Workers' Compensation

Both California and Federal law guarantee certain benefits to employees who are injured on the job.

"Workers' compensation" is a system of laws to provide injured workers with specific benefits and a system where disputes can be resolved. Some patients, who are injured on their job, are afraid of using the workers' compensation mostly becuse they are not famiar with it.

In fact, a workers' compensation claim is not a lawsuit against your employer, but is a request for insurance benefits. Workers' compensation insurance protects you if you are injured on the job. It will pay for needed medical treatment and time lost from work. It may provide retraining and compensate you if you have a permanent disability. This insurance is provided by your employer.

Please call us whey you injured at work. Our team of specialists of work injuries, are here to guide you to the appropriate treatment program which includes injury evaluation, acupuncture, medical massage therapies, ultrasound as well infrared and other examinations and treatments when necessary. We will submit the medical claims to your insurance. Your cost is nothing.

What are eligible to wokers' compensation?

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Workers' compensation is a "no fault system."

In most cases you are covered, no matter who or what caused the injury. Any injury or illness that is caused (or worsened) by your job is covered by workers compensation insurance. This includes specific injuries (falls, cuts, etc.) as well as illnesses or other problems related to cumulative trauma (carpal tunnels, etc.). Some injuries from voluntary, off-duty, recreational, social or athletic activities (for example, a company bowling team) may not be covered.

There are generally two categories of work injuries, namely acute and chronic:

1.	Acute injuries

	Work injuries may be due to a myriad of causes including slipping and falling, lifting heavy loads, twisting arms and legs, chemical burns, falling objects, and flying projectiles. Acute injuries as in injuries suffered in auto accidents, if treated early and properly, can heal quickly and with a marked reduction of chronic problems.

The reasoning is rather simple. Tense muscle causes pain and an immobile position actually requires the muscle to stay contracted to maintain that position. And after a long period, the muscle learns to stay tense all the time, and that makes it much more likely to hurt. If the process is repeated for months or years, problems will eventually develop.

Chronic injuries

If one sustains repeated trauma, the cumulative injury may eventually reach a threshold where severe and disabling symptoms suddenly develop. Following are two examples:

A secretary who types several hours a day may have enough cumulative trauma to the finger joints to develop arthritis. A forklift operator that needs to use an arm to push a lever for several hours in a shift can experience chronic pain in his elbow.
A computer operator who sits in a chair in the wrong position without taking frequent breaks may put enough strain on the back muscles to cause chronic back aches.

What should do when injured on job?

Report injuries to your supervisor

	If you are injured at work, you need to inform your employer, typically your supervisor, as soon as reasonably possible. Your supervisor will provide you a claim form. Simply fill it out, keep a copy, and return it to your supervisor. If your employer does not give you a form, write your employer describing your injury a letter and keep a copy of that letter. Generally your supervisor will refer you to an occupational medicine specialist, for your care. You will be assigned an insurance company "claims representative" or "adjustor" who will contact you. You may also be assigned to an insurance claims administrator, who will handle your insurance benefits. That doctor may also refer you to other specialists.

Go to see doctor

	Get treatment. Go to the emergency room if needed. You will receive immediate medical treatment, up to a $10,000 cap, until their workers’ compensation claim is accepted or denied. Previously before the California reform in 2004, injured workers had to wait—sometimes up to 90 days—for their claim to be accepted prior to getting medical care.

If you have "pre-designated" a doctor (usually done when you are hired, or when you are provided with your insurance information) you may see this doctor when you are injured on the job. If you do not have a pre-designated doctor, you can be sent to the doctor contracted with your company and their worker's comp carrier.

After the 1st 30 days of injury, by law, you have the right to change to a doctor of your own choice. This is called "Free Choice Selection". You must notify your employer/insurer immediately upon a change of primary treating doctor. You can also see other physician if you get a referral from your primary treating doctor.

Generally, the doctor will communicate with your claims administrator who will authorize your care. In most cases you will not need to worry about authorizations and will never see a bill.

When your work status changes, your doctor will tell you and your claims administrator. When your case is ready to settle, your doctor will report to your insurance company. Either the doctor will provide the information to your claims adjuster, or you will be sent to another doctor for a special report called a "QME (qualifed medical evaluator)."

What are the benefits from wokers' compensation ?

In general, There are four basic benefits.

1.	Medical care

	All medical treatment is covered, without a deductible or dollar limit. Doctors visits, acupuncture, chiropractic care, psychological counseling, hospitalization, x-ray and lab, durable medical items (splints, braces, etc.), some furniture and any other item needed to "cure or relieve" you from the effects of your injury are covered. Costs are paid directly by the insurance company.

2.	Payment for Lost Wages

	If you are temporarily disabled by a job injury, you will receive tax-free income until your doctor says you are able to return to work. Under the California system, payments are set at two-thirds of your average weekly pay, up to a maximum set by state law. Under the California system, payments start after you are off for three days unless you are hospitalized or off for over fourteen days. The rules are different for injuries in the Federal system.

3.	Vocational Rehabilitation

	If the injury or illness prevents you from returning to your usual job, and your employer cannot offer modified work, you may qualify for job placement assistance or retraining. You receive payment for time spent retraining. The amount is less than that paid while you are totally temporarily disabled.

4.	Permanent Disability Settlement

	If you don't completely recover from your injury, you may be entitled to a monetary award. In California this is called a "permanent disability." In the Federal system it is called ”impairment." For California injuries you are compensated based upon your loss of ability to "compete in the open labor market" or find a new job. This is estimated based upon how your injury limits your activities, your age, and your occupation. Most Federal plans compensate you for your loss of earning capacity. It depends upon your earnings at the time of the injury and the amount you will be able to earn after the injury.

	Insurance covers acupuncture & acupressure. Call (408)524-0676 now for any helps.