Making a false or fraudulent workers' compensation claim is a felony subject to up to five years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.
NOTE:
The following information is based on the Workers' Compensation Laws for the State of California.
NOTICE
Your Employer
YOUR EMPLOYER Your employer is required to post information and give you written materials that explain workers' compensation. If you have questions, you can contact your supervisor, someone else in management, or your employer's personnel or benefits department. THE CLAIMS ADMINISTRATOR This person handles workers' compensation claims for your employer and usually works for the employer's insurance company. The claims administrator is required to send you written information about your claim and may answer questions. If you can't reach the claims administrator, ask to speak with his or her supervisor. STATE DIVISION OF WORKERS' COMPENSATION DWC administers workers' compensation laws and provides information and help to injured workers. Check the Government Pages at the front of the white pages of your phone book. Look under: State Government Offices/Industrial Relations. See also the Department of Industrial Relations Web site: www.dir.ca.gov. Information & Assistance. I&A officers answer questions and help injured workers resolve problems with their claims. Their services are free. For more information, see "Questions and Answers About State Information & Assistance Services" below. For phone numbers, see "State Division of Workers' Compensation (DWC) Information & Assistance Offices" below. Workers' Compensation Appeals Board. This is where Referees (workers' compensation judges) hear cases and decide on problems and disputes. If a problem can't be resolved through discussions with your claims administrator, an I&A officer can help you request a hearing before a Referee, or an attorney can represent you in a hearing. Vocational Rehabilitation. State Rehabilitation Consultants oversee vocational rehabilitation, make decisions about vocational rehabilitation benefits, and help resolve problems. STATE INDUSTRIAL MEDICAL COUNCIL State Industrial Medical Council. The IMC oversees QMEs (qualified medical evaluators). For problems with a QME or QME report, call toll-free 1-800-794-6900. See also the following Web site: www.dir.ca.gov. APPLICANTS' ATTORNEYS These are lawyers who specialize in helping injured workers with their workers' compensation claims. For more information, see "Questions & Answers About Attorneys" below. YOUR TREATING DOCTOR We can tell you about the kind of medical care you need, the kind of work you can do while recovering, and whether you'll have a permanent disability. We can also provide you with copies of all medical reports that we send to the claims administrator. YOUR UNION Your union may help resolve problems with your workers' compensation claim, tell you about other benefits, negotiate changes needed in your job, and protect you from discrimination. OCCUPATIONAL HEALTH CLINICS Although we do specialize in work-related injuries and illnesses, if your injury would be better served by a different facility we will provide you with a referral. For information about occupational health clinics, call the Association of Occupational and Environmental Clinics at 1-202-347-4976, or contact our office. INJURED WORKER SUPPORT GROUPS These groups of injured workers provide support and practical information on how to handle problems with your claim. Listed below are some resources: Association for Repetitive Motion Syndromes (ARMS) (1-707-571-0397). Gives recorded information about injured worker groups in the San Francisco Bay Area and nationwide. Compensation Alert (1-707-575-9311). E-mail address: workcomp@sonic.net. Provides support to injured workers statewide. HEALTH & SAFETY AGENCIES AND ORGANIZATIONS For help with health or safety hazards at work: California Division of Occupational Safety and Health (Cal/OSHA). Check the Government Pages at the front of the white pages of your phone book. Look up: State Government Offices/Industrial Relations/ Occupational Safety & Health. Cal/OSHA takes worker complaints, inspects workplaces, and enforces health and safety laws. Labor Occupational Health Program (LOHP), University of California at Berkeley (1-510-642-5507) and Labor Occupational Safety and Health Program (LOSH), University of California at Los Angeles (1-310-794-0369). These organizations offer information, training, and help on health and safety matters, including workers' compensation. They serve workers, unions, and others in California and nationwide. OTHER STATE AND FEDERAL AGENCIES For Financial Assistance: California Employment Development Department (EDD). Check the Government Pages at the front of the white pages of your phone book. Look under: State Government Offices. EDD gives information on State Disability Insurance (SDI). U.S. Social Security Administration (SSA) (1-800-772-1213). For a local office, check the Government Pages at the front of the white pages of your phone book. Look under: United States Government Offices. SSA gives information on Social Security Disability Insurance (SSDI) and other benefits. For Discrimination Complaints: If you face discrimination for filing a workers' compensation claim or for having a job injury, you can contact an Information & Assistance officer, an applicants' attorney, or your union. If you face discrimination because of a permanent disability or other medical condition, you can contact an attorney who specializes in employment law. You can get names of attorneys from the State Bar of California (1-415-241-2100), a local bar association, a county legal aid society, your union, or other injured workers. You can also ask for help from these agencies: U.S. Equal Employment Opportunity Commission (EEOC) (1-800-669-4000). For a local office, check the Government Pages at the front of the white pages of your phone book. Look under: United States Government Offices. California Fair Employment and Housing Department (1-800-884-1684). For a local office, check the Government Pages at the front of the white pages of your phone book. Look under: State Government Offices.
BOOKS AND OTHER MATERIALS Your Medical Evaluation and Getting Your Medical Evaluation. Available in English and Spanish. For free copies, contact the Industrial Medical Council, P.O. Box 8888, San Francisco, CA 94128-8888 (1-800-794-6900). California Labor Code. Contains most of the California workers' compensation laws. Available in public libraries and law libraries. Important sections include:
Caution: Certain rules that apply to your case may be found in case law and not the Labor Code. Case law includes past decisions of Referees (workers' compensation judges) and state courts. Schedule for Rating Permanent Disabilities. This state publication is used to rate permanent disabilities. There are two schedules, depending on your date of injury. To see the schedule that applies to you, contact a state Information & Assistance officer (see page 7). To buy a copy, call the California Department of General Services at 1-916-574-2200. To view the schedule for workers injured April 1997 or later, go to the following Web site: www.dir.ca.gov. Through this Web site, link to: Division of Workers' Compensation/ Reports, Schedules, and Publications. How To Handle Your Workers' Compensation Claim, by Christopher A. Ball, 1995. A detailed guide for workers, available in bookstores or from Nolo Press (1-800-728-3555). California Workers' Compensation Practice, by Charles L. Swezey and Dennis J. Hannigan, Continuing Education of the Bar, 1996. A comprehensive reference for attorneys, available in law libraries. Workers' Compensation, by Alan Eskenazi, Steven Siemers, and Ellyn Moscowitz, Bancroft-Whitney, 1994. A reference book for legal assistants, available through bookstores. Basic Stuff, by Dorsey Hamilton, Paupers Publishing, 1991. A "survival guide" for injured workers. Some of the laws that it describes only affect workers injured before 1994. To buy a copy, call 1-707-575-9311. Navigating the California Workers' Compensation System, 1996. A report of injured workers' experiences, prepared by U.C. Berkeley's Labor Occupational Health Program. For a free copy, contact the Commission on Health and Safety and Workers' Compensation (1-415-557-1304).
QUESTIONS & ANSWERS ABOUT ATTORNEYS
A. An applicant's attorney's job is to:
A. Most applicants' attorneys provide one free consultation. If you hire an attorney, you don't pay right away. Instead, the attorney's fee is taken out of your benefits later. The fee is usually 9% to 15% of your final permanent disability settlement or award, plus an additional amount if you receive vocational rehabilitation benefits. A Referee must approve the fee. Note: Often applicants' attorneys can't afford to take cases where the worker does not have a permanent disability.
A. You may need an attorney if:
A. The attorney's fee will be taken out of your benefits. Also, other people involved in your case may be allowed to speak only with your attorney on important matters, not directly with you.
A. Choose one with experience in workers' compensation, preferably one who is certified by the State Bar of California as a workers' compensation specialist. You can get names of applicants' attorneys from the State Bar (1-415-241-2100), a local bar association, the California Applicants' Attorneys Association (1-800-459-1400), a county legal aid society, your union, or other injured workers. Choose carefully. In your first meeting, see how well the attorney and his or her staff communicate with you. If you hire an attorney and then later want to switch, it may be difficult to find another attorney to take your case. QUESTIONS & ANSWERS ABOUT STATE I&A SERVICES
A. I&A officers can give you workers' compensation forms and printed guides. The guides include:
I&A officers:
A. Call toll-free 1-800-736-7401 to hear recorded messages or request written materials. Attend a free, one-hour workshop. Contact a local I&A office for more information. I&A offices are listed below. CALIFORNIA STATE DIVISION OF WORKERS' COMPENSATION (DWC) INFORMATION & ASSISTANCE OFFICES State Information & Assistance (I&A) officers answer questions and help injured workers. Their services are free.
• Bakersfield • Eureka • Fresno • Grover Beach • Long Beach • Los Angeles • Oakland • Pomona • Redding • Sacramento • Salinas • San Bernardino • San Diego • San Francisco • San Jose • Santa Ana • Santa Barbara • Santa Monica • Stockton • Van Nuys • Ventura • Walnut Creek
Making a false or fraudulent workers' compensation claim is a felony subject to five years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.
|