How Do I Know if I Need Help From Workers’ Compensation Attorneys?

5 Reasons to Hire a San Jose Workers’ Compensation Attorney

Workers compensation law books injured on the job and seeking help inside workers' comp law offices in San Jose, CAWorkplace accidents are unique from other types of personal injury accidents because they are considered “no-fault” accidents. This means that regardless of who may have caused the accident, the employer is responsible for the damages their employees incur, such as medical bills and lost wages.

However, these accidents do share similarities in how insurance companies devalue the extent of damages, and because some injured employees may not be aware of the benefits they are entitled to, they may be cheated out of maximum coverage for their workplace injury.

While not every work-related accident will require legal help, some certainly will. Here are the top reasons why an individual may need help from a San Jose workers’ comp lawyer.


1. Workers’ Compensation Benefits Are Being Denied

Workers’ compensation is a form of insurance that provides medical care and income protection to employees who are injured while performing job duties. These benefits may cover the following:

  • Medical treatment
  • Lost wages
  • Temporary disability
  • Permanent disability
  • Job retraining to pursue a new career

It is a state requirement to safeguard the financial well-being and medical needs of employees while they recover from work-related injuries or illnesses.

However, workers’ comp benefits are regularly questioned by insurance companies, especially when the claim holds much value. Additionally, employers may argue that the injury or illness was sustained outside of job duties.

Workers’ compensation benefits are a legal right of an injured worker, so if it’s being challenged, legal assistance is necessary. 

Need to File an Appeal with the Workers’ Compensation Appeals Board

A denied workers’ comp claim can always be reconsidered. In California, injured workers have the right to fight for an appeal with the Workers’ Compensation Appeals Board (WCAB) and present their cases before a judge.

Navigating the workers’ compensation system with the insurance company to appeal the initial decision will be complex and challenging. However, working with an experienced attorney makes a significant difference for the following reasons:

  • Help gather and organize evidence to support the workers’ comp claim
  • Prepare clients for the WCAB hearing and represent them during the proceedings
  • Establish a convincing argument for how the work-related accident impacted their client


2. Workplace Injury Was Not Reported by the Employer

Filling Worker Compensation AfterWhen an incident occurs, injured employees must immediately report it to their employer, and a worker’s comp claim form will be provided to be completed. Then, it is the employer’s responsibility to submit this form and report the workplace injury to their insurance provider. 

If an employer fails to report a work-related injury, the commitment to employee safety and compliance with workers’ compensation laws becomes a concern. 

Sometimes, employers fail to report an accident due to various factors, such as fearing safety violations, lacking adequate insurance coverage, or attempting to avoid paying compensation benefits. Regardless, it is in violation of California law.

If it is suspected that an employer is intentionally withholding a work-related injury from being reported, experienced San Jose workers’ compensation attorneys can help offer guidance in recovering due benefits. 


3. Accident Was Reported, But Benefits Have Not Been Received

monitor screen with the mouse hovering over a file that says "claim" There are some instances where an employee is provided with the proper medical care but is refused reimbursement for the time missed while recovering from work injuries. 

Based on other circumstances, some employees are still entitled to disability payments to compensate for wages that could not be earned while injured. This is divided into two different forms:

  • Temporary Disability Benefits: When an injury interferes with working entirely, an employee is entitled to receive a portion of lost wages
  • Permanent Disability Benefits: When an injury results in permanent impairment and affects earning capacity, an employee is entitled to long-term benefits

Workers’ comp disability benefits are essential for maintaining financial stability after suffering from an injury or illness. By understanding eligibility and taking action against benefit denials, attorneys are equipped to secure the financial well-being for injured employees.

Not Certain All of the Benefits Entitled to Have Been Presented

When an employer or the insurance company summarizes what employees will be entitled to after an accident, they may accept that explanation at face value, which not be entirely accurate.

Some injured workers may not realize the full extent of benefits they are entitled to. Generally, the following benefits are granted in a workers’ compensation claim:

  • All medical expenses related to the work injury should be paid for, including doctor’s appointments, physical therapy, surgeries, and other care to treat injuries
  • Temporary disability benefits, which generally cover two-thirds of the pre-taxed average weekly wage
  • Permanent disability benefits, which may cover medical care, supplemental job displacement, and other financial help, like Social Security disability benefits

These benefits are crucial for covering living expenses during the period of time the injured employee is unable to earn an income. If there is any uncertainty of not receiving the full amount, consult with a workers’ comp lawyer. 


4. Employer Retaliated

Crutches near the chair and table belonging to an injured personWorkers’ compensation benefits are designed to protect employees financially and medically while they recover from a work-related injury or illness. Therefore, it is their legal right to file a workers’ compensation claim after a workplace incident.

It is unlawful for an employer to engage in retaliatory practices against employees. Forms of retaliation may include termination of employment, unfair treatment, or other forms of discrimination. 

If it is suspected that an employer is enforcing unfair treatment, a San Jose workers’ compensation lawyer can help with:

  • Gathering evidence: Document any instances of retaliation, such as verbal or written communication, changes in work assignments, or exclusion from meetings
  • Filing a complaint: File a complaint with the Department of Fair Employment and Housing (DFEH)
  • Pursuing legal action: File a lawsuit against the employer for damages, including emotional distress, lost wages, and punitive damages

Employers who are found guilty of retaliation or unlawful mistreatment against injured workers may face penalties, such as fines and lawsuits.

Alternative Work Not Offered

After sustaining an injury while performing job functions, the doctor may place permanent work restrictions to avoid re-injury, such as:

  • Lifting restrictions (weight limits, overhead lifting)
  • Exertion limitations (pushing, pulling)
  • Postural limitations (prolonged sitting, standing, walking)
  • Environmental limitations (hazardous environments)
  • Repetitive motion restrictions
  • Bending and twisting restrictions
  • Sedentary work restrictions (limited movement)

If an employer is unable to provide modified or alternative work that meets those restrictions, then supplemental job displacement benefits (SJDB) must be offered. This is designed to assist injured employees in pursuing a new career path when rendered unable to perform their previous job duties. 

These benefits provide financial support in the form of a retraining voucher to cover the costs of vocational training or enrollment in a trade school, allowing employees to acquire new skills and qualifications for a different line of work.

If the workers’ compensation insurance company denies a retraining voucher request or does not offer alternative work, consult with a workers’ compensation attorney.


5. There Are Issues Communicating with the Employer’s Doctor

The choice of medical providers in a workers’ compensation case is limited to the medical provider network (MPN), which is established by an employer or their workers’ compensation insurance company. If an MPN is in place, the injured employee must select a doctor from the designated network.

MPNs are meant to be beneficial, but injured workers may encounter situations where they feel dissatisfied with the medical treatment of their assigned physicians. This may vary from communication style to the treatment plan.

If an employee is facing challenges of expectations not aligning with a medical provider, a San Jose worker’s compensation attorney can provide assistance in finding a suitable doctor who specializes in the type of injury that was sustained. 

Finding a doctor outside of an MPN who is willing to treat work-related injuries can be challenging. However, an attorney can ensure the new doctor will only advocate in the patient’s best interest and not the company whom he or she is contracted with. 


Contact Valley Accident Attorneys in San Jose, California

The Statue of Justice - lady justice or Iustitia, Justitia the Roman goddess of Justice.

The workers’ compensation laws in San Jose, CA are intended to streamline the process of getting adequate medical care and compensation for time missed from work after sustaining an injury while performing job duties. 

However, when employers or their insurance carriers do not proceed fairly and honestly, the need for an experienced workers’ compensation lawyer becomes a necessity. At our law offices, we help our clients get the full benefits they are rightfully entitled to. 

Contact our San Jose workers’ compensation law firm for more information on how workers’ comp benefits work. We offer a free consultation and are available to answer any questions. Schedule yours here.

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