Law Offices of Edward J. Singer APLC

A MTA WORKER IS BOTH A HERO….AND AN INJURED WORKER: INJURED WORKER IN THE NEWS, #55

Posted on August 18, 2022 by Edward Singer

Mr. Anthony Wilson, an MTA Worker, is both a hero and an Injured Worker. It was reported that “[l]ast week, Nelson was cleaning the Pelham Bay subway station in the Bronx when police allege 49-year-old Alexander Wright began to harass customers. Nelson stepped in to protect them, but the suspect quickly turned his rage toward Nelson, breaking his collarbone and nose.” KESQ.COM

This fact pattern may involve many unique issues. This article will discuss two important issues that come up with these type of events; the injury investigation and the Injured Worker’s high profile work injury celebrity status.

Why Would High Profile Claim Like This Be Investigated?

In California, any assault claim has the possibility of an insurance company defense of initial physical aggressor. The initial physical aggressor rule could bar an Injured Worker’s claim. Therefore, it is worthy of inquiry by the insurance company. In other words, there will be an investigation as to whether the Injured Worker made the first physical contact.

Labor Code Section 5402, allows insurance companies 90 days to investigate claims. “If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division.” Thus, the Insurance Company will got out and get witness statements and see if the incident was caught on tape before accepting the claim.

Why Is The Injured Worker’s Celebrity Status A Problem?

An Injured Worker who becomes a celebrity as a result of their injury creates a problem.

When an Injured Worker is in a high profile worker’ compensation case, they may be on television or interviewed for news articles. These television reports or interviews may reveal information concerning the Injured Worker’s injuries and their physical activity level. Additionally, in interviews, Injured Workers may try to make a positive and uplifting impression rather than be accurate concerning their complaints. This information can be used to impeach the Injured Worker. Also, it could be sent to examining or evaluating physicians.

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?