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Brandon, Esq.
Brandon, Esq., Lawyer
Category: California Employment Law
Satisfied Customers: 1953
Experience:  Has received a certificate of recognition from the California State Senate for his outstanding legal service.
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I had an employee fall at work, x-rays were negative and she

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I had an employee fall at work, x-rays were negative and she was released to return to work but not to lift more than 10 lbs (she is a server, not a problem). She still complained of pain so she went to the specialist. The specialist did routine exam didn't see anything wrong and released her back to work but scheduled a MRI. MRI concluded she had two herniated disk and is scheduled to have three follow up visits for cortisone shots. I know herniated disk is usually due to age and wear, rarely to a fall (I also know the fall may have irritated or caused inflammation), amI required to continue to pay for these follow up visits or any future issues.

Brandon, Esq. :

Hello, my name is XXXXX XXXXX it will be my pleasure to assist you today. My goal is to provide you with excellent service. Are you online with me today?

Brandon, Esq. :

You are required to pay for any medical treatment that can be seen as necessary as a result of the at work incident. This can include exacerbation of a pre existing injury. That being said, workers compensation insurance companies constantly argue that injuries like these are pre-existing, and the treatment required is only for the pre existing condition and not for the exacerbation. Arguments like this will likely keep you out of having to pay penalties until after a WC judge issues a demand to pay. A failure to pay at that juncture would likely result in penalties, however. The easy solution to this is that you should pass this off to your workers compensation insurance. They will deal with it and decide if they want to pay out or defend against a lawsuit. If you do not have workers compensation insurance, then you should highly consider paying for this persons treatment, because if they decide to report you to the DLSE, even if they don't have recourse, you will have significant fines levied against your business.

Brandon, Esq. :

This is because Labor Code Section 3700 requires all employers with at least 1 employee to carry insurance. A failure to do so will result in cause the DLSE to issue a stop order prohibiting further use of employee labor until you purchase workers compensation insurance. It will also carry a fine for every employee you have working for you and may even be seen as a misdemeanor. The fine you will end up paying will be far in excess of any medical bills this person requires.

Brandon, Esq. :

So, in short, if you have insurance, let them deal with it. They will try to find a doctor willing to state that her current condition is where she was at prior to the accident. If you do not, it will be in your best interest to take care of this quietly, because if you do get reported, the consequences far outweigh the possible benefits.

Brandon, Esq. :

Please do not hesitate to let me know if you have any questions or concerns regarding the above and I will be more than happy to assist you further. If you do not require any further assistance, please do not forget to provide my service with a positive rating, as this is the only way I will receive credit for assisting you.

Brandon, Esq. :

Have a wonderful rest of your day.

Customer: replied 3 years ago.
Thanks Brandon, I'm sure it doesn't matter because most states probably have similar laws in this area but I'm located in SC. Unfortunately I was in between coverage and didn't have gap coverage. I've paid everything thus far and don't mind covering the next scheduled visits but at what point should I say enough is enough? And what should I do moving forward to protect myself the best I can?
While the laws are similar, they do in fact differ as to the penalties and requirements. SC requires that you must have workers compensation if you employ 4 or more employees and that a failure to do so will result in significant fines and penalties. For example, if this gets reported, you could end up having to pay $1,000 per day for each day you went without workers compensation insurance. Under South Carolina law, the Workers' Compensation Commission has authority to double the fines and penalties for each workers' compensation violation. Except however, in cases where employers fail to carry workers' compensation in violation of state law, a minimum penalty of $750 for each year of no insurance and a maximum of $1,000 per year of no insurance can be assessed. The Commission also has the authority to subpoena witnesses and request the production of books, records or any documents necessary for their investigation. Any subpoenaed person that cannot show just cause for failing to appear or produce the requested documents can face up to 30 days in jail or a fine for each failure to comply.

So, while legally you can stop paying for this person, realistically speaking you may end up significantly worse off if you get reported for not having insurance. The best thing to do is to get insurance as soon as possible. For less than $2,000 you would have a business that is insured. Then, after you are insured, you can reevaluate whether or not you want to keep paying for these visits.
Customer: replied 3 years ago.
I'm currently covered, when i realized i wasnt covered i immediately ran out and got covered, I've been covered for about 3 weeks. Unfortunately, this incident happened about 4 weeks ago. The reason I didn't have coverage is because I pay my premiums in full and when it was time to renew a year later my agent/agency didn't renew my policy and for me it was just "out of sight, out of mind (guess I just leaned on my agent to keep me up to date). Come to find out the agency was bought or merged with another agency and I seemingly fell through the cracks. I didn't know I wasn't covered and didn't actually realize the amount of time that had elapsed until this particular incident, I went to pull my information and basically said, "oh shit". Moving forward, what would you recommend me do? I know your not my "attorney" but based on your expert opinion what is my best course of action.

As you are well aware, I cannot create an attorney client relationship with you and thus cannot tell you what you should do in this situation, however, if it was me, I would not want to run the risk of this employee causing any problems. Thus, I would not coddle this person (as employees try to take advantage when they think they can) but I would make sure all of their medical needs are met. You could ask the employee to make sure to have something from the doctor stating that they believe the procedure is related to the work injury, but never deny payment long enough to have them feel their only recourse is to go to the workers compensation board.

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