Why Do I Need An Attorney to Handle My Workers' Compensation Claim?

By David Goldstein, Esq.
Partner, Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP

As a police officer, you face the chance of injury—or worse—during every shift,  so it’s important to be equipped with the knowledge and—oftentimes the experienced counsel—you need to ensure you receive the full range of Workers’ Compensation benefits to which you are entitled, should you get injured.

Workers’ Compensation laws are confusing and constantly changing; having a knowledgeable attorney on your side can mean a world of difference in terms of your medical, professional and financial future.  The following are examples of when you might want to call an attorney for back-up:

Medical Care

If you’re injured at work, you will undoubtedly be asked to be evaluated by a state panel Qualified Medical Examiner (QME). If you ignore the process, your employer will pick a physician for you.  If you choose a physician, but later decide you don’t want to see that doctor, you may be able to select another QME if the evaluation hasn’t already occurred, and only if you retain an attorney.  Your choice of physician can greatly affect the benefits you receive. 

Presumptions

It is imperative that you understand your rights in relation to Labor Code Section 3212. Although police officers are entitled to a “presumption” or advantage in proving certain types of work injuries, persistence is key. You cannot assume that medical evaluators will cooperate even though it is very difficult for an employer to rebut the presumption.  We just received a substantial six-figure settlement in a case involving a police officer who died from a brain tumor caused by toxic exposure.  In this case, the Qualified Medical Examiner’s opinion was contrary to the presumption of compensability.

Salary Continuation

As stipulated in Labor Code Section 4850, you are entitled to your full salary, not to exceed one year, while on leave of absence for a work injury or when permanently disabled. However, it is important to note  that this is not limited to one calendar year immediately following the date of injury; money will be paid (not necessarily continuously) for a period totaling one year.  It is also important to understand the relationship between salary continuation benefits and Workers’ Compensation temporary disability leave benefits.

Utilization Review

Basically, utilization review, which is covered in Labor Code Section 4610, is the insurance company’s review of a treating physician’s medical treatment recommendations in a Workers’ Compensation case. It is a complicated process with many timelines involved that must be followed to the letter.  In order to receive medical care in a timely manner, you must be knowledgeable about the process. An experienced attorney can help prevent utilization review denials. 

Exceptions to the Fireman’s Rule

The concepts behind the Fireman’s Rule are that police officers and firefighters willingly assume the risks inherent in their duties and that  they have adequate Workers’ Compensation laws available to them so they cannot bring a civil action for an on-the-job injury. However, Civil Code Section 1714.9 provides exceptions to the Fireman’s Rule. An experienced attorney can help you utilize these exceptions to your benefit.

We take particular pride in being able to protect the rights of those who put their lives on the line every day to ensure our safety. We’re always available to answer questions, provide information or help out in any way we can.  At the very least, we advise all workers to do the following:

• Pre-designate a  physician in writing before an injury—preferably your primary care physician— so you can bypass your employer’s physicians and are able to control your own care.
• Document, document, document—the facts about the injury, including date, location, treating doctors, etc.
• Understand that specific injuries (specific event) as well as continuous trauma (injuries that occur over time) both qualify as industrial injuries.

(If you would like to speak with David Goldstein about your legal options, please contact him at 213-739-7000. For more information about GEK’s legal services, visit our website at www.geklaw.com.)

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