Santa Barbara Workers’ Compensation Attorneys

Determining Eligibility for Workers’ Compensation

In many workers’ compensation cases, people find their claims denied by their employer’s workers’ compensation insurance provider, citing ineligibility for benefits. However, eligibility to receive workers’ compensation benefits can easily be established in many cases.

Basic eligibility for workers’ compensation hinges on the following factors:

• An employer-employee relationship: Eligibility of workers’ compensation benefits requires the existence of an employer-employee relationship. When you perform work for your employer, there is a legal presumption of employment under California law. Your employer’s workers’ compensation provider has the burden of refuting that presumption to deny eligibility for benefits.
• Relationship between injury and employment: To receive benefits, the injury in question must be related to your work. Under California law, injuries arising out of employment and injuries sustained during the course and scope of employment are covered by workers’ compensation benefits.
• Exclusions from compensability: California’s workers’ compensation system provides benefits to injured workers without regard to fault. However, workers’ compensation benefits are statutorily excluded for intentionally self-inflicted injuries and injuries resulting from intoxication.

Who Is Not Covered by Workers’ Compensation in California?

In California, nearly all employees are covered by workers’ compensation. Employers with at least one employee in the state must provide workers’ compensation insurance for all part-time, full-time, and seasonal employees. Note that employees of all immigration statuses are entitled to workers’ compensation as long as they meet all other eligibility requirements.

There are very few exemptions under the law, but some include:

• Independent contractors
• Workers who are self-employed (not including roofers)
• Sole proprietors or business owners (not including roofers)
• Workers who provide services in exchange for aid instead of pay
• Deputy sheriffs
• Deputy clerks
• Student athletes participating in amateur events
• Amateur sports officials

If you are unsure whether you are covered by workers’ compensation in California, reach out to our team at Crane Flores Injury & Car Accident Lawyers to speak to one of our workers’ compensation lawyers in Santa Barbara during a free, no-obligation consultation.

Independent Contractor Classification in California

One notable exception to the state’s workers’ compensation eligibility laws is independent contractors. In California, employers generally do not need to have workers’ compensation insurance for workers who are classified as “independent contractors” rather than “employees.”

But what exactly is an “independent contractor?” California law defines an independent contractor as someone who:

• Maintains primary control over their work-related performance, including how and when the work is carried out/conducted
• Customarily engages in independent work that is similar to or the same as the work being performed for the employer
• Conducts work that is outside of the normal type or scope of work performed by the employer/hiring entity

To be lawfully classified as an independent contractor in California, a worker must meet all three of these requirements. If an independent contractor does not meet even one of these criteria, he or she is misclassified and may be entitled to all the same benefits as any other employee, including workers’ compensation benefits for qualifying work-related injuries, illnesses, and medical conditions.

Workers’ Compensation Benefits

The California workers’ compensation system provides comprehensive benefits for workplace injuries. Workers’ compensation benefits are designed to compensate workers for injuries to different degrees. The nature of the benefit to which you may be entitled is based on your average weekly earnings.

Under California’s workers’ compensation system, you may be entitled to the following benefits:

• Medical and hospital treatment: Workers’ compensation benefits cover the full cost of any reasonable and necessary medical treatment.
• Temporary disability benefits: If a workplace injury impairs your ability to perform your normal job responsibilities, temporary disability benefits compensate you for up to two-thirds of your lost earnings.
• Permanent disability benefits: When a workplace injury results in a permanent disability that interfere with your earning capacity or activities of daily living, you can receive permanent disability benefits based on the extent of your disability.
• Supplemental job displacement benefits: You may be entitled to recover benefits compensating you for training costs if your injury precludes you from working in your original occupation or at full capacity.
• Death benefits: The surviving family of a worker who died due to a work-related injury is entitled to compensation for the economic losses they sustained as a result, such as loss of income and funeral/burial expenses.

What to Do If You Are Injured at Work

If you are injured in a workplace accident, or if you are diagnosed with a work-related illness or medical condition, there are several things you should do right away to protect yourself and your rights:

• Seek Medical Attention Right Away: The first thing you should do after a work-related accident or injury is seek medical attention. Do not worry about finding an employer-approved physician if you need emergency treatment; simply call 911 and ensure you receive the prompt attention you need. If you do not require emergency care, your employer will inform you where to seek treatment. You can also find information on finding a physician via posted notices at your place of employment regarding your employer’s Medical Care Network. If you cannot find this notice, you can ask your employer where you should seek treatment.
• Notify Your Employer of Your Injury or Illness: You should also notify your employer right away about your work-related injury, illness, or medical condition. The sooner you do this, the better, as you may lose your right to file a workers’ compensation claim and seek benefits if you wait too long. Typically, deadlines to report injuries to your employer commence on the date of diagnosis or the date on which you were made aware that the injury was work-related.
• Make Sure Your Doctor Knows Your Injury/Illness Is Work-Related: You should make sure that your treating physician is aware that your injury, illness, or condition is related to your employment. This allows your physician (or the medical facility where you received care) to bill your employer or your employer’s insurance company instead of you directly for your care. If you are injured at work or suffer a work-related medical condition, you should not receive any medical bills. If you do, make sure you keep those bills and provide them to your employer or your attorney.
• Submit Your Official Workers’ Compensation Claim Form: After you have reported your work-related injury or illness to your employer, your employer has one day to provide you with an official claim form. You should complete this form accurately and promptly and return it to your employer as soon as possible. Your employer should then fill out the employer section of the form and submit it to their workers’ compensation insurance provider. This should begin the process of your payments.
• Follow Your Doctor’s Treatment Plan: You should never try to go back to work, even light-duty work, until your doctor has cleared you to do so. Always follow all your doctor’s treatment plans, recommendations, and advice, as failing to do so could result in your claim being denied or your benefits being terminated. Similarly, if your doctor clears you to return to light-duty work or determines that you have met maximum medical improvement (MMI), but you do not agree, you should still follow your doctor’s advice and reach out to a workers’ compensation attorney.

If you encounter any issues with your claim or difficulties with your employer—including coverage or eligibility disputes, denied or terminated benefits, or any other challenges—get in touch with a Santa Barbara workers’ compensation lawyer at our firm. Even if your claim was denied, you may be able to file an appeal and continue seeking benefits, and our team can help.

Consult an Experienced Workers’ Compensation Lawyer from Crane Flores Injury & Car Accident Lawyers

Our work culture in America often requires us to make certain sacrifices in service of our duties and responsibilities. It is only fair that our employers compensate us for those losses and injuries we sustained in furtherance of their business pursuits. At Crane Flores Injury & Car Accident Lawyers, our legal team is committed to protecting the rights of Santa Barbara workers when it comes to compensation for the serious and often life-changing injuries they suffer on the job.