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Workers’ Compensation FAQ

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Workers' Compensation FAQ

Workers' Compensation FAQ

For the average person, the field of workers' compensation is entirely foreign to them until they sustain a work-related injury. Once an injury does occur, many without the right guidance are forced to educate themselves quickly on this complex legal field while simultaneously worrying about their physical recovery.

This can soon prove to be a task too large to bear, at times resulting in someone receiving less than they should have and failing to adequately protect their own rights.

The best way to avoid this risk is by hiring an experienced accident injury attorney such as Alexander Napolin, Esq., who can walk you through any uncertainty and ensure that the best decisions will be made to obtain a legally just settlement.

If you still have questions before deciding if you should pursue a claim or hire a workers' compensation attorney, the list of FAQs below may provide some much-needed answers. For more information, call our office or visit the State of California Department of Industrial Relations' website at www.dir.ca.gov/DWC.

What Is A DWC Medical Unit?

The “DWC” Medical Unit stands for the Division of Workers' Compensation Medical Unit. It is a unit within the DWC that manages medical problems in workers' compensation by:

  • Overseeing medical provider networks (MPNs) and health care organizations (HCOs)
  • Utilizing review and medical treatment guidelines
  • Appointing qualified medical evaluators (QMEs), spinal surgery second opinion physicians (SSSOPs) and independent medical reviewers (IMRs)
  • Issuing QME panels to claims administrators and those who were injured on-the-job

How does the appointment of the above positions help the DWC Medical Unit to manage medical problems? The evaluators, physicians and reviewers are ultimately the ones who aid in the resolution of medical disputes. They do this by issuing professional opinions that can later be used as evidence for or against your claim if it gets taken before a Workers' Compensation Appeals Board.

What Exactly Is A QME? Do I Need One?

Not all workers' compensation claims are clear-cut. In fact, disputed often arise over the exact benefits that an injured worker is entitled to. When disagreements like this arise, a qualified medical evaluator (QME) steps in to evaluate you and offer their professional opinion as evidence in a Workers' Compensation Appeals Board. This could either help or hurt your claim depending on the extent of your injuries.

All QMEs must meet educational and licensing requirement in order to qualify. Additionally, they are required to pass a test and participate in workers' compensation education classes through the course of their career. Suffice to say many QMEs are well-trained and qualified for their position.

What Is An AME? How Does It Differ From A QME?

The QME process differs slightly when you obtain the services of an attorney. In this case, your claims administrator may work with you to find an agreed-upon doctor to conduct the evaluation. This doctor, called an agreed medical evaluator (AME), will ultimately serve the same purpose as the QME in helping to decide what benefits an injured worker is entitled to.

What Is A Panel QME?

A panel QME is simply a list of three qualified medical examiners that is generated randomly for purposes of objectivity. You will be issued a panel QME in the case of a dispute about whether or not your injury was related to your work. Another instance in which you will be issued a panel QME is in the case of a medical dispute that was not resolved by the treating physicians report.

What Is/Is Not Covered By Workers' Compensation?

Workers' compensation can help an injured worker recovered for:

  • Medical expenses
  • Ongoing care costs
  • Funeral expenses
  • Lost wages
  • Impaired future earning capacity in some instances

Workers' compensation will not cover, for example:

  • Injuries a worker sustains as a result of intoxication due to drugs or alcohol
  • Intentional injuries
  • Emotional injuries (when not accompanied by a physical workplace trauma)
  • Injuries sustained by an assault incited by a worker

Where Does The Money Come From? Who's Paying?

Generally, employers in California purchase workers' compensation insurance. This insurance will pay for the cost of benefits for injured employees. In fact, most states with the exception of Texas and New Jersey mandate employers to carry workers' compensation insurance.

Do My Workers' Compensation Benefits Make Me Ineligible For Disability, Unemployment, or Social Security Benefits?

Typically, injured workers who receive workers' compensation benefits do not damage their eligibility to receive benefits for disability, unemployment, or social security. However, it is wise to contact you company's benefits office in order to ensure that your eligibility for other benefits will not be affected.

Still Have Questions? Call Today.

Our attorneys at Napolin Accident Injury Law have extensive experience in the field of workers' compensation. Call today to request your free case consultation. During this consultation, we will get you in touch with an experienced attorney who will be more-than-qualified to answer your questions and address your concerns.

When you hire Napolin Law Firm, you will no longer be pushed around by an insurance agent who cares nothing about you or your injury. Instead, you will have a lawyer who will fight for all the workers compensation benefits to which you are entitled. If you have been injured at work, Attorney Alexander Napolin will speak with you for free about your case. Call him at 909-325-6032 for your free consultation, or fill out a claim evaluation form at NapolinLaw.com and Attorney Alexander Napolin will call you within 24 hours to discuss your case for free.

Remember, do not let the insurance agent tell you what you are entitled to or what you claim is worth. They do not care about you or your case. Retain an attorney who does. Call Napolin Law Firm today! Napolin Law Firm serves Southern California, including the Inland Empire, Orange County, Los Angeles County and Riverside County. Nearby cities serviced include Chino, Claremont, Upland, Ontario, Rancho Cucamonga, Azusa, Glendora, Pomona, Montclair, Fontana, Rialto, San Bernardino, Corona, Colton and Diamond Bar.

Alexander D. Napolin, Esq.