Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPModesto Lawyers | Law Office of Rockwell, Kelly, Duarte & Urstoeger, LLP2024-03-18T19:54:42Zhttps://www.workcompmodesto.com/feed/atom/WordPress/wp-content/uploads/sites/1100403/2020/03/cropped-OG-32x32.jpgOn Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504442024-03-15T19:55:42Z2024-03-18T19:54:42ZLoud work environments
One major cause of hearing loss at work is exposure to loud noise. Industries such as construction and manufacturing use machinery that produces high noise levels. Being around these loud sounds for long periods can harm the delicate parts of a person's ears, causing permanent hearing damage over time.
Sudden injuries
Some sudden ear injuries happen due to explosions or accidents with heavy machines. These incidents can cause immediate and severe hearing loss, requiring urgent medical care. Even small injuries to the ears can lead to long-term problems if not treated quickly.
Chemical exposure
Certain workplaces have dangerous chemicals that can also harm a person's ears and hearing. Chemicals like solvents and pesticides may damage hearing over time. The effects might not show up right away, but they can become apparent later.
Vibrations
Vibrations from machinery can hurt an individual's hearing. Jobs like mining and construction involve a lot of vibrating equipment. If workers face exposure to these vibrations for too long, they can damage their ears and cause hearing loss.
Lack of safety measures
Sometimes, hearing loss at work happens because safety measures are not good enough. If employers do not give workers the right ear protection or do not train them properly about noise risks, it raises the chances of hearing damage.
Poor hearing can affect a person's ability to navigate daily life and continue building their career. By understanding what to do after an injury at work, individuals can reduce feelings of stress and move forward.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504422024-03-11T19:26:46Z2024-03-11T19:26:46ZInadequate medical evidence
The Social Security Administration requires extensive documentation of your medical condition. Required information includes:
Diagnoses
Treatments
How your condition affects your ability to work
If your medical records are incomplete or lack details about your limitations, it can result in denial.
Failure to follow treatment plans
The SSA expects applicants to pursue all reasonable avenues for improving their health and ability to work. They may deny your application if you do not follow prescribed treatment plans without a valid reason. Some examples of failure to comply with treatment include not taking prescribed medications, skipping therapy sessions or refusing recommended surgeries.
Too much income
Your income must be less than the substantial gainful activity limits set by the SSA. The 2024 SGA for blind individuals is $2,590, and the limit for non-blind individuals is $1,550.
The administration may deny your application if you earn above these limits. You must accurately report all sources of income on your application.
Insufficient cooperation
It is important to provide any requested action, documentation or information promptly. Requirements may include attending scheduled medical exams, responding to inquiries from the SSA and submitting paperwork on time.
Lack of work history
Disability benefits are for individuals with a significant work history who have paid into the Social Security system through payroll taxes. You may receive a denial if you have not worked enough to qualify for benefits or have not worked recently.
Short-term disability
The SSA only provides benefits for disabilities expected to last at least one year or result in death. They may deny your application if your condition will likely improve within a year. Your condition must also meet the criteria for disability. If it is not severe enough to do so, you may not be eligible for benefits.
Understanding the reasons for denial can help you prepare a stronger application. Effectively navigating the disability application process can help you get the desired outcome.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504402024-02-22T01:46:25Z2024-02-27T01:45:20ZClearing injured workers for work
After a workplace injury, your primary treating physician will examine you and send a report to the claims administrator about your condition. If the doctor says you can work, the report may describe specific limits called work restrictions on your job tasks.
Work restrictions protect you from further injury. For example, the doctor may forbid you from lifting over forty pounds at any time or say that you should wear a headset to keep your neck and head steady.
Work with restrictions
If your treating doctor reports you can work with work restrictions, any work your employer assigns must meet these restrictions. Your employer may change certain tasks, reduce your time on certain tasks or provide helpful equipment.
Alternatively, your employer may assign you different tasks that meet your restrictions. If your employer cannot provide work that meets the restrictions, the claims administrator must pay temporary total disability benefits. Additionally, you have the right to refuse work that does not comply with your current restrictions.
Work without restrictions
It is possible your doctor will report that you can work without restrictions. In such cases, your employer usually must give you the same job and pay you had before the injury. The employer can require you to take this job, soon after the injury or later when your condition improves.
By understanding your work restrictions and communicating effectively with your employer, you can navigate the process of returning to work safely while recovering from a workplace injury.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504372024-02-21T14:55:13Z2024-02-21T14:53:07ZThe impact of pre-existing conditions
Under California law, workers' comp covers injuries caused or aggravated by your work. However, if you have a pre-existing condition, the insurance company might argue that your work didn't contribute to your injury.
If a work-related injury caused you permanent disability, you will undergo an assessment. The physician in charge of assessing your condition will prepare an apportionment report. This report contains the physician’s findings on what approximate percentage of permanent disability was caused by other factors before and after the injury.
The physician might conclude that a pre-existing condition was a larger factor in your permanent disability. However, their report can’t completely deny your medical coverage.
Proving work-related injuries
To navigate these challenges, it's essential to prove the connection between your work activities and your injury. Detailed medical records can support your claim by showing the extent of the aggravation caused by your job. It's important to disclose your pre-existing conditions to your treating physician and to discuss how your job duties have worsened your health.
Settling disputes
If your claim is disputed, you may need to undergo a Qualified Medical Evaluation (QME) to assess the impact of your pre-existing condition on your current injury. You must be honest and thorough in describing your medical condition and the work incident that led to it to the QME. The QME’s findings will play a significant role in resolving your claim.
However, should your employer or insurer continue to deny your claim, you still have the right to appeal the decision. A legal professional may be able to help you navigate the appeal process and fight for your right to fair compensation.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504352024-02-07T09:15:54Z2024-02-07T09:15:54ZWhat is occupational hearing loss?
Occupational hearing loss occurs when an employee suffers from hearing impairment due to noise or toxic substances at work. It can result from long-term exposure to moderate noise or a single incident involving a very loud sound. Symptoms might include difficulty understanding speech, needing to turn up the volume on devices, or constant ringing in the ears, known as tinnitus.
Your rights under workers’ comp
California workers' compensation law covers injuries and illnesses arising out of or during employment. This includes hearing loss caused by workplace conditions. Workers' comp can provide medical benefits, assistive devices like hearing aids, and even compensation for permanent disability if applicable.
Filing a claim for hearing loss
To file a workers' comp claim for hearing loss, you must report the condition to your employer as soon as possible. Seek medical attention and have your hearing assessed by a professional. A claim form (DWC-1) should be filled out and submitted to your employer. Remember that there are time limits for filing, so act quickly to ensure your employer receives your form as soon as possible.
What to expect after filing
After filing, you'll likely undergo further evaluations to determine the extent of your hearing loss and its connection to your job. If your claim is accepted, you'll receive benefits that cover medical expenses related to your hearing loss and may be entitled to additional compensation.
If your employer or insurer disputes your claim, you have the right to appeal the decision.
Workers' comp is there to help you if you’re suffering from occupational hearing loss. But there’s no guarantee that your employer or insurer would approve your claim. For personalized advice and assistance with your claim, consider consulting with a legal professional.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504332024-01-31T12:28:28Z2024-01-31T12:28:28ZUnderstanding transferable skills
Transferable skills are abilities that you gain from working and that you can apply to a variety of different jobs or industries. When you have been working in a skilled or semi-skilled labor profession, you likely have acquired skills that you might be able to use in less demanding types of work. Examples of transferrable skills include supervising, managing, taking inventory, typing, clerical work and teaching.
How transferable skills impact SSD claims
The Social Security Administration (SSA) evaluates both your work history and the severity of your medical condition when reviewing your claim. If you are unable to return to your previous job and you lack transferable skills, there's a strong possibility you will qualify for SSA benefits. For instance, individuals employed in highly specialized areas that require specific machinery or proprietary knowledge often find that their skills do not easily transfer to other industries.
Conversely, if you are capable of working and possess transferrable skills that match a similar or lower-level job, the SSA may deny your disability claim. For example, nurses who are close to retirement age may develop a disability that prevents them from returning to such physically demanding work. However, they could still provide training, teach or chart.
Still, one important thing to keep in mind is that transferable skills are generally only relevant if you are over 50. The SSA is aware of how much more difficult to retrain and start over in a new role when nearing an advanced age and while managing a disability. However, the SSA may assume that you still have time to learn new skills and reenter the workforce if you are under 50.
Proving that you can’t be retrained
Transferable skills can play a pivotal role in determining the outcome of your SSD claim. If the SSA denies your claim and you believe it was due to an inaccurate assessment, you can appeal the decision. An experienced disability attorney can help determine whether you have non-transferable skills and be your advocate at a disability hearing.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504262024-01-16T20:26:46Z2024-01-22T20:26:39ZWork-related injuries
Workers' compensation typically covers injuries that occur in the course of employment. For remote workers in California, the key factor is establishing a direct connection between the injury and the job responsibilities. If an injury happens while performing work-related tasks, even outside the traditional office setting, it may be eligible for workers' compensation.
Home as the new workplace
Remote work blurs the boundaries between the traditional office space and home. In California, the courts recognize the changing nature of work environments and acknowledge that injuries can occur in the home workspace. However, proving the direct connection to work-related activities remains necessary.
Common scenarios
Workers' compensation generally covers injuries someone gets during work hours while performing job duties. If a remote worker becomes hurt during a scheduled break, coverage might apply. However, injuries from activities unrelated to work, such as personal breaks or engaging in nonwork-related tasks, may not qualify for workers' compensation.
Reporting and documenting
For remote employees seeking workers' compensation in California, timely reporting and accurate documentation are necessary. Reporting the injury to the employer as soon as possible is a fundamental step. Providing detailed information about the incident and seeking medical attention promptly helps establish a clear connection between the injury and work-related activities.
Despite the recognition of remote work injuries, challenges may arise in proving the connection between the injury and work. Employers and insurance providers may scrutinize claims more closely in remote work scenarios.
Remote employees in California can be eligible for workers' compensation. The process does require a clear connection between the injury and work-related activities.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504282024-01-19T20:38:40Z2024-01-19T20:38:40ZThere comes a time when, if an injury or illness prevents you from doing your usual job, you may start receiving Temporary Disability (TD) benefits during your recovery period. However, after your condition stabilizes but still permanently affects your ability to work, you may be eligible to transition to Permanent Disability (PD) benefits.
It's essential for you to understand this transition from TD to PD, as it has significant legal and financial implications for your future.
The permanent and stationary stage
Once your doctor determines that you've reached a point where your condition has stabilized – not improving, but not worsening – you've arrived at the 'permanent and stationary' (P&S) stage. This is also known as 'maximal medical improvement' (MMI). This stage signals that your temporary disability may transition into a permanent one. For instance, if you were temporarily unable to walk due to a leg injury but, even after healing to its fullest extent, you still can't walk as before, you may be deemed permanently disabled.
Filing the report
After reaching P&S, your primary treating physician will write a report indicating the specifics of your condition. In this report, they should detail the following:
Your medical condition
The limitations your injury imposes on your work
Your future medical care
How much your job contributed to your disability
Your physician sends this report to the claims administrator assigned to you. It's important to remember that you can request a copy of this report. Plus, if you disagree with any of its conclusions, you have the right to challenge them.
Appealing if you disagree
Once you receive the P&S report, the claims administrator will calculate your PD benefits and send you a notice of offer. The P&S report directly affects the amount of benefits you can receive. So, if you reject this offer, you can request a hearing before a workers' compensation judge, who will decide your PD benefits. But if you accept it, you will start receiving benefits and give up your right to appeal.
Due diligence is important
Moving from TD to PD is an important step in your workers' compensation claim. Evidently, it affects the amount and duration of your benefits, as well as your legal rights and options. So, you should consider consulting a workers' compensation attorney to help determine the best course of action for your case and avoid settling for less than you deserve.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504242024-01-11T16:11:44Z2024-01-11T16:11:44ZNot authorizing treatment or disputing injuries
Some employers might find ways to hinder a worker from receiving necessary medical attention after a work incident. They could refuse to authorize treatment or dispute the injury, prolonging the application and delaying payout. By creating obstacles to appropriate medical attention, businesses can contest claims as not having concrete proof of harm.
Offering a light-duty job
Another tactic is offering temporary light-duty work, even making it seem like the gesture is a favor to the injured employee. However, accepting the work could make it seem like the worker has not suffered as much harm as the claim states.
Even worse, the new assignment could be unsuitable for someone recovering from a major injury, worsening the situation and delaying recovery. This move could also buy the company additional time to build an argument against the worker’s claim.
Slowing down communication
The California Department of Industrial Relations makes clear that an employer must complete specific sections of the claims form. The company must then forward the completed document to the insurance company. Also, the injured employee has the right to receive a completed claim.
However, a business might also intentionally delay the process by neglecting to respond to a worker’s compensation inquiry or failing to complete necessary paperwork. Such delays have the potential to affect the entire insurance claims experience, and employers could be banking on confusion to slow things down to give themselves more time.
Workers’ comp insurance provides protection and support to any worker who sustains an injury on the job. If an employer uses tactics to delay claims for compensation, employees have ways to pursue a just resolution.]]>On Behalf of Law Offices of Kelly, Duarte, Urstoeger & Ruble LLPhttps://www.workcompmodesto.com/?p=504172024-01-08T09:28:11Z2024-01-08T09:28:11Zseek a review involving an independent medical evaluation (IME).
An IME involves a doctor who has not dealt with the patient before and aims to verify the primary physician’s findings. This medical exam is a critical part of the claims process as it can make or break a case. So, injured parties must be aware of what not to do during their IME.
Dishonesty can ruin a claim
An IME doctor’s job is to establish the cause and extent of a person’s medical condition and determine their capacity to return to work. Knowing whether they require further treatment or they can go back to work on light duty can affect the benefit payout from an insurance company.
Before speaking with the IME physician, injured workers must prepare to disclose necessary medical information and communicate the truth by avoiding the following:
Inflating symptoms, or the degree of their pain and discomfort
Leaving out crucial details, such as how the accident occurred and relevant medical history
Speaking ill of an employer and sharing inaccurate remarks
Engaging in false statements in hopes of increasing the amount of compensation can only risk a worker’s credibility and jeopardize their claim. After all, medical professionals have the experience, technological tools and intuition to uncover the truth.
Vigilance can work in a person’s favor
An IME doctor has a significant role in providing a neutral evaluation of the injured worker’s condition. However, there are cases when their biases and the potential profit from insurance companies may entice them to manipulate their medical reports. Injured workers can fight back with their legal team to reveal inconsistencies and pursue the financial relief they deserve.]]>