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What to do When Medical Treatment is Denied

California Workers Compensation Lawyer

If you sustain an injury while working, you’re entitled to file a claim against your employer’s workers comp insurance to cover treatment. In the acute phase of the injury, you may have hospital and doctor bills, lost wages from missing work, and other associated costs. In the long term, depending on the type of injury, you may need to pursue a larger claim that covers future costs for things like physical therapy, pain, and suffering, etc. What do you do, however, if you receive notice that you’ve been denied medical treatment? Your claim could be totally denied, or, if accepted, the insurance company’s doctors could deny treatment.

Unfortunately, this happens all too often, and many people don’t pursue the matter further. Insurance companies now hire doctors to review and often deny medical care and prescriptions your treating doctor wants you to have. They. of course. do what they’re paid to do — deny care whenever they can. We recommend that you do not give up your rights just because your claim is initially declined or because your doctor’s treatment or prescription is denied. Contact Gold Country Workers Comp Center and schedule a free consultation with an attorney who can help you navigate the system and ensure that you receive the compensation you deserve.

Getting authorization

Assuming you’re not in immediate danger for your life, the first step, when you’re injured at work, is to notify your employer of the incident, at which point you’ll be asked to fill out authorization forms. (If your employer does not offer these forms to you, or if you are worried about how your employer will react to your request for the forms, you should consult with an attorney who specializes in Workers’ Compensation to provide them to you and advise you on how best to proceed.)

These documents notify the insurance company regarding your injuries and intent to pursue medical treatment. There is standard State of California forms that you’ll be required to fill out. Don’t be surprised, though, if you experience a delay in getting approved for medical treatment.

Should you have questions or concerns about the process, ask your workers comp attorney to advise you on your rights as well as the expectations of the insurance company. For example, in many workers comp cases, the insurer will require that you be seen by a doctor that is approved by them even if you’ve already seen a physician of your own choosing.

The review process

The bottom line is that being denied medical treatment does not mean that you don’t have a legitimate claim OR that you don’t have access to medical care through other programs. In addition, if you’re not in agreement with the insurance company on the course of treatment that is authorized by their physician, you can ask for an independent medical review.

Unfortunately, the statistics show that, once a treatment or prescription is denied by the insurance company’s doctor, the review process will UPHOLD the denial in about 85% of the reviews (vs. about 30% of appeals in those rare cases where treatment or a prescription is denied at the initial review stage ny private insurance companies).

A Workers’ Compensation specialist can make a real difference in getting you the medical care you need through the system. Call Gold Country Workers Comp Center today to speak with an attorney for workers comp cases who can make sure your best interests are represented and that you receive proper care and financial compensation after your injury.

The system is very complicated, and initial consultations are free. It costs no more to get an attorney involved early on in a case compared to later in the proceedings. If you encounter resistance from the insurance company, an attorney can help keep the case on track and settled or tried for maximum value.

What to do When Medical Treatment is Denied

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Workers’ Comp Facts for the Natural Resource Extraction Industry

California Workers Compensation Lawyer

Natural resource extraction industries, together with agriculture, form the basis of the primary sector of the economy; in other words, this is the sector of an economy that makes direct use of raw materials such as coal and timber. Natural resource extraction industries include mining, logging, oil and gas drilling, and forestry.

Natural resource extraction and mining is considered to be a high-risk industry with respect to workers’ compensation. Employees in these types of jobs face a greater risk for accidents, and the injuries that they suffer are often more severe.

Some of the more common types of work-related injuries that employees are at risk for include:

  • Contact with objects and equipment
  • Fires and explosions
  • Overexertion and fatigue
  • Transportation accidents
  • Exposure to noxious substances

If you’re an employee of one of the natural resource extraction industries, and you’ve been injured on-the-job, you’re best option is to seek the help and advice of an experienced and knowledgeable attorney specializing in workers’ compensation cases.

Getting an attorney involved early on costs no more than bringing one in later in the proceeding. Doing so helps ensure the case stays on track and avoids the real risk of any significant problems that could easily develop unless guided by an attorney

Legal protection for employees

The Occupational Safety and Health Act of 1970 mandated that employers are responsible for providing a safe and healthful work environment. They must comply with the General Duty Clause of the OSH Act which requires employers to maintain conditions in the workplace such that it is free of serious recognized hazards.

However, potential hazards still exist throughout the industry. Natural resource extraction jobs involve the use of machinery and equipment such as excavators, loaders, backhoes, and drills which can pose a serious risk of injury to employees if routine maintenance is not performed on them or the equipment is defective.

Mining can expose workers to chemical burns, respiratory problems, and poisoning from toxic substances as well as injuries resulting from the use of explosives. Vehicular accidents, falling rock and debris, and machinery can cause back and head injuries as well as broken or crushed limbs.

Working with an attorney

Living in and around Nevada City, you may be employed by one of the many logging companies in the area. If you’ve been injured while on the job, you have the right to receive benefits under California’s workers’ compensation laws.

Gold Country Workers’ Comp Center specializes in two areas of law — workers’ compensation claims and disability claims. Founder Kim Lavalley has worked as an attorney for workers’ compensation cases for most of his 40 plus years of practicing law.

Our firm will work tirelessly to ensure that you receive money and benefits to which you’re entitled from your employer’s workers’ comp insurance, but, in addition, will advise you as to your legal rights to initiate a lawsuit outside of the workers’ comp system.

Injured on the job? Call our firm for your free initial consultation. We’re committed to helping you receive the full benefits that you deserve.

Workers’ Comp Facts for the Natural Resource Extraction Industry

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What You Need to Know About Workers’ Comp for the Manufacturing Industry

California Workers Compensation Lawyer

The workplace environment in the manufacturing industry has more potential dangers for employees than many other workplace settings. The work can be physically demanding with employees often being responsible for moving heavy objects and operating large machinery and equipment.

Employees in many manufacturing settings are continually subjected to loud noises and, in some types of industries, are exposed to potentially dangerous chemicals as well as poor air quality.

The top 5 most common types of injuries that occur in the manufacturing workplace are:

  • Contact with harmful objects
  • Overexertion
  • Slips and falls
  • Repetitive motion
  • Contact with harmful substances and/or chemicals

Work-related injuries in manufacturing can range from soft tissue and stress injuries to catastrophic injuries involving head trauma, crushed limbs, and severe lacerations that can leave an employee partially or totally disabled.

Workers comp claims for manufacturing employees can be complicated because, in addition to receiving compensation from your employer, there are situations in which you may be able to sue for damages resulting from your injuries.

Your rights as an employee

Manufacturing employees rights are guaranteed under the Occupational Safety and Health Act of 1970. Employers have the responsibility to provide a safe workplace that does not present serious hazards to their employees, and they must follow all OSHA safety and health standards.

While workers’ comp insurance provides money and benefits to an injured worker, in many cases it does not adequately compensate the employee for pain and suffering, future medical bills, and lost wages. Additionally, workers’ comp doesn’t grant punitive awards for unsafe or dangerous working conditions unless the employer is guilty of serious and willful misconduct which causes the injury.

Manufacturing jobs often involve the use of machinery and equipment which can be defective. Employees are sometimes injured by exposure to a toxic substance or due to negligence on the part of a third party. Suing for damages as a result of your injury in these types of situations could be an option.

What you deserve

If you’re one of the thousands of manufacturing industry employees in California, and you’ve been injured on the job, it’s important for you to retain the services of a workers’ comp attorney who can provide legal advice and represent your interest throughout the entire claims process.

Securing the services of an experienced workers’ comp and disability attorney early on in the claims process will help to ensure that you receive all of the benefits to which you’re entitled. Gold Country Workers Comp Center, founded by attorney, Kim Lavalley, specializes in workers’ comp and disability claims.

For over 40 plus years, Kim has helped many people who’ve been injured on the job secure the compensation they deserve and need to move forward with their lives. Take a few minutes to read the testimonials from many of his satisfied clients to see why he’s considered to be the best attorney in Nevada City when it comes to workers’ comp and disability cases.

Contact us today for your free consultation.

What You Need to Know About Workers’ Comp for the Manufacturing Industry

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The First Step You Take After an Injury is the Most Important

California Workers Compensation Lawyer

If you’re a California resident and have been injured on the job, you need to know how to file a workers’ comp claim in California. CA workers’ comp laws require employers to provide medical treatment and pay workers’ comp benefits to injured employees. These benefits are for medical treatment and care, replacement of lost income, and long-term disability treatment and rehab services if needed. Death benefits are also available to the surviving family members of the deceased.

First and foremost, you should seek immediate medical treatment for your injury or illness. Make sure that any medical documentation includes the fact that you’re being treated for a work-related injury or illness.

There are several steps to filing a workers’ comp claim in California.The filing process for a California workers’ compensation claim begins when you inform your employer of your injury or illness. You must do so within the 30-day statute of limitations that is mandated by the state of California.

How to file a workers comp case in California

It is important and in your best interest to know how to file a workers’ comp claim in California.To officially make your claims, you must fill out and file several documents:

  • DWC-1 Workers’ Compensation Claim Form and Notice of Potential Eligibility
  • Application for Adjudication of Claim
  • Declaration Pursuant to Labor Code
  • Document Cover and Separator Sheets

Your employer is required to provide you with claims forms within (1) day of you having reported your injury. Under California law, filing a claim must take place within one year from the date of your injury.

The most common types of cases in California include one-time accidents such as slip-and-fall accidents, being struck by an object, and vehicular or machinery accidents. Specific scenarios include slipping and falling on a wet or icy surface or being struck by a falling beam. Repetitive motion injuries such as carpal tunnel syndrome and work-related stress were the second and third most common cases.

Getting everything you need and deserve

The process of filing a workers’ compensation claim and getting workers’ compensation benefits can be confusing and overwhelming. There is a lot of time-consuming paperwork involved — the claims forms themselves, medical statements, witness statements, if applicable, insurance forms. And, unfortunately, legitimate claims are often denied by employers or their insurance carriers. Remember — the insurance company is not looking out for your best interests because they want to reduce the costs to your employer.

Gold County Workers Comp Center specializes in workers’ compensation and disability claims and will work on your behalf to protect your legal rights and to make sure that you are getting the benefits that you deserve. We are skilled at engaging in productive negotiations and structuring settlements or going to trial if necessary.

Getting an attorney involved early in the claims process is critical to its success. All of our fees are contingent upon a successful resolution of your case. Contact our office for your free initial consultation.

The First Step You Take After an Injury is the Most Important

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The Most Common Workers’ Comp Claims Are…

California Workers Compensation Lawyer

Workers’ compensation is a claim and benefits system established for workers who become ill, are injured, or die while on the job. Workers’ comp is actually a type of state-mandated insurance purchased by employers as coverage for their employees, each state having its own individual program. Benefits may include medical expenses, death benefits, lost wages, and rehab services.

The most common types of workers’ comp claims include:

  • Slips, trips, and falls
  • Vehicular accidents
  • Repetitive strain
  • Machinery accidents
  • Overexertion
  • Being struck by an object

Types of injuries that are most commonly seen in workers’ comp cases are strains and sprains, cuts or punctures, contusions, inflammation, fractures, and repetitive stress injuries such as carpal tunnel syndrome and tendonitis.

As a general rule, these are clear cut cases because workers’ comp is a “no fault statute” which means that, with few exceptions, who caused the injury is not crucial to an injured employee being able to get benefits.

Filing a claim with your employer if you’ve been injured on the job should happen as soon as possible and within the statutory deadlines mandated by the state in which you reside.

Where does your case fall?

Among the types of workers’ comp claims, the top 3 most common workers’ comp claims are:

  • Overexertion — usually happens when an employee lifts, pushes, or pulls something beyond his or her normal range of motion
  • Slips, trips, and falls — occur most often due to wet, slick, or uneven surfaces, poor lighting, other maintenance concerns
  • Falling to lower levels — occurs when an employee falls off a ladder, a roof, scaffolding,or down a flight of stairs

Your workers’ comp case may be similar to the aforementioned examples in which case you’ll want to file a claim ASAP.

Filing a claim involves several steps, the first being to seek immediate medical treatment. Make sure that you notify your employer in writing, fill out an official form which should be provided to you by your employer, and keep detailed records concerning all medical treatment. You should also keep receipts for any out-of-pocket expenses that are related to your injury.

Fast results

If you’ve suffered a work-related injury, in can be a frightening and confusing time. You’re injured, you can’t work, and you’re worried about how you’re going to pay your bills without any income.

To ensure that your rights are protected and that you get adequate compensation, you should contact an attorney who specializes in workers’ comp injury cases, especially for more complicated cases such as those resulting in severe injuries requiring surgery, a permanent disability, or if you have pre-existing disabilities, for example.

At Gold Country Workers’ Comp Center, we’ll advocate on your behalf to ensure that you receive all of the benefits to which you are entitled. Additionally, if you have sustained an injury that may keep you from working permanently, we can advise you about filing for Social Security disability benefits, too. Contact our office to schedule a free consultation.

The Most Common Workers’ Comp Claims Are

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