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Los Angeles Employer Workers' Compensation Law Blog

Reviewing California’s Employer’s Bill of Rights

As an employer in Los Angeles, you likely view the safety and well-being of your employees as one of your top priorities. Like many of those that we here at Sacks and Zolonz LLP have worked with in the past, that is why you work to ensure that your staff is covered by workers’ compensation insurance in the event of a workplace accident. Yet should such a benefit need to be used, the cost could be reflected in you having to pay more for your coverage. You may be fine with that provided that an employee’s claim is completely valid. Do you have any recourse, however, if you believe one is not?

The answer to that question is yes, thanks to the Employer’s Bill of Rights established by the California Labor Code. Say that you have an employee that is injured on the job, but then you later discover that he or she was under the influence of alcohol at the time of the accident. According to the Employer Bill of Rights, your workers’ compensation insurance provider is first supposed to inform you within 15 days of a claim being filed that your employee is seeking benefits. If you respond to such a notice, in writing, that you believe that the employee’s actions should prohibit him or her from receiving workers’ compensation, benefits may still be extended, but only after you have been notified by your insurer of the date of your appeal hearing.

Defining who is an employee

As most of those who employ people in Los Angeles likely know, state law requires that any company or party for whom more than one employee works is required to carry workers’ compensation insurance to protect its workers. Yet how the state defines an employee may be the determining factor as to whether or not one who may employ someone informally (i.e., a landlord paying a person to handle the landscaping duties on his or her property, a parent paying a neighbor to babysit his or her kids multiple times in a week) is required to comply with this law.

Those employees whose employers do not carry workers compensation insurance may receive similar benefits through the state’s Uninsured Employer’s Benefit Trust Fund. Information shared by the state’s Department of Industrial Relations shows that for the 2014 fiscal year, 57 percent of those employees paid through this fund were classified simply as “laborers.” In the aforementioned employment scenarios, the compensated parties could potentially be viewed as a laborers. Yet how does state classify such a situation?

Employee rights in high-heat work areas

With summer nearly here, the California Occupational Safety and Health Administration held a press conference to educate and remind employers of the necessary safety steps to protect workers from the rising temperatures. Since workers are most at risk in industries where they are outdoors in the summer heat, Cal/OSHA does targeted inspections during the hotter months of the year on outdoor worksites, such as for construction sites and farms and other agricultural workplaces.

Cal/OSHA regulations require employers to train their employees at all levels of methods to prevent sickness due to overheating. They must provide shade so employees can take breaks to cool off, and there needs to be enough fresh water on site so that workers can drink at least one quart of water per hour of work. Employers are to encourage their employees to take advantage of the water and shade in order to maintain their health. Employers are required to have written procedures in place to assist workers who suffer from heat-related illness who may need emergency medical attention.

Latino workers face higher workplace death rate

California is typically one of the safest states in the nation, Safety.BLR reports that new findings show Latino workers have a higher risk of dying on the job. Although the Golden State has a fatality rate of “2.2 workers per 100,000, each year, compared to 3.4 per 100,000 nationally,” the U.S. Bureau of Labor Statistics found that Latino workers faced a fatality rate of 4.0 per 100,000. There were 903 total deaths of Latino workers in 2015. This is up from 2014 by almost 100 fatalities in one year (804 in 2014).

Although the immigrant population, and Latinos in particular, suffered more fatalities in the workplace, the causes of death were similar to the overall work fatalities. Transportation incidents led to 36 percent of Latino worker deaths, and 42 percent of worker deaths overall. This is followed by falls, which affected 23 percent of Latino workers, 17 percent overall. The industries with the most worker deaths were agriculture, construction and transportation, followed by oil and gas.

Physicians and pharmacists said to be part of insurance scam

Most employers in California know that carrying workers' compensation insurance is something they have to do, with a few exceptions based upon the nature of the company. For those companies who are required to carry this insurance, one thing they should be able to count on is that the system will be responsibly used by people who are legitimately injured or ill. Similarly, it would be wonderful if employers could trust that all other entities involved in the workers' compensation system operated honorably.

Sadly, this does not always happen and a recent case illustrates this all too well. A married couple who own a medical laboratory, medical management company and a medical billing company have been accused of spearheading a multi-million dollar workers' compensation fraud ring. In all, 23 different insurance companies were essentially swindled by the couple and the others who were recruited to be part of the plan.

Examples of false workers' compensation claims

If you are employed in California, you should be able to trust that workers' compensation benefits may be available to you if you should ever be injured in an on-the-job accident or if you should ever develop a work-related illness. If you must file a claim for these benefits, you should know that your claim will be reviewed carefully as, sadly, there are people who attempt to cheat the system. For this reason, the workers' compensation program must assess every claim with this in mind.

The Coalition Against Insurance Fraud indicates that there are many ways in which people attempt to illegally and unethically benefit financially from workers' compensation. One of these is by remaining away from work longer than an injury or an illness truly requires and claiming benefits in the process. Some people may have legitimate injuries but they find ways to make them appear worse to seek more benefits.

Stress cited as reason for Uber employee’s suicide

When most in Los Angeles hear stories regarding workers’ compensation claims, they may likely assume them to involve injuries suffered while on the job. While that may be the case in many situations, such an assumption may fail to take into account the emotional toll that one’s career can exact. Such a toll may result in psychological or emotional issues that can be equally as damaging as physical injuries. Unfortunately, securing workers’ compensation benefits for stress and psychological issues may not be as simple as it is when dealing with typical work-related injuries.

Take the recent case of a young mother attempting to collect workers’ compensation benefits following her husband’s suicide at their home in Pittsburgh. She (as well as others) claim that his death was brought on by the emotional stress he had been experiencing since taking a job as a software engineer at Uber. The man’s family and friends claim that the company’s culture, which has already come under scrutiny in claims filed by past employees, drove him to work long hours and ultimately lose his confidence. The man himself had confirmed the stress he was feeling to a psychiatrist shortly before his death.

Defining soft fraud

The following scenario has been relayed to us here at Sacks and Zolonz LLP several times before: an employee slips and falls at work, resulting in knee injury. After a while, word comes out that he or she is also experiencing neck and back pain due to the accident, and suddenly needs more money to cover medical expenses and compensate for time off of work. If this describes the same situation you are currently having with an employee, you may be facing a bit of a conundrum: On the one hand, you may feel sympathetic to his or her suffering and simply want him or her to improve. On the other, you may be wondering how one single incident could produce so many health issues.

If your employee is indeed embellishing his or her injury situation, he or she may be attempting what the Insurance Information Institute defines as “soft fraud.” Most soft fraud cases do stem from legitimate claims. However, ultimately people end up exaggerating the extent of either damages or injuries in an attempt to collect for money or benefits. It’s estimated that millions is lost to cases of soft fraud every year.

What should I know about workers’ comp in CA?

For California workers, being hurt on the job can be a devastating experience. Loss of income can quickly lead to financial instability, which is why most employers are obligated to carry workers’ compensation insurance to protect their employees in the event of a workplace injury. Knowing the ins and outs of workers’ compensation law is crucial to this end, so that you can be sure that your employer is abiding by all pertinent rules and regulations.

According to the State of California Department of Industrial Relations, all businesses with one or more employee must provide workers’ compensation coverage. Additionally, employers are obligated to post signage listing workers’ rights in terms of compensation if injured. If proper signage is not posted, employers run the risk of incurring a fine of $7,000. Employers are also mandated to provide new hires with a pamphlet explaining their rights and benefits.

Signs of work comp fraud that employers should be aware of

In our last post, we highlighted new potential legislation that would give the Division of Workers’ Compensation more resources to detect and prevent fraudulent claims. Yes, false claims do not outnumber legitimate claims, but fraud still causes problems for employers and insurers alike.

Because of the number of fraud claims we deal with, we find it helpful to remind our clients periodically of the signs of a false workers’ compensation claim. This post will highlight a few common red flags.

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