Workers' Compensation: It Works on Paper, But…

Los Angeles, CAIf you work for a car wash in Los Angeles, your employer may not have the Workers' Compensation insurance coverage you, as an employee, are legally entitled to.

According to those who have gone through Workers' Compensation hell, you may not want it anyway.

This month officials with the State Division of Labor Standards Enforcement in California issued 47 citations to car wash businesses for various violations, the majority of which included citations for not having the required Workers' Compensation coverage. Such violations serve to reduce a businesses' bottom line, which increases profits. However, as a result employees are denied the coverage that is their legal right.

Employers are legally responsible for providing workers' compensation coverage for their employees in almost every State in the land. Failure to do so can result in hefty fines—as was the case in California, where $356,200 in fines were levied against various entities found to be in contravention of the statutes. It should be noted that in some States larger companies are allowed to self-insure, while smaller companies can opt out altogether, according to the size of the company and the State laws which apply.

In general, an employee can expect compensation if he, or she is hurt on the job. That may all be well and good—but actually seeing those benefits just might be another matter, according to some who have fought the benefits system to claim what is rightfully theirs'.

Consider the story of the mechanic who toiled for a government contractor before injuring his back a few years ago. The accident happened on the job site just prior to quitting time (there were four witnesses), so the accident wasn't reported until the next morning. And then began a convoluted exercise that ended in frustration.

The doctor his employer sent him to put him on medication for his pain and allowed him to remain off work for three days, only to pronounce him fit for the job site again. Upon reporting for duty, even though he could barely move, he was told that he couldn't work while on medication.

He was sent to a chiropractor, and after 12 visits there was still no major improvement. Next stop, a neurosurgeon, who felt the injured mechanic was in need of a lumbarectomy. In the meantime, because our friend was cleared to return to work his benefits stopped—however, he could not return to work because of the medication for pain that the doctor to whom he was directed by his employer, had prescribed. And so he stopped taking the medication—but was in so much pain that he could barely function, let alone walk.

It all came to a sorry end in August of that year when, seven months after sustaining the injury, the man was forced to resign his position and cash out his 401(k) in an attempt to pay his bills. Back on the medication for pain, he returned to the neurosurgeon, who tells him that a lumbarectomy would probably no longer be beneficial for him. Too much time has gone by.

He's out of a job, and he's now just lost the surgical option. And he's about to lose his pain medication too, because his doctor has cut off the supply until the patient gets in for an updated consultation. That's impossible because, without insurance now, the man can't afford to see the doctor.

He is trapped.

Here's another story. A State government employee of 27 years injured her knee at work, and while suffering from mild arthritis at the time, wound up with end stage arthritis and in need of a full knee replacement. It took Workers' Compensation months to get her approved for arthroscopic surgery, which turns out to have been the wrong treatment in that the surgery accelerated her arthritis and left her walking bone-on-bone for two years.

Had Workers' Compensation bitten the bullet, and had the knee been replaced in the beginning, it would have saved her two years of pain and lost time at work. Instead, not only did she have to wait for the more appropriate procedure to proceed, but she was denied paid sick leave for her surgery and her recovery time because the knee replacement was properly traced back to the knee injury two years prior, but that the statute of limitations ran out after a year for the original injury—thus she did not qualify.

In general, for the duration of the injury, an employee is entitled to 50 percent to 66 percent of his or her normal salary; additionally, workers comp pays for medical expenses associated with the injury, including (in many States) rehab. If an employee is permanently injured, he or she is eligible for compensation for the decrease in earnings attributable to that injury as determined by a state-schedule or by a percentage of weekly salary.

That's the law in theory. In practice, it can be far different. At the end of the day, you need to assess how you are being treated by the system and, if necessary, employ the services of a Workers' Compensation Law lawyer to help you navigate the waters.