Readers of this blog know that most California employers are required to comply with workplace safety regulations applicable to their industry, as set by the state’s Division of Occupational Safety and Health. Most employers also carry workers’ compensation insurance policies, to protect against liability in the event of a worker receiving an on-the-job injury.
However, readers might incorrectly assume that the process is as simple as submitting an insurance claim. To the contrary, many workers’ compensation attorneys might agree that that the application of specific coverage provisions to an individual worker’s injury is rarely formulaic. Each injury must be evaluated on a case-by-case basis, and the amount of treatment may subject to dispute.
Even if certain medical procedures or treatments are approved, a worker’s recuperation may exceed the timeframe provided by his or her employer’s insurance policy. When that happens, an injured worker might once again need to enlist the services of an attorney, as in today’s story.
A city firefighter and paramedic recently brought suit in a state court because his employer did not want to extend his temporary total disability benefits. The worker had injured his back and knee while working, and undergone surgery. His municipal employer had approved benefits for an estimated 104-week recovery.
At the end of the 104 weeks, the man’s doctor did not believe he was ready to return to his firefighting work. Yet when the man requested an extension of benefits from his employer, his claim was denied. Since he was showing signs of daily medical improvement, he also could not apply for permanent disability benefits. Without wages, however, he might not have been able to continue paying for his treatment. The man’s remaining option was to take his employer to court. Fortunately, the court agreed that the city was not justified in limiting the man’s injury benefits to 104 weeks.
Source: riskandinsurance.com, “104-week limitation on TTD benefits fails constitutional test,” April 29, 2013