Law Offices of Edward J. Singer APLC

Housekeeper Hospitalized After Cleaning Mystery Substance : Injured Workers in the News #71

Posted on December 1, 2022 by Edward Singer

A Hotel Housekeeper became ill when she encountered a mysterious white powder in a hotel room. It was reported that there was “a “white powdery substance” near the bathroom sink and [the worker] began feeling dizzy and nauseous…” Nypost.com According to the reports, tests found that the substance was not hazardous material.

This article will discuss how this type of claim would be handled from the onset within the workers’ compensation system.

After the Worker Got Hurt, What Should Happen?

In California, Employers are obligated to provide treatment. The Hotel Worker, in this matter, would be taken to a medical facility to be treated and evaluated. Hopefully, the Worker would receive blood, urine and drug testing.

Because of the mysterious nature of the powder, the insurance company most likely would delay in accepting liability for the claim. . The insurance company may want to know “what was in the powder?” before taking any action. Under Labor Code 5402, the insurance company is allowed to investigate a claim for 90 days.

How Will This Case Be Proven To Be Work-Related?

In this matter, the initial medical treatment records will be important. The worker’s medical diagnosis is critical. The nature of the powder, however, is of lesser importance.

Even if the powder was not toxic and was benign, a Worker, seeing the powder, could have suffered an emotional reaction from that event. This would be covered under workers’ compensation. In that circumstance, either a psychiatric injury or physiological response to stress, i.e. aggravation of hypertension, could have occurred.

If there were an un-stress related medical diagnoses, a nexus or connection would have to be made to the substance. Thus, medical testing, i.e. blood or urine, would be important to prove the case. Likewise, testing of the substance would be of import.

In the end, the medical injury will be determined by a medical evaluator. A treating physician, qualified medical examiner or agreed medical examiner will offer their opinions on industrial causation.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

A QUESTIONABLE AMPUTATION WORK INJURY? INJURED WORKERS IN THE NEWS, #13

Posted on January 24, 2022 by Edward Singer

A story comes out of Maine in which a Man was found carrying a severed arm. He had severed it allegedly while operating a ban saw. The man worked at a store. The police department “ have not determined how the man lost his arm, beyond describing the gory amputation as a ‘workplace incident.’ From the story’s facts, there were no witnesses to the accident that were interviewed. dailymail.com

For the purposes of this blog post, the assumption will be given that there is some uncertainty as to how the accident happened.

Will The Workers’ Compensation Carrier Accept This Type of Claim Immediately?

No. Given the paucity of the hypothetical’s facts, the Insurance Company would likely wish to investigate the claim to determine whether there was a work injury. They would want to talk to the Injured Worker as well as his co-workers.

Are There Any Times Limits to the Investigation?

Yes. Labor Code Section 5402(b) provides for a 90 day period for an Insurance Carrier to investigate a clam.

Can The Injured Worker Get Medical Care During the Period of Investigation?

Yes. Labor Code Section 5402(c) provides for up to $10,000.00, of medical care to be provided up to the date of the carrier’s determination.

Are There Any Special Benefits That Applicant to Amputation Cases?

Yes. Labor Code Section 4656(c)(3) allows for 240 weeks of total temporary disability benefits as opposed to the 104 weeks which is provided for cases that are not afforded an exception.

What if I Need Advice?

WHY IS MY WORKERS’ COMPENSATION CLAIM DELAYED? INJURED WORKERS, OUTSTANDING CLAIMS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on January 25, 2021 by Edward Singer

Many Injured Workers have their workers’ compensation claims delayed.

This article will discuss why claims are delayed and what Insurance Company activities occur during the delay period.

Why Are Claims Delayed?

Insurance Companies delay claims in order to verify that there is a legitimate claim. Per the Labor Code, they are afforded this opportunity to investigate.

As part of their investigation, Insurance Companies will investigate the following matters.

Coverage: Insurance Companies need to verify that they actually insure the Employer for the date of the injury.

Employment Verification: Insurance Companies need to verify the Injured Worker actually worked for the Insured Employer.

Date of Injury: Insurance Companies need to verify the date of injury.

Employer Injury Knowledge: Insurance Companies need to know if the Employer knows about the work injury. They need to know the details how the injury happened, whether there were witnesses, and whether it was reported to management.

Medical Verification: Insurance Companies will seek to obtain the medical reporting from the Industrial Clinic or the Medical Provider who treated the worker.

Statements: Insurance Companies may seek the use of an investigator to take statements of the injured worker, other employees of the company, or witnesses, to verify the injury. Investigations can be done by Attorney who may take depositions.

Records: Insurance Companies may seek records from prior employers, insurance companies or medical providers

Qualified Medical Evaluation: An Insurance Company may seek a Panel Evaluator from the State of California to obtain a medical opinion on causation. .

What is the Authority for Delaying a Workers’ Compensation Claim?

Labor Code Section 5402(b) provides for a 90 day period upon which Insurance Companies have to deny a claim. Thus, there is a 90 day period to delay the claim and investigate. This 90 days is from the knowledge of the claim.

The date of knowledge is per LC 5402(a) which provides that “ [k]nowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.” Thus, employer knowledge can trigger the start of the insurance company’s delay period

What If I Need Advice?