If you suffered a work-related injury that prevents you from doing your job, you could be eligible for temporary disability payments while you are unable to work. While these payments can be immensely helpful, disputes sometimes arise regarding temporary disability payments if an employer’s insurer does not believe an injury is work-related or if there are disagreements about your capacity to work. These disputes can affect your disability payments.
If you are dissatisfied with a decision regarding your temporary disability workers’ compensation claim in Santa Ana, consult a lawyer right away. A dedicated workers’ comp attorney could help you strengthen your claim for benefits and support you through every step of the process.
Anyone who cannot work in their job because of an occupational illness or injury is entitled to temporary disability benefits. An occupational illness or injury is any condition that arose from an individual’s work or was worsened by their employment. Physical and psychiatric conditions could make someone eligible for temporary disability benefits.
A worker who suffers an injury or develops an illness must report it to their employer and see a doctor. If the doctor’s report indicates that the worker cannot do their job because of illness or injury, the employee could receive temporary disability payments.
Temporary disability payments are equivalent to two-thirds of the employee’s weekly wage up to the statutory maximum if they cannot work at all while recovering. If the employee could work with restrictions and the employer has an appropriate position, their disability benefits would equal two-thirds of the difference between their pre-injury wage and the wage they earn in the limited role.
Treating physicians must see an injured worker at least once every 45 days and prepare a report about the worker’s recovery. The report must state whether the employee is ready to return to their former job full-time, could return to work part-time, could work at a different job with restrictions, or should not work at all.
Sometimes a treating physician issues a report about a worker’s condition that the worker believes misstates their ability to work or minimizes their limitations. California Labor Code §4062.3(j) allows a worker to request an opinion from a different physician. A workers’ compensation insurance company might also request a second opinion if they believe a worker should be ready to return to work.
The physician providing the second opinion must be a Qualified Medical Examiner (QME) or Agreed Medical Examiner (AME). The QME or AME can only evaluate the individual’s ability to work and cannot provide treatment. A Santa Ana attorney with experience handling temporary disability workers’ compensation claims could help an injured employee get in touch with the necessary parties to get a second opinion.
Sometimes, insurers will refuse to pay benefits despite a doctor’s report indicating an employee cannot work. The insurer might not believe an injury or illness was related to the claimant’s employment, or doctors’ opinions of the worker’s condition might conflict. In other cases the insurance company may pay benefits, but it could be at the wrong rate. Perhaps the injured worker had a second job that was not accounted for. Other times, the injured worker may have worked overtime, but it was not reported by the employer so the injured worker is not being paid at the correct rate.
When the defendant is either not paying benefits or paying at the wrong rate, injured parties can file a case with the local workers’ compensation board and make a request for adjudication. The worker and their attorney appear before an administrative law judge to present their case for temporary disability benefits. If the judge rules against the worker, their attorney could request a reconsideration of the decision.
In many cases, a worker and the workers’ compensation insurer could settle a dispute without going through the hearing process. A Santa Ana attorney could negotiate with the insurer to reach a reasonable settlement regarding temporary disability workers’ compensation benefits.
The workers’ compensation program offers important and valuable benefits, but it can be difficult to take full advantage without the guidance of a lawyer. Do not risk losing benefits because you missed a deadline or did not comply with a rule. If you are considering filing a temporary disability workers’ compensation claim in Santa Ana, work with an attorney who has handled cases like these successfully in the past. Give us a call today to get started.