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QUESTIONS FOR AN ATTORNEY FOR WORKERS COMPENSATION INSURANCE

IN CALIFORNIA FOR MY EMPOYEES.I...
QUESTIONS FOR AN ATTORNEY FOR WORKERS COMPENSATION INSURANCE IN CALIFORNIA FOR MY EMPOYEES.I called State Compensation Insurance Fund in California and they gave me a quote for my renewal. The policy states the Employer Liability Limit of 1 million dollars is written on the Policy. When I asked them to explain what the 1 million dollar limit means they stated I will be covered 100% for all employees Medical Bills; but the language implies that the insurance company will not pay more than 1 million, but I’m told it unlimited. Around 1-million dollars is written on the policy of several Worker Compensation Insurance Companies in California.I was always told that when employer pays for Workers Compensation Insurance for their employees they have zero liability in California.QUESTION:
1. Historically, I was always told in California as long as you pay for Worker Compensation Insurance there is NO liability to the employer?
2. You send employee to pick up some supplies and by the employee’s actions hits a telephone pole. Since the employee is working he files a claim for Workers Compensation because he lost his Arm as a result of the accident. The employee sues employer and workers- compensation insurance for Medical Bills, Lost future Income and pain and suffering.
A. Does Workers Compensation Insurance in California cover for all future medical Bills, Lost future wages and pain and suffering; and employer has no liability?
B. Or in California the Employee has no recourse if the Employer is not negligence; has no right to sue for pain and suffering or lost wages…just medical bills?
C. What/why is the 1-million dollar written in all the Workers Compensation insurance carriers’ agreements in California?
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Answered in 10 minutes by:
9/19/2017
Legal Eagle
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Hello! I am a licensed attorney, admitted to practice in state and federal court. I have a nearly 100% satisfaction rating so all that means is that you can count on me to help today. Do you mind if I take a moment to review your question?

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Thank you very much for your patience. Let me answer your questions one by one.

QUESTION:

1. Historically, I was always told in California as long as you pay for Worker Compensation Insurance there is NO liability to the employer? - Correct. The exception is if the company did something intentionally to injure the employee, WC insurance will pay for the expenses of the injured person.

2. You send employee to pick up some supplies and by the employee’s actions hits a telephone pole. Since the employee is working he files a claim for Workers Compensation because he lost his Arm as a result of the accident. The employee sues employer and workers- compensation insurance for Medical Bills, Lost future Income and pain and suffering. - Claims aren’t automatically barred if someone can prove that the employer was negligent. WC insurance is for injuries that occur within the normal scope of the job; not for negligent actions of the employer.

A. Does Workers Compensation Insurance in California cover for all future medical Bills, Lost future wages and pain and suffering; and employer has no liability? - Not typically, it usually covers the lost wages of the person plus their medical bills related to the injury.

B. Or in California the Employee has no recourse if the Employer is not negligence; has no right to sue for pain and suffering or lost wages…just medical bills? - They can still sue if there was negligence, but again, a negligence claim will be barred if the person was injured in the normal course of their duties and they were receiving worker’s compensation as a result.

C. What/why is the 1-million dollar written in all the Workers Compensation insurance carriers’ agreements in California? - Although I’d have to see the policy itself, usually this means that there is a $1 million limit to the amount of money that will be paid out by insurance.

Also, although I provided an initial answer, it’s important that you are 100% satisfied. If you feel I have done so, please rate me 5 stars and let me know if you have any follow up questions. As a side note, you can also click here in the future to request me individually.

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Customer reply replied 2 months ago
MY MAIN QUESTION IS:
What/why is the 1-million dollar written in all the Workers Compensation insurance carriers’ agreements in California? - Although I’d have to see the policy itself, usually this means that there is a $1 million limit to the amount of money that will be paid out by insurance.
REPLY: I called several Workers Compensation insurance companies and they all state Employer’s Liability Limit is 1 Million Dollars stated on the face of the Agreement…as previous disclosed. There must be some reason why they disclose this. Let stay with the premise that there is no negligence by the employer as previously stated, and you state there is no limit in California; the 1 million dollar is in direct conflict with your statement? Would you be concerned about the 1-million dollar limit when all the policies in California state the Maximum pay out including attorney fee is 1 million? Has the law changed in California in the last year? If Medical Bills and lost wages are 4 million and there is a Judgment in California; who pays the difference of 3 million?B. Or in California the Employee has no recourse if the Employer is not negligence; has no right to sue for pain and suffering or lost wages…just medical bills? - They can still sue if there was negligence, but again, a negligence claim will be barred if the person was injured in the normal course of their duties and they were receiving worker’s compensation as a result.
REPLY: The question is not answered. I already stated that the Employer is not negligence. The question is; does the employee have the right to sue for pain and suffering?If the employee lost his arm and there were no negligence by the employer; the employees can’t perform his job function for the rest of his life because of the injury; are you saying as long as employer paid for workers compensation in California and was not negligence; the employee has no recourse in California to hold the Employer responsible? And if the Insurance company will only pay out 1 million dollars; the employee and his Attorney has no recourse against employer? (Again remember the Employer is not negligent)

Bear with me a moment while I do some digging...

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Ok, thank you for your patience. There is no state law that limits the liability for worker's comp to $1 million; this is likely just an industry standard used by most insurance carriers. To give you an example, many attorney malpractice insurance carriers have a $100,000 per incident and $300,000 total limit on liability even though there is no state law on minims or maximums.

Because there is no limit, it is possible that an employer would have to pay the employee for time missed at work if they were injured on the job if it were in excess of the policy limits.

As far as the negligence issue, if there was no negligence by the employer and the person was injured in the regular course of their job, your WC insurance will pay out up to the policy limit and the minimum amount of time consistent with state law. If there was no negligence, then the employee won't be able to hold the employer personally responsible.

Let me know what other questions you have so we can clarify this matter.

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Customer reply replied 2 months ago
YOU STATED: Because there is no limit, it is possible that an employer would have to pay the employee for time missed at work if they were injured on the job if it were in excess of the policy limits.
MY REPLY: base upon your answer if an employee could not work for 30 years and missed work they employer would have to pay for lost wages for 30 years? That would not be my definition of Insurance.YOU STATED: As far as the negligence issue, if there was no negligence by the employer and the person was injured in the regular course of their job, your WC insurance will pay out up to the policy limit and the minimum amount of time consistent with state law. If there was no negligence, then the employee won't be able to hold the employer personally responsible.
MY REPLY: Before you stated there was no policy limit; now you are stating WC will pay out to the policy limit…I’m confused

I think I see the confusion. It depends on whether someone has temporary or permanent disability. Usually, a person will be paid worker's compensation until their work-related injury is healed. If the worker cannot be healed, then they will receive what's called a maximal medical improvement ("MMI") where they will receive a # from your insurance company that reflects their permanent disability. This is set by the state. Usually, it's going to be well under $1 million even for the most catastrophic injuries.

As far as the policy limits, you'll have to forgive me. State law does not limit the amount of coverage you can have. Your own insurance policy will limit the amount of coverage you can have, typical to any insurance policy.

What other questions did you have for me?

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Customer reply replied 2 months ago
The very first question: Historically, I was always told in California as long as you pay for Worker Compensation Insurance there is NO liability to the employer? - Correct. The exception is if the company did something intentionally to injure the employee, WC insurance will pay for the expenses of the injured person.Let keep it simple: No negligence by employer. Therefore if the employee had an accident and lost both of his hands just by an accident while working: (NO NEGLIGENCE)
1. Based upon your first statement you stated the employer is not responsible for any liability in California. Therefore if the employee can’t work any longer the insurance company will pay out for the rest of the employee’s life for lost wages? Pain and suffering? Medical Bills? Even if the amount came to 30 million dollars over the employees life; and the employer has no liability?
Please address directly all of the points above.

Thank you for clarifying. If there was no negligence, but the employee can no longer work because he lost his hands, then your worker's compensation insurance will determine the maximum payout to the employee consistent with the state's guidelines on making that determination. This amount is meant to cover any medical bills and the lost wages from working generally. Unless the individual is one of the highest paid executives in the industry, it will not amount to $30 million. Oftentimes it will be less than $1 million. Pain and suffering is not considered in a worker's compensation claim, only a negligence claim, but since there is no negligence, it won't apply.

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Customer reply replied 2 months ago
YOU STATED: Unless the individual is one of the highest paid executives in the industry, it will not amount to $30 million. Oftentimes it will be less than $1 million.
REPLY: Keep the questions as is. If there was a 3o million dollars liability for the employee who would pay that amount? Would the employer be responsible after the 1 million dollars?YOU STATED: pain and suffering is not considered in a worker’s compensation claim, only a negligence claim.
REPLY: Can the employee sue the employer for the pain and suffering?YOU STATED: Only a negligence claim is considered in a worker’s compensation claim.
MY REPLY: that can’t be true because workers compensation is paid to an employee even though there is no negligence by an employer???

Ok, I'm sorry for the delay. I had some other matters to which I had to attend, but I did not forget about your issue. The maximum payout would likely never exceed $1 million, but if for some reason it did, and your policy only covered $1 million, then you would be responsible for the remaining $2 million. However, it is improbable (highly improbable) that someone's future earnings would total out to $3 million. The only time the employer would be required to pay is if that person won a judgment in court against the employer for negligence, but if there was no negligence, then there is no need to worry.

A negligence claim is not considered in a WC claim.

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Customer reply replied 2 months ago
The purpose of these questions it to manage potential risks…I personally have 10 million personal Umbrella liability for my home and car.…I also have flood insurance in a zero percent chance of a flood zone. I also know of people who lost everything from the highly improbable recommendation. I also was told from an insurance adjuster there are many people throughout the United States that are disable for life as a result of a freak accident by working. I don’t intend to only have 1 million dollars in WC insurance; putting my entire estate at risk of what a worker might or might not do….I have recourse in how to conduct my Corporation by hiring many independent contractors instead of employees. I can’t guide the direction of my Corporation if I do not know what my exposures are.You are saying that all employers in California have liability; if the hurt worker liability is over 1 million dollars. If this is the case than I will fire most of my employees and hire independent contractors. I spoke with other owners of Corporations and two WC insurance agents today and they all disagreed with your statement….they stated in California employers have zero liability as long as they pay for WC insurance and are not negligent. They stated California protects EMPLOYERS when the claim is over 1 million dollars covered by the insurance company….the employee has no recourse against the employer for all his future doctor bills and lost wages after the Insurance companies pays the 1 million dollars. The only time the Employer is at risk, after a million dollar is paid out, is when the employer is negligent. Employers are required to have WC insurance to have this protection; otherwise the employer has total exposure and no protection???

I can understand your decision to manage the risk, particularly if there is a risk of injury in your business, whatever that may be. Also, employers may have liability if they did anything negligently to cause someone's injury. So, you may not need to fire all your employees because if someone files a negligence action, they don't need to be an employee of your business; they can be anyone. And you're correct, employers will avoid liability if they pay for worker's compensation insurance and they are not negligent. I haven't wavered from that statement. However, if the employer is negligent, then WC will not cover them. I hope that makes sense.

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Customer reply replied 2 months ago
Please answer the questions in order as asked. Do not skip the question or talk about a different subject matter. Answer the questions directly as asked.YOU STATED: When you state you may not need to fire all your employees because they anyone could sue for negligence.
REPLY: Your statement is off topic because I already knew anyone can sue for negligence. I did not ask if anyone could sue for negligence. The Corporation risk of employees is much greater than independent contractors. An independent contractor who is licensed, bonded and insured covers himself if there is a work accident. The employee files a claim if they get hurt; and according to court cases they could claim there was too much stress, etc…creating much greater risks of negligence. With an independent contractor and the Corporation following the laws regarding independent contractor; has an arms-length relationship and therefore the risks are greatly reduced just about zerio.You agree that no employer in California is at risk of any liability over the WC Insurance of 1 million if they are not negligent?Do you agree that if a worker lost both arms from an accident while working and he starts a lawsuit of 20 million against the Corporation and WC Insurance; the courts in California will only allow 1- million from the wc insurance and the Corporation will not be liability for the other 19 million because the Corporation did nothing negligent to cause the accident while working for the Corporation? The workers will have figure a way to support himself with no arms for the rest of his life?
(Please answer each question directly and don’t repeat what we already know)If all of the above is correct; California Law would state that all employees works for an employer at their own risk, unless the Employer was Negligent; and the employee would only be able to collect the amount of the wc insurance coverage?California states that if an employer doesn’t have wc insurance they could be held criminally for not having the insurance and would have to pay for Medical and lost wages for any employee?When the Employer pays for WC insurance it released the Employer 100% of all liability no matter if the claim was 100 million…of course the WC insurance would pay for 1 million dollars but the employee would have no recourse against the employer for the 99 million?
If the employer was negligent only than would the employer be responsible of the 99 million?Question: You are a Workers Compensation Attorney in California as requested?

John, I represent people who are suing their companies for a variety of reasons in California; however, I have the sense that you're heavily skeptical of my opinions and expertise and I have a feeling that your expectations may be inconsistent with what the website offers. Accordingly, I will need to opt out of this question altogether and let another expert who may be willing to help you answer some of your questions and provide you with a satisfactory answer to your hypotheticals. Thanks.

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Law Educator, Esq.
Category: Legal
Satisfied Customers: 119,599
Experience: JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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Thank you for your question. I am a DIFFERENT CONTRIBUTOR as you have asked for another contributor.

So, under CA workers compensation law, the employee cannot sue an employer for work related injury outside of workers compensation UNLESS the injury happened because of an INTENTIONAL TORT committed by some employee.

When the states passed workers compensation laws making employers strictly liable for work related injuries, those caused in the course and scope of employment, they removed the employee's right to sue the employer for any tort. So, this is why the employee cannot sue the employer for negligence in a work related injury, they can only sue for medical bills and temporary disability payment for time they cannot work. No pain and suffering is allowed under CA Workers Compensation, just those the limited damages provided for under the workers compensation laws.

Please do not forget to leave positive feedback by clicking on the 5 stars at the top of your page, as the experts are not employees of the site and get no credit for spending time with customers unless they leave positive feedback. Thank you.

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Customer reply replied 2 months ago
Thank You…
My WC Insurance policy states they will only pay out to 1 million for each employee per incident, including Attorney Cost. If fact almost all California wc insurance policies has a limit of 1 million or 2 million dollars.What happens if the worker drive his own car to home depot to pick up paint for the Corporation and accidently crashes his car into a telephone poll and loses both of his arms; let say his medical bills is 8 million including lost wages; who would pay for the amount greater than 1 million dollars stated on the WC insurance policies.

Thank you for your reply.

Yes that is correct, that is what the requirements of CA W/C carriers are.

Workers compensation is liable to the policy limits only. Furthermore, if he is in such a horrific car accident, his auto insurance must also cover him even if he was working. If the accident was the fault of a third party they would be liable as well. In the rare event there is such a judgment against an employer, what the employers do is file bankruptcy (Chapter 11) and these debts are reorganized and extinguished. It really does not happen often and the risk you would have such a judgment would be slim.

Also, most employers carry an umbrella coverage general liability policy in case their employee causes some type of catastrophic harm.

But you cannot prepare for every single contingency and you can come up with a million what if's but if you are worried, they make excess lines general liability or umbrella coverage to cover those contingencies.

Please do not forget to leave positive feedback by clicking on the 5 stars at the top of your page, as the experts are not employees of the site and get no credit for spending time with customers unless they leave positive feedback. Thank you.

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Customer reply replied 2 months ago
EXCELLENT!
My Corporation owns rental properties and 50 percent of the workers are Independent Contractor (45 of them) who does plumbing work, paint apartments when vacant etc. The Corporation has no liability or risks with Independent Contractor because the Corporation complies too all State Laws to insure the independent contractors can’t be reclassified as an employee in a court of law.Since you confirmed that the Corporation has complete exposure after 1 million dollars WC Insurance Coverage; I decided not to have any employees and hire more Independent Contractors eliminating the potential risk of losing the Corporation. I will continue to purchase WC insurance just in case something falls through the crack with Independent Contractors. I also just increased my 1-million dollar in WC Insurance coverage to 2-million dollars. Now my risk is lower substantially.I just called my regular Insurance Agent and he stated that my 10-million dollar Commercial Umbrella Policy would not cover the amount over the 1-million dollars covered by the wc insurance. He assured me every Commercial Umbrella Policy in California will specially disallows any coverage for WC insurance.If I have a manager at an apartment complex, that lives at the apartment complex and shows apartments periodically when there is a vacancy; there is very little potential for injury. My question is sometimes she will take a trip to home depot to make extra keys for the new tenant. While driving her own car to home depot to purchase the sign, she hits a telephone pole by accident and she loses both arms….this is a direct workers compensation claim because she was taking the trip for the Corporation. If the claim for lifetime medical and lost wages is 19 million; wc insurance would pay 2 million (New Policy) and the Corporation would pay 7 million? What if she brought her husband or children with her and they were all injured?… Should I write instructions stating, no one else is allowed in the car when she picks up supplies at home depot?Thank You,
John

Thank you for your reply.

If workers are independent contractors, your workers compensation would not cover them anyhow. You need to make them carry their own insurance and prove to you they have insurance.

You need to make sure you are sticking to the rules about employees v. independent contractors, just to make sure you do not cross the line.

If you do not have employees, then the umbrella liability policy would not be an issue, because you will not have employees to cover under workers compensation.

You know I have not seen a car accident claim, even with a death, that has gone over 2 million in a long time, so your claim of 19 million would likely be unrealistic.

Instructions that nobody else should be in the car would not be enforceable and would not protect you.

Like I said, you cannot cover every little contingency you would go broke. However, as condition of her employment you can make her cover sufficient vehicle insurance to cover her uses during the times she is working with you even if you offer to split the cost with her.

Please do not forget to leave positive feedback by clicking on the 5 stars at the top of your page, as the experts are not employees of the site and get no credit for spending time with customers unless they leave positive feedback. Thank you.

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Customer reply replied 2 months ago
Hi Law Educator...I'm ready to close this session. Thank You
You stated Workers Compensation for Independent Contractors will not be covered by Workers Compensation; but if an independent contractor who claimed to have no employees did bring employees without the Corporations knowledge and did not have WC insurance, there will be legal fees. If the Judged ruled against the Corporation for some unforeseen reason and classified the sub-workers as employees; the Corporation’s WC that was paid, even though the Corporation has no employees would now be covered by wc insurance for the 2 million dollars since they are classified as employees.Thank You Law Educator

Thank you for your reply.

Independent contractors are not covered by your workers compensation. If they bring in workers who they do not cover, this is their problem if you make them present you proof of insurance before you hire the contractors. Contractors in CA do carry their own insurance and you need to make them prove it.

If the judge rules against you and claims that the contractors are actually employees, your coverage is up to the limits and as I said you would go broke planning for every what if, but there is excess insurance available, but it is expensive and generally unnecessary. Typically 2 million is more than you or anyone needs even major corporations do not carry more than that.

Please do not forget to leave positive feedback by clicking on the 5 stars at the top of your page, as the experts are not employees of the site and get no credit for spending time with customers unless they leave positive feedback. Thank you.

Law Educator, Esq.
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Customer reply replied 2 months ago
Thank You...I had to respond because your answer did not exactly square with my thought process
My explanation: if the Contractor has no employees and is licensed and bonded; can do work for the Corporation as an independent contractor with no employees is not a reportable event to WC. By law an independent contractor who does not have WC insurance and is classified as exempt, but who is licensed and bonded is responsible for his own injuries; according to the WC insurance company. If that Contractor brings workers without the knowledge of the Corporation onto the worksite and one of those workers get hurt; there could be liability to the Corporation by an unfair ruling. The Corporation has no employee but continue to pay for WC Insurance just in case something like this happens, and a Judge makes a bad ruling; states the Corporation is responsible. Than the WC Insurance of 2 million that is never used because the Corporation has no employees will now be implemented because the Judge classified these unapproved workers to be Corporate Employees. This is how you cover for the unexpected.Note: I have flood insurance for my home in a zero rated flood zone. I have a 10 million dollar umbrella policy for my home in case something happens…you can’t cover for everything; but you can get close.

Thank you for your reply.

I did not say that you had to report it to WC, I said if you are going to use independent contractors and they have employees, you need to insist they have insurance and give you proof of insurance to avoid you being sued together with the contractor.

I know IC who are licensed are supposed to have insurance and be bonded and are liable for their own injuries, I said that, but you need to make sure they provide you proof of that insurance when you hire them, that is all I said. I was telling you how to be proactive to minimize your risk.

Keeping WC insurance is another protection, but $2million is enough insurance just in case.

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Customer reply replied 2 months ago
Thank You for the Clarification. I appreciate your Excellent on point answers to all my questions. Have a Great Day!
John

Thank you. I wish you the best.

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Auto insurance question. Vehicle registered in the state of
Auto insurance question. Vehicle registered in the state of Washington under X wife's name and lender. Used in Arizona .How can you use the insurance of her significant other in Arizona because of his… read more
Law Educator, Esq.
Law Educator, Esq.
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I live in California and have personal auto insurance
I live in California and have personal auto insurance through Ameriprise. I had a vehicle accident while driving a company vehicle on the weekend. I am only authorized to drive the vehicle M-F. My Emp… read more
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If you drop an auto insurance policy does that insurance
If you drop an auto insurance policy does that insurance have the right to turn you in to your state law enforcement agency as someone driving without insurance? … read more
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My 18 year old daughter is on my auto insurance policy. If
Hi. My 18 year old daughter is on my auto insurance policy. If she were to have some type of accident that was above and beyond my insurance, would I be held responsible or would she since she is an a… read more
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I had insurance with progressive auto insurance. the policy
i had insurance with progressive auto insurance. the policy was written feburuary the 23, 2017. I presented all the information they needed. And i recieved the insurance policy. Thet needed pior insur… read more
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The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.

The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

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