FREQUENTLY ASKED QUESTIONS

Do I have a viable workers’ compensation case?

California law defines a work injury as any injury arising out of employment, or sustained in the course of employment, which requires medical treatment beyond first aid.  Generally, if (1) you are an employee, (2) have sustained an injury, and (3) the injury occurred during the course of employment, you are entitled to various types of workers' compensation benefits, including medical treatment, wage loss benefits, permanent disability benefits, and potential job displacement benefits.  However, there are time limitations for filing your claim, and there are defenses available to the employer which may bar your right to benefits.  Every case is different.  It is imperative that you consult an attorney as soon as possible if you have sustained, or think you have sustained, an injury at work. 

What type of benefits am I entitled to?

Generally, if you sustain a work injury, you are entitled to lifetime medical treatment to cure or relieve the effects of the work injury, including treatment for compensable consequences. 

You are entitled to temporary disability benefits, calculated as two-thirds of your average weekly wage and subject to statutory minimum and maximum rates, to compensate you for temporary wage loss while you recover from your injuries.  There is a statutory cap of 104 weeks for temporary disability, but in certain cases you may be entitled to up to 240 weeks of temporary disability within a period of five years from the date of injury, for certain types of injuries, such as amputations and severe burns.

You are entitled to permanent disability benefits, which is calculated through a formula pursuant to the Permanent Disability Rating Schedule after you undergo a medical-legal evaluation with a doctor who assesses your permanent impairment according to the American Medical Association Guides, 5th Edition.  In some cases, you may be entitled to increased impairment under applicable case law – this is one area in particular that unrepresented claimants invariably fail to take advantage of.  Your permanent disability may also be reduced if the doctor evaluating you determines that there were other causes of your disability.  This is where strategic advocacy by an attorney can mitigate any potential reduction of your permanent disability.

If you are given permanent work restrictions as a result of your work injury, and your employer is unable to accommodate the permanent work restrictions, you may be entitled to supplemental job displacement benefits, in the form of a voucher.   

Am I required to have an attorney to claim workers’ compensation benefits which I am entitled to?

You are not required to hire an attorney to pursue your claim for workers’ compensation benefits.

Why should I hire an attorney?

The California Labor Code and Code of Regulations governing workers’ compensation law are lengthy, complicated, subject to frequent legislative amendment, and subject to continual litigation which creates new case law not readily accessible to the public.  Most unrepresented claimants do not have the requisite knowledge to oppose claims adjusters and defense attorneys with years of experience and whose jobs it is to minimize your recovery of benefits.  In my decade-plus of experience litigating workers’ compensation cases on behalf of employers and insurers, represented claimants invariably came away with better outcomes in their cases versus unrepresented claimants.  You need someone in your corner who knows the system and understands how the other side thinks.

What does it cost me to hire an attorney?

There is no out-of-pocket cost to you to hire an attorney.  Workers’ compensation attorneys work on a contingency basis, which means that we earn a percentage, usually between 15% to 18%, of money we help you recover either in a settlement with the insurance company or in an Award after trial.  Bottom line, your attorney is only paid if he or she helps you recover money.

Why should I hire SU LAW?

There are many excellent and competent workers’ compensation attorneys in the San Francisco Bay Area.  However, only a handful have any experience handling cases for insurance companies.  I have handled cases for self-insured employers, claims administrators, and insurance companies for more than thirteen years.  This experience provides me valuable insight into the thought process of the insurance company which can be an advantage to my injured worker clients.  I have handled hundreds of cases, and settled or tried dozens of cases for insurance companies.  This experience helped me become familiar with how the insurance companies and their attorneys evaluate your case.  I leverage this knowledge to help my injured worker clients navigate their workers’ compensation cases and recover benefits to which they are entitled, as quickly as possible.  

My claim has been denied. What do I do?

If your claim has been denied, it is important that you consult an attorney as soon as possible as there are time limits within which you can pursue your claim.  The denial may be without merit and an attorney may help you overcome the denial.  Further, if your claim has been denied, you can obtain treatment outside the defendant’s Medical Provider Network, provided your doctor is willing to treat you on a lien basis.

My claim has been denied or delayed.  I’m not receiving benefits and I have no income.  What do I do?

If your claim has been denied or delayed, you should consult an attorney.  Often after a work injury, you are unable to return to work.  At the same time, the workers’ compensation insurance carrier has delayed accepting your claim pending an investigation, and is not paying temporary disability benefits.  While waiting for your workers’ compensation benefits, you may apply for State Disability Insurance (SDI) benefits from EDD if your private physician or primary care physician certifies you for disability benefits.  Visit the EDD website for more information, or you can apply for SDI benefits online.

What is a Medical Provider Network?

A medical provider network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. If your employer has a valid MPN and your claim has been accepted, you are required to treat with a physician within the MPN. Find out if your employer has an approved MPN. Read more about MPNs.