Burn Injuries and Workers’ Compensation: What You Need to Know

In the Workforce, there are many workers who are at risk for sustaining burn injuries.  Many occupations expose workers to the risk of burns. These occupations include firefighting, food processing, and construction. Burn injuries can be serious. They can cause the need for extensive treatment, create severe impairments with respect to the ability to work, and severely impact an individual’s ability to perform activities of daily living. Continue reading

QME Specialties & Your Qualified Medical Evaluation: The Choice Of QME Specialties & Your Workers’ Compensation Case: What You Need To Know

California Workers’ Compensation Law provides for the employment of Qualified Medical Evaluators (QMEs) to assist in resolving disability and medical disputes between Injured Workers and Insurance Companies.

The Department of Industrial Relations (DIR) Medical Unit is responsible for the assignment of the QMEs to the parties. As part of this process, the Medical Unit also provides for a Medical Specialty choice with respect to the assignment of a QME Panel.

This article is intended to discuss the various QME medical specialties available.

What is a Qualified Medical Evaluator?

Per the DIR, “Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers’ Compensation – Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker’s eligibility for workers’ compensation benefits. “

The DIR believes that typically doctors with Medical Specialties have “typically gained through education, experience, and demonstrated competency.”

The DIR notes that a “QME physician certified by the DWC in a particular specialty characteristically has the knowledge to perform QME evaluations that fall within that specialty’s range of expertise. It is important to be aware that individual physicians vary in their specific knowledge, skills, and expertise.” [NOTE: The DIR acknowledges that not all QME are equal. Some are more competent than others.]

What is a Medical Specialty?

The practice of medicine has many different areas of concern. A specialty means that the physician has taken steps to have an increased proficiency with respect to a certain area of medicine. Certain physicians, after graduating medical school, enter into residency programs. These programs can include specialties such as urology and surgery. Further, there is additional specialty and subspecialty training in the form of fellowships. For example, there are doctors who focus their practice to treating people with musculoskeletal problems; there are doctors who practice performing surgery on bones and joints. There are doctors who focus their practice treating patients with cardiovascular disease.

How Do Medical Specialties Impact QME Evaluations?

Injured Workers generally have specific injured body parts and body systems that need to be evaluated. Injured Workers, as part of their evaluation, need to have a QME who will examine and render medical opinions with respect to these body parts and body systems. Therefore, it is very important for an injured worker to choose a medical specialty in which the body part or body systems will be addressed. Therefore, it is important to understand the medical specialties that are available and what areas each specialty covers.

What If My Medical Injuries Involve Multiple Specialties?

QMEs are allowed to consult with other doctors concerning the generation of the QME report. They may reach out to your treating physicians for consultation. Further, frequently, QMEs note in their reporting that they defer evaluations of certain conditions outside their medical specialty to other evaluators. Sometimes, the QMEs will report that an additional QME Panel for other medical specialties.

What are the QME Medical Specialties Available?

The QME Medical Specialties include Allergy and Immunology, Dermatology, Emergency Medicine, Family Practice, General Preventative Medicine, Hand Surgery, Internal Medicine, Internal Medicine-Cardiovascular Disease, Internal Medicine-Endocrinology, Diabetes and Metabolism, Internal Medicine-Gastroenterology, Internal Medicine-Hematology, Internal Medicine-Infectious Disease, Oncology, Nephrology, Pulmonary Disease, Rheumatology, Neurological, Neurological Surgery, Obstetrics and Gynecology, Occupational Medicine, Orthopedic Surgery, Otolaryngology, Pain Medicine, Pathology, Physical Medicine & Rehabilitation, Psychiatry, Spine, Surgery, Surgery-General Vascular, Thoracic Surgery, Medical Toxicology, and Urology.

Are there additional QME Medical Specialties Available?

Yes. The Medical Unit also provides for non-physician specialties. These non-physician specialties include:

  • Acupuncture
  • Dentistry
  • Optometry
  • Podiatry
  • Psychology

Descriptions of all the QME Specialties:

 

What is the Acupuncture QME Specialty?

Per the DIR, “An acupuncturist may be consulted for specific symptoms and conditions such as pain, anxiety, arthritis, asthma, migraine, menstrual disorders, intestinal disorders, addiction, and other conditions. The World Health Organization (WHO) has listed the above conditions as being responsive to acupuncture treatment. Acupuncture is generally categorized as alternative medicine or complementary medicine. Acupuncturists complete at least three years of study beyond their college education and receive a master’s or doctoral degree.”

What is the Allergy and Immunology(MAI) QME Specialty?

Per the DIR, “An allergist/immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immune system diseases including primary immunodeficiency disorders. These conditions range from the very common to the very rare, spanning all ages and encompassing various organ systems.”

What is a Chiropractic QME Specialty?

Per the DIR, “Doctors of Chiropractic (chiropractors) care for patients of all ages, with a variety of health conditions. Chiropractors are especially well known for their expertise in caring for patients with back pain, neck pain, and headaches. They may use manipulations or mobilizations (chiropractic adjustments). They also care for patients with a wide range of injuries and disorders of the musculoskeletal system, involving the muscles, ligaments and joints. Chiropractors also counsel patients on diet,

nutrition, exercise, healthy habits, and occupational and lifestyle modification. Chiropractors receive a Doctor of Chiropractic (DC) degree after four to five years of education following their college education.”

What is the Dermatology (MDE) QME Specialty?

Per the DIR, “Dermatology involves the evaluation and management of patients with benign and malignant disorders of the skin, hair, nails and adjacent mucous membranes. A dermatologist has had training and experience in the following:

The diagnosis and Treatment of Skin Cancers

  • melanomas
  • moles
  • other tumors of the skin
  • The management of contact dermatitis and other inflammatory skin disorders
  • The recognition of systemic and infectious diseases that manifest on the skin
  • Dermatopathology, the microscopic diagnosis of diseases of the skin
  • Surgical techniques used in dermatology

The management of cosmetic disorders of the skin, including:

  • hair loss
  • scars
  • the skin changes associated with aging.”

What is an Emergency Medicine(MEM) QME Specialty?

Per the DIR, “Emergency medicine is the specialty concerned with the stabilization, management, diagnosis, and disposition of individuals with acute illness and injury. It also includes the management of trauma resuscitation, advanced cardiac life support, advanced airway management, poisonings, pre-hospital care and disaster preparedness. Emergency medicine encompasses a large amount of general medicine but involves the technical and cognitive aspects of virtually all fields of medicine and surgery including the surgical sub-specialties.

Emergency medicine physicians have a broad knowledge base and possess the skills of many specialists and have the ability to:

  • Manage a difficult airway (Anesthesia)
  • Suture a complex laceration (Plastic Surgery)
  • Reduce a fractured bone or dislocated joint (Orthopedic Surgery)
  • Treat a heart attack (Internal Medicine)
  • Delivery a baby (Obstetrics and Gynecology)
  • Stop a bad nosebleed (ENT)
  • Manage suicide attempts and complex overdoses (Psychiatry & Toxicology)
  • Tap a septic joint (Rheumatology)
  • Protect an abused child (Pediatrics)
  • Place a chest tube (Cardiothoracic Surgery.)”

What is a Family Practice QME Specialty?

Per the DIR, “A family practice physician has been trained in: Providing continuing, comprehensive health care and a specialty in breadth that integrates the biological, clinical and behavioral sciences.

The scope of family practice medicine encompasses all ages, both sexes, each organ system and every disease entity.”

What is General Preventative Medicine (MPM) QME Specialties?

Per the DIR, “General preventive medicine focuses on: The health of individuals and defined populations to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death; Control and prevention of occupational and environmental factors that may adversely affect health; Clinical preventive medicine activities, including measures to promote health and prevent the occurrence, progression, and disabling effects of disease and injury; and Assessment of social, cultural, and behavioral influences on health.”

What is a Hand Surgery (MHH) QME Specialties?

Per the DIR, “Hand surgeons focus on surgical and non-surgical assessment of problems of the hand, wrist, and forearm. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems. Hand surgeons are orthopedic, plastic, or general surgeons who have additional training in surgery of the hand. Because many hand surgeons devote most of their time to examining, treating and studying the hand, they are specialists in hand care, including:

  • Carpal tunnel syndrome
  • Wrist pain
  • Cuts on the fingers and hand
  • Fractures
  • Dislocations
  • Contractures
  • Amputations
  • Creating fingers from toes and other joints
  • Vascular injuries
  • Prosthetics
  • Orthotics.”

What is an Internal Medicine (MMM) QME Specialty?

Per the DIR,” Internal medicine physicians, or internists, specialize in adult health care. They spend at least three years of medical training learning how to prevent, find and treat illness in adults. Internists have a broad knowledge base and possess the skills of many internal medicine specialists. They care for any adult sickness, including those involving:

  • Blood (Hematology)
  • Cancer (Oncology)
  • Diabetes (Endocrinology)
  • Digestion (Gastrointestinal)
  • Heart and blood vessels (Cardiovascular Disease)
  • Hormones (Endocrinology)
  • Infections (Infectious Disease)
  • Kidneys (Renal)
  • Liver (Gastrointestinal)
  • Rheumatoid arthritis (Rheumatology)

Internists take care of people from their teen years through old age and manage their care even when other doctors are involved.”

What is the Internal Medicine-Cardiovascular Disease (MMV) QME Specialty?

Per the DIR, “Cardiovascular disease, or cardiology, is the subspecialty of internal medicine that focuses on prevention, diagnosis, and treatment of conditions of the heart, blood vessels and circulation system in adult patients.

Cardiology is the subspecialty of internal medicine concerned with the functioning of the heart, blood vessels and circulation of blood throughout the body. It may also encompass evaluation of the lungs.”

What is the Internal Medicine-Endocrinology, Diabetes & Metabolism (MME) Qualified Medical Evaluator Specialty?

Per the DIR, “Endocrinology, diabetes, and metabolism (endocrinology) is the subspecialty of internal medicine that specializes in conditions specific to the endocrine system and major endocrine glands, including the pituitary, pineal, thyroid, parathyroids, thymus, adrenals, pancreas, ovaries, and testes. Endocrinologists provide treatment for a wide range of functions and disorders of the human body – diabetes, thyroid disorders, infertility, metabolism, glandular cancers, growth hormone deficiency, genetic dysfunction, heart disease, osteoporosis, obesity and hormonal imbalances. The skills of an endocrinologist are necessary for complicated disorders, such as uncontrolled diabetes, thyroid cancer, pituitary dysfunction, familial endocrine and auto-immune disease.”

What is the Internal Medicine-Gastroenterology(MMG) Qualified Medical Evaluator Specialty?

Per the DIR, “Gastroenterology is the subspecialty of internal medicine involving the management of diseases of the gastrointestinal tract (esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts) and liver. It includes common and important conditions such as colon polyps and cancer, hepatitis, gastroesophageal reflux (heartburn), peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, Irritable Bowel Syndrome (IBS), and pancreatitis. In essence, all normal activity and disease of the digestive organs are part of the field of Gastroenterology.”

What is the Internal Medicine Hematology (MMH) Qualified Medical Evaluator Specialty?

Per the DIR, “Hematology is the subspecialty of internal medicine concerned with disorders of the blood, bone marrow and lymphatic systems. These include disorders of red and white blood cells and platelets, bone marrow failures, such as aplastic anemia, abnormal clotting, and bleeding, Hodgkin’s disease and blood malignancies such as leukemia, lymphoma, multiple myeloma, hairy cell leukemia and related problems. Hematologists coordinate total patient care, working, where needed, with surgeons, radiation therapists, gynecologists or other specialists. Treatments may include therapeutic phlebotomy, bone marrow aspiration, core bone marrow biopsy, and chemotherapy or other special therapy.”

What is the Internal Medicine Infectious Disease(MMI) Qualified Medical Evaluator Specialty?

Per the DIR, “Infectious disease is the subspecialty of internal medicine that focuses on the diagnosis and treatment of infectious diseases. Infectious disease specialists have expertise in infections of the sinuses, heart, brain, lungs, urinary tract, bowel, bones, and pelvic organs. Their extensive training focuses on all kinds of infections, including those caused by bacteria, viruses, fungi, and parasites. Many infectious disease physicians specialize in treating patients with infections due to human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS). Infectious disease specialists have specialized knowledge about the use of antibiotics and their potential adverse effects. They also have additional training in immunology (how the body fights infection), epidemiology (how infections spread) and infection control.”

What is the Internal Medicine Medical Oncology(MMO) QME Specialty?

Per the DIR, “Medical oncology is the subspecialty of internal medicine that focuses on the diagnosis and management of cancer. Medical oncologists are broadly trained in all areas of treating cancer. Some medical oncologists also further specialize in specific types of cancer, such as breast cancer, lung cancer, prostate cancer, leukemia, or lymphoma.”

What is the Internal Medicine Nephrology(MMN) QME Specialty?

Per the DIR,” Nephrology is the subspecialty of internal medicine concerned with kidney diseases. Nephrologists diagnose and treat kidney diseases, including both the conditions these diseases can produce — such as hypertension — as well as diseases that can cause kidney failure — such as diabetes mellitus and polycystic kidney disease. Nephrologists evaluate patients in cases of protein or blood found in the urine, severe high blood pressure, kidney stones, renal insufficiency or kidney failure.”

What is the Internal Medicine-Pulmonary Disease (MMP)/Pulmonology QME Specialty?

Per the DIR, “Pulmonology is the subspecialty of internal medicine concerned with diseases of the lungs and bronchial tubes, which often involves evaluation of the upper respiratory tract (nose, pharynx, and throat) as well as the heart.

Pulmonologists are specially trained in diseases and conditions of the chest, such as pneumonia, asthma, tuberculosis, emphysema, or complicated chest infections. Pulmonologists have expertise in complex pulmonary problems, such as emphysema, tuberculosis, asthma, complicated infections of the chest, the pulmonary complications of AIDS, injury, and complications of respiratory diagnostic and therapeutic procedures.”

What is the Internal Medicine-Rheumatology(MMR) QME Specialty?

Per the DIR, “Rheumatology is the subspecialty of internal medicine concerned with joints, muscles and bones and their roles in health and disease.

Rheumatologists study conditions specific to the musculoskeletal system – arthritis, certain autoimmune diseases, pain disorders, and osteoporosis. Rheumatologists are specially trained to do the detective work necessary to discover the cause of swelling and pain. This may include diseases such as rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia or tendonitis.”

What is the Neurology(MPN) QME Specialty?

Per the DIR, “Neurologists diagnose and manage disorders of the nervous system (brain, spinal cord, and nerves) and muscles. These disorders include: Stroke ,Brain and spinal cord tumors, Muscular dystrophy, Headache and other pain, Meningitis, Encephalitis, Epilepsy (seizures), Parkinson disease, Alzheimer disease and other memory disorders, Multiple sclerosis, and Effects of systemic diseases, like high blood pressure and diabetes, on the nervous system.”

What is Neurological Surgery(MNS) QME Specialty?

Per the DIR, “[a] neurological surgeon specializes in operative and non-operative management (prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of patients with disorders of the brain, spinal cord, spinal column, and peripheral nerves, including their support structures and blood supply. They also evaluate and manage disorders that affect the function of the nervous system and the operative and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders of the brain, meninges (membranes covering the brain and spinal cord), skull, spinal cord, and vertebral column. This also includes the carotid and vertebral arteries, the pituitary gland, spinal fusion or instrumentation, and disorders of the cranial and spinal nerves. Pediatric neurosurgeons manage children with head injuries, brain and spinal tumors, vascular malformation, seizure disorders, and hydrocephalus.”

What is the Obstetrics and Gynecology(MOG) QME Specialty?

Per the DIR, “Obstetrician/gynecologists have specialized knowledge of medical and surgical care of the female patient, with a focus on the female reproductive system. This includes surgical procedures, managing the care of pregnant women, delivering babies, and rendering gynecologic care, oncology care, and primary health care for women.”

What is the Occupational Medicine (MPO) QME Specialty?

Per the DIR, “Occupational medicine physicians have knowledge in a number of clinical areas and expertise in a wide variety of disciplines. Occupational medicine focuses on comprehensively preventing and managing illness and injury among workers. An occupational medicine physician typically has expertise in The harmful effects of chemicals, metals, gases, and pesticides) and other workplace hazards, such as radiation and noise (Toxicology); Fitting the job to a person (Ergonomics); Musculoskeletal injuries including back, neck, and extremities; Hearing loss; Disorders of the lung, such as asbestosis, silicosis, and work-related asthma (Pulmonary); Work-related cancers (Oncology); Infectious diseases in the workplace, including bloodborne pathogen exposures and tuberculosis; and Preventing illness and promoting wellness (Preventive Medicine)”

What is the Optometry QME Specialty?

Per the DIR, “Dentistry involves the evaluation, diagnosis, prevention, and treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity (mouth and related structures), maxillofacial area (jaws and face), and adjacent areas. Dentists receive a doctoral degree (DDS or DMD) in dentistry after attending dental school for four years following their college degree.”

What is the Orthopedic Surgery(MOS) QME Specialty?

Per the DIR, “Orthopaedics is the broad-based medical and surgical specialty dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system. The frequency and impact of these diseases and injuries combined with recent advances in their diagnosis and treatment make orthopedics a critical part of health care. Areas of orthopedic surgery include:

  • Sports Medicine.
  • Care of injuries related to athletic activities
  • Joint Replacement and Surgery in Arthritis
  • Care of patients with advanced arthritis including medical treatment, joint replacement, and other procedures.
  • Foot and Ankle
  • Care of patients with injury and diseases of the foot and ankle
  • Shoulder and Elbows
  • Care of diseases and injuries of the shoulder and elbow
  • Trauma and Fractures
  • Treatment of injuries to the bones, joints, muscles, tendons, nerves, and vessels of the arms, legs, back, and neck.
  • Musculoskeletal Oncology
  • Treatment of benign and malignant tumors of bones, joints, and muscles.
  • Rehabilitation
  • Short and long-term programs to improve strength and mobility and optimize recovery.
  • Arthroscopy and Arthroscopic Surgery
  • Diagnosis and treatment of joint diseases and injuries using arthroscopic methods.”

What is the Otolaryngology (Ear, Nose, and Throat, or ENT)(MTO) QME Specialty?

Per the DIR, “Otolaryngology or ENT surgery focuses on the comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems and related structures of the head and neck. This includes: Knowledge of audiology and speech-language pathology; the chemical senses and allergy/immunology, endocrinology and neurology as they relate to the head and neck; Medical and/or surgical therapy or prevention for diseases, neoplasms, deformities, disorders and/or injuries of the ears, the respiratory and upper alimentary.”

What if I need advice?

If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, A Professional Law Corporation. They have been helping people in Central and Southern California deal with their workers’ compensation cases for 26 years. Contact us today for more information.

 

Subsequent Injuries Fund & Workers’ Compensation: Additional Benefits for Seriously Disabled Injured Workers with Pre-Existing Disabilities: What You Need To Know

The State of California has a Special Program for Injured Workers who have pre-existing labor disabling conditions. It is called the Subsequent Injuries Fund. It is commonly referred to by the abbreviation “SIF”. This Special Program allows for Injured Workers who are seriously disabled to obtain additional compensation beyond their ordinary workers’ compensation case.

What is the Subsequent Injuries Benefits Trust Fund?

Per the Department of Industrial Relations, “[t]he Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIBTF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least 70 percent. The fund enables employers to hire disabled workers without fear of being held liable for the effects of previous disabilities or impairments.” In sum, ratings of an Injured Worker’s overall disability, regardless of it being industrial, must be 70 percent or more to qualify. Continue reading

workers compensation benefits

Pain And Suffering In California Workers’ Compensation: What You Need To Know

As an Attorney representing Injured Workers, I am frequently asked by clients or prospective clients as to whether they are going to be compensated for their “Pain and Suffering” that arose out of their work injuries. This article will discuss the nature of “Pain and Suffering” within the framework of the California Workers’ Compensation Law.

Where does “Pain and Suffering” come from? 

“Pain and Suffering” is a concept that arises from Personal Injury Law. Black’s Law Dictionary, Fifth Edition, defines “pain and suffering” as a term used to describe not only physical discomfort and distress but also mental and emotional trauma which are recoverable as elements of damage in torts. Tort is a civil action involving injury. Personal Injury Claims fall within the field of law called “Torts”.

Is there Compensation for “Pain and Suffering” within Workers’ Compensation?

The answer is “No” and “Yes.” The reason I say “no” and “yes” is that the correct initial answer to the question is “no.”

As noted by the California Department of Industrial Relations

“[w]orkers’ compensation is the nation’s oldest social insurance program: It was adopted in most states, including California, during the second decade of the 20th century. The workers’ compensation system is based on a trade-off between employers and employees. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries or illnesses no matter who is at fault and, in return, are prevented from suing employers over those injuries. As a result, California employers are required by law to have workers’ compensation insurance, even if they have only one employee. And, if your employees get hurt or sick because of work, you are required to pay for workers’ compensation benefits. Workers’ comp insurance provides basic benefits, including medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits and a return-to-work supplement, and death benefits.” [emphasis added] Note: workers’ compensation is intended to replace personal injury claims for Injured Workers.

As noted by the California Supreme Court in Jacobsen v. Industrial Acci. Com., 212 Cal. 440, 299 P. 66, 1931 Cal. LEXIS 644, “damages for physical pain and mental suffering, which are elements not compensable under the Industrial Accident Law unless they affect the employee’s ability to work.”

Thus, the “Yes” answer to the question to whether “Pain and Suffering” is part of a workers’ compensation award is premised on whether the “pain and suffering” affects the Injured Worker’s ability to work. If there is credible evidence to that effect, there is a likelihood that they may be some compensation for “pain and suffering” within the framework of workers’ compensation law. The challenge for the Injured Worker, in these circumstances, is to translate the “pain and suffering” into the framework of permanent disability.

How Can Recovery for “Pain and Suffering” be Translated into the Workers Compensation Benefits?

First, there must be an understanding of what workers’ compensation benefits cover. Workers’ Compensation benefits cover periods of temporary disability and provides for permanent disability payments. Temporary disability benefits compensate Injured Workers when they are unable to perform their job while they recover from their injury. Permanent Disability benefits provides compensation for the permanent impact of the injury on one’s ability to work. Permanent Disability is in large part based upon the AMA Guides to the Evaluation of Permanent Impairment, the 5th Edition. Working with Doctors and Attorneys who are knowledgeable about these Guides is important to most accurately assess the Injured Worker’s permanent disability with respect to incorporating the aspects of “pain and suffering” within the assessment of permanent disability.

Sometimes, Injured Workers sustain horrific accidents which do not cause them either to miss work or to have any residual effects. By this, the Injured Worker completely recovered from the injury. Under Personal Injury Law, this injury may have resulted in “pain and suffering.” In the workers’ compensation system, however, it does not translate into workers’ compensation benefits. On the other hand, if the incident caused residual psychiatric impact which may be labor disabling, it is possible to pursue a psychiatric impairment. Further, exploration as to whether there was in effect some permanent impairment on a physical level should be examined as well. Sometimes, however, human beings are resilient and heal up.

What is the “Pain and Suffering” that Injured Workers commonly believe that they should be compensated for? 

Many Injured Workers complain about the “pain and suffering” from being in the workers’ compensation system. This includes the pain of dealing with an insurance company, the pain of having their claim denied, the pain of being denied benefits, the pain of having medical care denied or delayed, the pain of being deposed by an insurance company attorney, the pain of going to medical treatment and having to wait, the pain of getting bad medical treatment or dealing with unfriendly medical providers, the pain of being investigated, the pain of being evaluated by a Qualified Medical Evaluator, the pain of having to go to court hearings and doing trial. Finally, the pain of dealing with Applicant’s attorneys such as myself. At times, because the nature of claims is often uncertain or unknown, Attorneys and Injured Workers have to address difficult stressful situations.

Is “Pain and Suffering” from Litigation compensable?

“Pain and Suffering” from participating in litigation are generally considered as non-industrial. See Rodriguez v. Workers’ Comp. Appeals Bd., 21 Cal. App. 4th 1747, 27 Cal. Rptr. 2d 93, 1994 Cal. App. LEXIS 67, 94 Cal. Daily Op. Service 642, 59 Cal. Comp. Cases 14, 94 Daily Journal DAR 1084

There is a slight exception when there is employer/carrier misconduct. See Unruh v. Truck Ins. Exch., 7 Cal. 3d 616, 498 P.2d 1063, 102 Cal. Rptr. 815, 1972 Cal. LEXIS 217, 37 Cal. Comp. Cases 590. Also Lee Patrick, Applicant v. Marina City Club, State Compensation Insurance Fund, Defendants, 2010 Cal. Wrk. Comp.P.D. LEXIS 19

What Does this all Mean?

In sum, “Pain and Suffering” is not compensable in workers’ compensation. Pain, however, if it is labor disabling, is something upon which permanent disability can be awarded. This pain should be quantified in terms of the AMA Guides or under a Psychiatric Disability using the GAF. This quantification should be done through medical reporting documenting the disability.

What if I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.

California Workers Compensation Insurance

California Workers’ Compensation Insurance: What Your Employer Pays for In Their Workers’ Compensation Insurance Bill That May Benefit Injured Workers: What You Need to Know

California Workers’ Compensation Law requires that Employers pay surcharges in addition to their regular California Workers’ Compensation Insurance Premiums.   These Surcharges are very important to Injured Workers. These surcharges fund certain programs which are important for Injured Workers to know about. These Surcharges can help Injured Workers collect benefits from their claims.  These surcharges allow Injured Worker to have access to the Workers’ Compensation Appeals Board so that they can obtain benefits.  These surcharges can also be a source of an additional form of compensation for Injured Workers.

What are Surcharges? 


California Insurance Carriers are obligated by California Law to participate in the surcharge program by collecting these surcharge funds from Employers.  These surcharges are used to fund various programs which involve the workers’ compensation system.  See Labor Code Sections 62.5, 62.6 and Insurance Code Section 1063.5.

What are the Programs that the Surcharges fund? 


There is a Fraud Assessment Surcharge, a Workers’ Compensation Administration Revolving Fund Surcharge, an Uninsured Employers Benefits Trust Fund Surcharge, a Subsequent Injuries Benefits Trust Fund Surcharge, an Occupational Safety and Health Fund Surcharge, a Labor Enforcement Compliance Surcharge, and a California Guarantee Insurance Code Association Surcharge.

These surcharges, in many different ways, directly benefit many Injured Workers.  I have arranged them in order of importance.

What is the Workers’ Compensation Administration Revolving Fund Surcharge? 


This Administrative Surcharge is one of the most important. It provides for the funding of the workers’ compensation administration, the return to work program, and for employers’ workers’ compensation coverage compliance enforcement.

In sum, this surcharge pays for the Workers’ Compensation Appeals Board offices and their staffing.   Injured Workers cannot get their claims adjudicated without this surcharge.   Also, this surcharge benefits Injured Workers through the return to work program which includes the job displacement benefit.  Finally, this surcharge assists in making sure that Employers are properly insured so that Injured Workers can get benefits.

What is the CIGA Surcharge? 


The CIGA Surcharge is another very important surcharge for Injured Workers.   The California Insurance Guarantee Association settles unpaid claims of insolvent insurers.  In this surcharge, the entire Insurance Industry assumes responsibility for defunct carriers’ obligations to their claimants.  In sum, when an Insurance Company goes insolvent, monies from this surcharge help to pay out these claims.  In other words, Injured Workers do not lose their entitlement to benefits should the adjusting Insurance Company goes bankrupt.

What is the Uninsured Employer Benefits Trust Fund Surcharge? 


The Uninsured Employer Benefits Trust Fund Surcharge is a very important surcharge for Injured Workers. In the event that there is no workers’ compensation insurance, this surcharge assists in creating a fund so that Injured Workers can collect benefits.

In sum, there are times when an Employee is injured at work for which the Employer did not have an insurance policy in effect. This surcharge helps these Injured Workers get the same benefits as if there was insurance.

What is the Subsequent Injuries Trust Fund Surcharge? 


The Subsequent Injured Trust Fund Surcharge is another very important surcharge for Injured Workers. For Injured Workers who have pre-existing permanent disabilities and physical limitations, if they meet certain eligibility qualifications, they are allowed to collect additional compensation beyond their ordinary compensation.

What is the Occupational Safety and Health Fund Surcharge? 


The Occupational Safety and Health Fund Surcharge is used to promote safe and healthful working conditions by funding state safety and health agencies to implement and enforce occupational health and safety laws.

What is the Labor Enforcement Compliance Fund Surcharge? 


The Labor Enforcement Compliance surcharge is used to enforce employer compliance with labor standards and securing workers’ compensation insurance.

What is the Fraud Surcharge? 


The Fraud Surcharge funds the investigation and prosecution of workers’ compensation fraud.   This is one surcharge that does not necessarily benefit an Injured Worker directly.  Fraud Investigation and Prosecution, in the Workers’ Compensation system, can involve Employers, Employees, and Medical Providers.

What if I Need Advice? 


If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.