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Los Angeles Employer Workers' Compensation Law Blog

If your employee tests positive for marijuana use

Employers in California have a responsibility to their employees to provide a safe workplace, but if an employee is hurt on the job, it is the workers’ compensation insurance that covers the costs related to the injury. Carrying this insurance saves a company money, but the high costs of claims may drive up the rates. This factor makes it important to ensure that worker claims are valid, and that injuries are caused by a compensable incident.

Occupational Health & Safety magazine notes that, with the changes regarding the recreational use of marijuana, employers may have some questions about their rights and responsibilities, and workers’ compensation. Although an employee may not be smoking or ingesting the drug illegally, it still creates significant hazards on the job due to its effects on the body, including problems thinking, paying attention, reacting safely and controlling movement. Employers may still perform drug tests to ensure that workers are not creating safety hazards for themselves and others on the job.

Beyond negligence: serious and willful misconduct

As a California employer, having an employee sustain a minor, serious or fatal injury on the job may be at the top of your list of things you never want to happen. Sometimes, though, accidents do occur. In these cases, your workers’ compensation insurance should provide benefits for an employee’s medical costs and some of the lost wages, regardless of whether it was a working condition that caused the injury, or the employee’s own negligence or carelessness. However, at Sacks & Zolonz, LLP, we understand that there are times when dishonest employees make false claims in an attempt to hold the employer liable beyond what is covered by workers’ compensation.

If your employee alleges that you are guilty of serious and willful misconduct that led to his or her injury, that worker must be able to provide proof to the court. According to the Houston Chronicle, mere negligence on your part typically does not qualify. So, although there may be evidence that your company somehow failed to correct a situation that led to an injury, that is not likely to be enough to hold you to further responsibility. Instead, the employee would need to show that the act was deliberate, with a reckless indifference for the worker’s safety.

How to combat worker’s compensation fraud

Workers’ compensation fraud costs everyone in California money. However, employers are usually the first victims of this crime. According to the Coalition Against Insurance Fraud, there is a small number of people who actually try to scam the workers’ compensation system, but even a small number of fraudulent claims can create a huge expense. The cost of fraud includes a loss of jobs and pay, more expensive premium costs, closure of businesses and higher prices for consumers.

There are many ways that workers may try to pull off fraud. They could work with dishonest medical providers to get false medical records. A worker may claim an injury that occurred away from work happened at work, or claim an old injury that is flaring up is a result of a work injury, so he or she can get coverage under workers’ compensation. An employee may also fake an injury or claim an injury is worse than it actually is.

What is the Uninsured Employers Benefits Trust Fund?

If you get injured on the job in California, you are entitled to payment for your medical expenses through workers’ compensation. Employers are legally required to carry this insurance, but some employers may choose not to carry it. If this happens, you are not left without recourse should you get injured. The state has set up the Uninsured Employers Benefits Trust Fund, which will step in and pay what workers’ compensation should have.

According to State of California Department of Industrial Relations, you have to file a claim and follow several steps to get coverage under this fund. You will begin by getting an application from the Division of Workers’ Compensation. You start the application process by completing the employee section of the benefits form, which will enable you to put in a claim that your employer does not have coverage.

What can I do if my work injury claim is denied?

If you are a worker in California, you may have concerns about the proper reporting of workplace injuries. In some cases, your claim may be denied if a particular injury is not considered to be worthy of coverage. To this end, there are steps you can take to appeal your denial, which is imperative for getting the compensation necessary to make a recovery.

As stated by California’s Department of Industrial Relations, filing an Application for Adjudication of Claim is an integral component of appealing a denial of benefits. You will need to provide this document to the Division of Workers’ Compensation, as well as the claims administrator involved in your case. To file a claim you must locate your county’s office if you work in the same area where you live. If you work in a different county, you will file the document within that office.

How does CA deal with workers’ compensation fraud?

For employers in California, workers’ compensation fraud can be a real issue. Fortunately, the state recognizes just how damaging this type of fraud can be to businesses and the public at large, and as a result has devised methods for dealing with workers who engage in nefarious practices regarding workplace injuries.

According to the California Department of Insurance, the Workers' Compensation Fraud Program was created in 1991 to address workers who are alleged to have reported false injuries or exaggerated the effects of existing ones. In just a one year span California’s fraud division was responsible for the arrest of 240 workers suspected of fraud, and estimates that possible losses could have amounted to $277,032,462. Additionally, the district attorney’s office was involved in 1,409 fraud cases during that same time period, which culminated in the conviction of 650 individuals.

What you need to know about workers’ compensation subrogation

Before modern workers’ compensation laws were implemented, employees who were injured on the job had to sue the business owners if they wanted to receive any support or compensation. While current California laws force employers to provide insurance for onsite accidents that result in injuries, changes have also been made to reduce the ability of others to enter into a lawsuit over the incident.

 

Top industries for fatal work injuries

While most jobs carry some risk, there are certain industries that are more dangerous than others. The California Department of Industrial Relations found that 344 workers were killed on the jobsite during the year 2014. While the majority of the deaths occurred in the private sector, 38 of the total number were government jobs. There are many different industries that were involved.

 

Red flags of employee fraud

When it comes to workers’ compensation, there are several different ways an employee could be committing fraud. The California Department of Insurance states that some of the most common examples include lying about the ability to work, extent of the injury or place where the injury occurred. Medical professionals can also join an employee in fraudulent activities by billing for service that was not provided or giving more treatment than is necessary. There are several red flags that employers can watch for to indicate that dishonest activity may be occurring.

 

The real cost of uninsured employers

When it comes to ensuring the health of employees, the government has sought to protect workers by requiring businesses to maintain a workers’ compensation insurance policy. Some businesses try to avoid paying premiums by neglecting this type of insurance, but the real cost of this illegal action may be surprising.

 

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