When to Hire a Workers’ Compensation Lawyer: Top 8 Reasons

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Experienced Workers’ Compensation Lawyer in Orange County

California’s workers’ compensation laws are designed to provide medical care and replacement income to injured workers. While the system should be straightforward, there are times when victims are not compensated fairly and appropriately.

It can be challenging to determine when help from workers’ compensation lawyers is actually necessary. For clarity, here are the top reasons to hire a workers’ comp lawyer in Orange County, CA.


1. Employer Is Refusing Workers’ Compensation Coverage to Injured Workers

Under California law, employers are obligated to provide specific workers’ compensation benefits to amend a workplace injury or illness. This may include:

  • Medical care till recovery is reached
  • Temporary disability benefits for lost wages while unable to work
  • Permanent disability or reimbursement when unable to return to work
  • Supplemental Job Displacement (SJDB) in the form of a voucher to pay for new educational training

The most common reason a workers’ comp claim may be denied often pertains to legitimacy, especially if the injury resulted in costly medical bills. Insurance companies will question if the accident was work-related and if it actually occurred on company property.

Certain injuries and illnesses will also be more difficult to prove. For example, repetitive motion injuries develop over a period of time and not from a single event or accident; this makes it extremely difficult to prove that this type of injury is work-related and is not a result of physical activity outside of the workplace.

If an employer or the insurance company is refusing benefits, contact a Newport Beach workers’ compensation attorney as soon as possible. 


2. Employer Has Not or Will Not Report the Injury

workers' comp attorney helping clients file workers' compensation claims in Orange County

After a workplace accident, employees are instructed to immediately report the accident. Then, they will be given a workers’ comp claim form to fill out, initiating the claims process.

Once completed, it will become the employer’s responsibility to report the injury to their workers’ compensation insurance. Urgency is vital, as delays in filing workers’ compensation claims can be perceived as injuries not being serious, and therefore, require minimal benefits.

Employers failing to immediately report workplace accidents is concerning. This may occur if the company violates safety protocols, does not possess workers’ compensation insurance (which is illegal), or is attempting to cut costs by not reporting the accident to their insurance.

Regardless of the reason, if a company refuses to report the accident, it is vital to speak with an experienced workers’ compensation attorney as soon as possible.


3. Some or All of the Disability Benefits Have Not Been Received 

Sometimes, an employer does not follow through on providing maximum benefits, offering medical care to an injured employee but failing to compensate for lost wages.

Workplace accidents entitle an employee to disability benefits and are not subject to an employer’s decision. If employees are injured at work, they should receive medical treatment, as well as compensation for the time missed from work while healing from injuries.

An employer or insurance company cannot simply make the decision to only compensate in one area. Disputing this can delay treatment, ultimately compromising recovery and jeopardizing the employee’s physical and mental well-being.


4. Employer Retaliated for the Workers’ Compensation Claim Being Filed

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Retaliating against injured workers for requesting workers’ compensation benefits for a workplace injury is illegal and unjust. Examples of retaliation include termination, not accommodating injuries when the employee returns to work, or any other mistreatment.

It is the legal right of an employee to report when an incident or accident occurs at work, and it is an employer’s legal responsibility to protect their employees. 

An employer who is found guilty of retaliating against employees for filing a workers’ compensation claim will be responsible for covering the costs of their medical bills, compensating for other damages, like lost income, and will be subject to additional penalties, like fines and lawsuits.


5. There Is Uncertainty Surrounding the Approved Benefits

The legal system is complicated. Incorporate strict insurance policies, mounds of paperwork, and varying state laws, and it is understandable why so many injured workers are unaware of the types of benefits they are entitled to.

As a result, many employees rely on their employers to clarify the details that are unclear to them. Unfortunately, the response is sometimes dishonest. 

When taking into account accumulated costs of lost wages, multiple doctors’ appointments, surgeries, physical therapy, and procedures from medical specialists, insurance companies will end up paying thousands, sometimes millions in damages. 

To avoid this, an employer or insurance may provide faulty advice or information to reduce the benefits of workers comp claims.

If it’s suspected that benefits are being withheld or that there are discrepancies between what is owed and what has actually been granted, talk to workers’ compensation lawyers. 


6. The Employer’s Doctor Has Become Difficult to Contact

frustrated injured employee trying to contact doctor

When it comes to the California workers’ compensation system, the way medical treatment is handled is very different than how it is handled with a personal injury claim.

This is because the injured worker must be seen by a doctor that the employer has previously selected and part of their medical provider network (MPN).

Being limited to where medical care can be administered is problematic, because, ideally, most would prefer to be seen by their primary care physicians.

While it is possible to begin treatment with a doctor outside of the MPN, it will be very difficult to find one willing to accept a workers’ compensation case. Billing and coding work differently in these types of cases, and most facilities would prefer that injured workers stay within their MPN.


7. The Doctor Has Prematurely Cleared to Return to Work

There are times when a doctor may clear someone to return to work, even if that individual does not feel fully healed.

This is particularly concerning if the type of work involves physical activity that could aggravate the problem area and cause re-injury.

Injured employees who feel that they cannot return to work may get a second opinion from another doctor. However, there is a process to this alternative, and it will also involve proving to the employer that the injury has not, in fact, healed.

This scenario may relate to maximum medical care (MMI), which describes the point after an injured employee either reaches full recovery or when a doctor determines that the patient will not reach full health.

However, if medical improvement to a condition is no longer possible, the victim may be able to qualify for permanent disability benefits.


8. Employer Will Not Offer Alternative Work to Accommodate Injuries

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When an injury prevents an employee from returning to the same level of work, a doctor may instruct work restrictions, limiting physical activity such as:

  • Lifting, pushing, pulling a certain amount of weight
  • Standing or walking for extended periods
  • Repetitive movements
  • Bending, twisting, or being situated in uncomfortable positions 

As an alternative, sedentary work may be offered. However, if an employer cannot accommodate work restrictions, they cannot enforce that an injured worker return to the same type of work, and they cannot terminate them. 

Another option for injured employees is to provide “supplemental job displacement benefits.” These benefits are designed to help victims retrain or learn new skills so that they can pursue a different line of work. An employer and insurance company must either provide work accommodations or a training voucher. 


Beach Accident Attorneys – The Top Orange County Workers’ Compensation Lawyers

If your employer or insurance company is withholding benefits, such as not covering medical expenses, denying a workers’ compensation claim, or not adhering to other workers’ compensation laws, contact experienced workers’ compensation attorneys.

Beach Accident Attorneys can help you in recovering workers’ compensation benefits. Our law firm offers a free consultation, where we will discuss your case, share all of the benefits you are entitled to, and address any questions. 


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