No-Fault vs. At-Fault Insurance Claims

Some states are “no-fault” states. In these states, an accident victim turns first to his or her own insurance coverage for reimbursement of lost income and medical bills and can only bring a lawsuit after meeting a threshold for serious injuries. California, however, is an at-fault state. After an accident, you generally will need to establish another party’s liability to recover damages. However, if an injury occurs on the job, you can obtain workers’ compensation benefits regardless of fault. If you are trying to figure out whether a no-fault or at-fault insurance claim is appropriate, you should consult the Riverside and San Bernardino County workers’ compensation lawyers at the Law Office of Joseph Richards, P.C.

In California, all employers are legally required to either become self-insured or secure a workers’ compensation insurance policy from a licensed insurer that is authorized to write policies in the state. Workers’ compensation is a no-fault system. Your no-fault workers’ compensation claim kicks off after you provide notice to your employer and complete a form.

Unlike a civil lawsuit, a workers’ compensation claim does not require you to show that anyone was at fault for your accident. And, conversely, nobody can get your benefits reduced by demonstrating that you were negligent in causing your accident. However, workers’ compensation denials can be issued for other reasons. For example, if you delay beyond 30 days in reporting your injury, the claim may be denied. You should notify your employer as soon as possible after a work accident or symptoms that appear to be work-related. This will help you avoid having the insurer believe or claim that your injuries were sustained somewhere other than the job.

In some cases, insurers cite a pre-existing condition as the basis for a denial. However, you should not assume that this denial is legitimate. You may still seek benefits so long as work aggravated the pre-existing condition.

Workers’ compensation benefits to which you may be entitled after an accident include medical care, disability benefits, and vocational retraining. They do not include compensation for any non-economic harm, such as pain and suffering. You should seek emergency treatment if you need it after a work accident. Your employer may require you to go to a specific medical provider. You should let the provider know that the injury or illness is work-related.

Temporary total disability benefits are paid if you are not able to work at all after being injured. They are calculated at the rate of two-thirds of your average weekly wage. You can get temporary partial disability benefit payments if you cannot work your full schedule while recovering, but you can work light duty or restricted hours. Permanent disability benefits are available to workers who will never fully recover from an injury.

While workers’ compensation is your exclusive remedy against your employer when you sustain work-related injuries, it may be worth looking at the situation more closely to determine whether there were other contributing causes. You may be able to bring a third-party lawsuit against someone other than your employer who is responsible for your injuries. Often, third-party lawsuits are brought under a theory of negligence.

To prove negligence, your attorney would need to establish that the defendant owed you a duty to use reasonable care, departed from that duty, and caused your injuries and damages. For instance, if you are injured in a truck accident while delivering goods to someone who has a contract with your employer, and the truck accident was caused by a drunk truck driver, you may be able to pursue damages in a third-party lawsuit.

It can take more than a year to win personal injury awards or settlements. Establishing the defendant’s liability may occur through the process of discovery, which takes time. You may be able to obtain no-fault workers’ compensation benefits more quickly than damages. The insurer may continue to investigate your claim even as it is paying benefits.

If you are considering filing a no-fault or at-fault insurance claim in Riverside or San Bernardino County, you should consult the Law Office of Joseph Richards, P.C. Our lawyers assist workplace accident victims throughout Southern California. Contact us at (888) 883-6588 or via our online form.