In California, an injured worker’s exclusive remedy against an employer for injuries arising out of an industrial accident is subject to the provisions of the Workers’ Compensation Act, found within our state constitution at Article XIV, Section 4, which provides that any dispute between the worker and their employer over the worker’s entitlement to benefits …
Employer Civil Liability: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
After incurring an industrial accident most employers are usually very busy investigating the incident and reporting the injury to their workers’ compensation insurer or administrator. Employers also interview witnesses, obtain statements, fill out internal accident reports, present a DWC-1 Claim Form to the injured worker and arrange for medical care. All the foregoing are necessary …
Claim Form Consequences: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
A mystery waiting to be unraveled sometimes arises when an injured worker reports a disability check as missing, and the check in question is identified as having been cashed or otherwise negotiated. The stakes are raised when a large settlement check turns up missing but cashed. We dedicate today’s blog to this scenario, since it …
Lost Disability Checks: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
It never ceases to frustrate us when we see employers suing themselves in workers’ compensation. We are not talking about a few employers, but rather dozens of companies suing themselves, often without even realizing it. Our readers are probably asking, “Why would a company sue itself and how could it do so without realizing it?” …
Suing Yourself: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
We believe with a high degree of certainty that very few claims professionals have ever received instruction on how to calculate a weekly life pension (LP) rate. Most claims professionals, including judges and attorneys, rely on the Disability Evaluation Unit (DEU) to do the calculations for them. Today we will show you how to double-check …
Most employers are aware of the concept of subrogation. California Labor Code §3852 specifically allows employers to seek recovery against third parties for reimbursement of workers’ compensation benefits paid due to an industrial injury attributed to third party negligence. Specifically, LC §3852 states: “Any employer who pays, or becomes obligated to pay compensation, or who …
Subrogation Waivers: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Today’s blog discusses witness testimony at the Appeals Board, particularly testimony offered when compensability of an industrial injury is in dispute. More frequently than one might anticipate, an employer is caught by surprise when their own witness completely changes their story on the witness stand. Employers naturally feel duped when this occurs and can’t understand …
Beware Your Own Witness: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
When dealing with a catastrophic injury it is not unusual for a claims administrator to hire a home health care attendant to look after the injured worker. Some severely injured workers require constant care and cannot be left alone. For the most part, claims administrators have no objection to engaging a medical management company to …
Home Health Care Attendant: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
In death benefit claims dependency is a threshold issue, and when paternity is uncertain, it can be a major one. For example: we are aware of a case where a decedent’s ex-girlfriend sought death benefits on behalf of her minor child. DNA testing became necessary as the child’s birth certificate was deemed inadequate proof of paternity. …
DNA Evidence in Work Comp: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Without a doubt, it is a major error whenever a claims professional stipulates to an injured workers’ Average Weekly Wage (AWW) being “maximum”, even though maximum earnings may exist. The AWW should always be identified as a specific dollar figure instead of taking a shortcut by stating “maximum.” The reason is quite simple. Although the injured …
When a fatality claim is filed, the claims administrator’s best practice is to immediately investigate the circumstances of both death and dependency. Often, the only dependent of the decedent is the spouse. For the sake of this blog let us presume that a deceased worker is survived only by a fully dependent wife. The decedent …
Investigating Dependency: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
Most claims professionals are aware that LC §4658.7(g) forbids settlement of a Supplemental Job Displacement Benefit (SJDB) voucher for an admitted industrial injury occurring on or after 1/1/2013. There is however, one exception. Namely, when an affirmative defense is raised, where if litigated the employee may “take nothing,” including the voucher. The purpose of today’s …
Voucher Eligibility: A Sixty-Second Seminar in Workers’ Compensation Claims HandlingRead More
