaluation, sat through your two hour deposition, dealt with an endlessly frustrating insurance company (even months before you obtained an attorney), been to Oakland for a hearing(s), gone through maybe one or two surgeries and subsequent recoveries, and now you are finally at mediation, a mediation that can at times seem as drawn out and frustrating as all that has been outlined above.  However, don’t get discouraged.  Like anything else you will encounter in the workers’ compensation system, it is important to at least attempt to keep a positive attitude and to keep perspective.

If mediation is something that your attorney has suggested or believes would be a good idea given the facts and circumstances of your case, it’s typically for a good reason.  Sometimes the two sides (you and the insurance company) just cannot agree about anything.  The only thing you can agree on is that you need a third neutral party to come in and assist with communication and finding some common ground to work with.  This third neutral party is called a mediator, and they will be present at the mediation session.  The mediation session is designed to help facilitate settlement of your claim.  Needless to say, this can take hours, and by hours I mean many hours.  That is why it is important to come prepared, mainly for two reasons: 1) So you yourself don’t go crazy (there are only so many cups of coffee you can drink and texts you can send) and 2) So your attorney can effectively put pressure on the other side without major distractions.

If you have been to the Workers’ Comp Board in Oakland, you know how time consuming/boring it can be when attorney’s are negotiating.  Mediation can be like going to the Board, except longer and without the people watching in the lobby.  Like we often tell clients to bring a book or a magazine to the Board, the same goes for mediation.  Feel free to bring books, magazines, even a portable DVD player with headphones (you might get three movies in during a mediation).  If you want to bring snacks/drinks with you feel free to do that also.  And don’t forget to get someone to take care of your kids/pets on the day of mediation, since you could be gone for the day.

One of the reasons behind why the mediation can drag on so long is because the Defense Attorney could count on you getting tired or hungry, and use it leverage in negotiation, counting on you wanting to leave early and settling for a lesser amount than they ultimately would be willing to put on the table if they had to.  That and they bill by the hour, so the longer they are there, the more they get paid.  That’s not a bad thing, that’s just how Defense Attorney’s are compensated.

However, more often than not the mediation takes a long time to complete because there are simply fundamental areas of disagreement over certain issues of your claim that need to be creatively worked through, and that work takes time.  You are not at mediation because you have an easy case.  You are there because your claim is most likely complex or you also are pursuing a civil claim and are attempting what attorney’s call a global settlement.

The most important thing to remember out of all that is put forth above is: be prepared for a long day of mediation, after all, at the end of the day, your claim could very well be resolved, making those twelve hours spent in a conference room or office with your attorney worth it.

Rodman J. Martin

The idea is only unreasonable requests will go through Utilization Review.  In the end costs will go down and UR will become a streamlined process unlike the difficult and costly system is it currently.

For more info go to:https://www.workcompcentral.com/members/index.php?fa=news&id=6c2ccbfa15185dfa068be4fe0d05c411g&state=CA&CFID=17580966&CFTOKEN=89730080