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Some claims are accepted by the employer and benefits are promptly provided.  In such cases, if the employee has a good recovery (little or no permanent injury), they may not need a Workers’ Compensation Attorney.

If you have a serious injury or if your claim is denied or disputed, it would be a good idea to at least talk to a workers compensation attorney about your rights and consider whether you wish to be represented.

The employer or insurance company may dispute that an injured worker was injured on the job or is entitled to any benefits.  Another type of dispute arises where the injury itself is admitted and some benefits are paid but the employer later disputes entitlement to particular medical treatment, periods of temporary disability payments, or the level of overall permanent injury or entitlement to the job re-training voucher.

In general, such disputes, if they cannot be resolved by the employee and the employer, are resolved by the Workers’ Compensation Appeals Board.  The Appeals Board is a special court created by the state Constitution and is set up only to hear workers’ compensation controversies.  No other court has jurisdiction.

In most cases, in order to resolve disputed issues, it is necessary to obtain expert medical-legal opinions from physicians with some expertise not only in medicine, but in workers’ compensation law.  Sometimes the physicians that are treating the worker can do this, although if they are in an employer controlled Medical Provider Network, their conclusions may be biased in favor of the employer.  Part of the 2004 legal changes modified the way these outside medical-legal opinions are obtained.  In 2004, workers lost the right to select their own medical expert to evaluate their workers’ compensation cases.  The state has replaced this fundamental right with an awkward, bureaucratic, complicated “Panel QME” process that is full of legal traps and time deadlines.  Furthermore, you need to not only know the time limits and regulations applicable to this QME Panel process, but you also need to know who the doctors are to successfully negotiate your way through it.  An experienced Workers’ Compensation Attorney can help you get through this process.

Once a QME has been selected, it is very important that they are asked the proper questions.  Some of the theories that allow us to increase settlement value require the physicians to comment on certain issues beyond the standard issues in a report.  Many physicians will not bring these matters up unless one of the parties actually asks the proper questions.  Anyone with a serious injury would be well served to at least consult with a Workers’ Compensation Attorney before going through the Panel QME process.

In all of these situations, once the medical reports and any other necessary evidence have been developed, the parties need to negotiate to see if they can resolve the matter. If they are unable to do so, either side may request a hearing before a Workers’ Compensation Judge.

Although the Workers’ Compensation Appeals Board was originally intended to provide informal, expeditious hearings, the technical issues and procedural requirements have become increasingly complicated.  A Workers’ Compensation Attorney knowledgable about Workers’ Compensation law can navigate through the procedural matters in your case.

Attorney’s fees in Workers’ Compensation Cases in California are regulated by state law.  The usual fee is 15% of the recovery.  All fees must be approved by the Judge.  There is no fee unless and until we collect money for you.  In certain types of unusually difficult or complex cases or cases establishing new legal theories, the Workers’ Compensation Appeals Board will allow fees above 15%. 

Sometimes employers and insurance carriers try to talk injured workers out of getting Workers’ Compensation Attorneys.  Insurance costs are based on claims, and insurance companies have an adverse interest to injured workers. Injured workers should always remember that they have an absolute right to be represented by an attorney.