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Workers’ Compensation for Off Duty Work

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Archive: Dec 2017

Workers’ Compensation for Off Duty Work

A lot of men and women display acts of great heroism in the face of danger. In the recent devastating shootings in Las Vegas, off-duty officers sustained serious injuries ushering people to safety. Those men and women were not technically injured in the line of duty, but they saved lives because it was their job. Now, a California assemblyman says they should receive workers’ compensation benefits for their heroism. This begs the question: Can people collect benefits when they sustain an injury off-duty?

A Deadly Massacre

There were more than 200 California police officers in attendance at the country music festival on October 1, when Stephen Paddock fired hundreds of rounds into the crowd, killing 58 and wounding an additional 500. During the shooting, many of these officers went into “work mode” and helped people to safety, administered CPR, and assisted other local authorities in securing the area. Some California police officers sustained injuries in the shooting, while others report developing PTSD in light of the incident.

In the months that have passed, the jurisdictions who employ some of those officers have come under fire for their answers to questions regarding time-off, long term medical treatment, and other benefits that officers might be privy to under worker’s compensation benefits. Those jurisdictions include Riverside, San Bernardino, Los Angeles, and Orange counties.

State Law and Loopholes

California state law clearly states that police officers can collect worker’s compensation benefits if they intervene in a crime anywhere in the state of California while on duty. Unfortunately, the law is less clear when these incidents occur out of state. Under this loophole, jurisdictions are not required and might not even be allowed to offer worker’s compensation benefits to these injured officers. One assemblyman’s new legislation plans to amend that.

Tom Daly, a Democrat from Anaheim, wants to introduce legislation that would banish any ambiguity in the law and extend worker’s compensation benefits to any officer who intervenes in a crime outside of California’s borders. The legislation follows after Orange County rejected four workers’ compensation claims from deputies injured in the shooting.

In passing this legislation, Daly hopes that worker’s compensation benefits could retroactively apply to the deputies injured in the shooting. However, some legislators argue that the measure could be more effective if California amended and clarified the current law, rather than introducing something new.

Other jurisdictions are handling the matter differently. Los Angeles has yet to come to a decision for its off-duty officers, stating the vague nature of the current law. In San Bernardino, the union has initiated talks on behalf of the 11 deputies who incurred injuries in the shooting. Their hope is to convince the county to treat them as on-duty officers.

Hope For Injured Off-Duty Workers?

In reality, there are some professions that require workers who are always “on duty” – first responders, police officers, and health care professionals to name a few. In the event of an emergency, these professionals often intervene to help others, even at risk to their own health and well-being. In the event they sustain injury, shouldn’t they be privy to worker’s compensation benefits? Tom Daly and many others throughout California believe so. What happens regarding these specific cases and pending legislation remains to be seen.

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What is a Workers’ Compensation Set-Aside Arrangement?

A work-related injury can turn your world on its head. You might be wondering how to pay for your medical bills or compensate for your lost wages. The worker’s compensation programs provides valuable recourse to workers by having employers pay for medical bills and a portion of lost wages when an employee sustains an injury on the job. Sometimes, though, an injury may take months or even years to fully recuperate, and the most severe injuries can lead to permanent disability. When a workplace injury leads to the need for long-term care, the Workers Compensation Medicare Set-Aside Arrangement can provide valuable assistance.

Set-Aside Arrangement

A Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) is a monetary agreement that funnels a percentage of a worker’s compensation claim to pay for future health expenses that are related to an occupational illness, injury, or disease. A claimant must use these funds prior to Medicare kicking in, which pays for treatment of an occupational condition.

Everyone involved in a worker’s compensation case must follow the Medicare as a Second Payer Laws. This helps protect Medicare’s funds and interests. The recommended method for protecting these interests is a WCMSA.

By law, Medicare is always a “secondary payer,” which means they will only pay if there is no other insurance available. In the event of a workplace injury, worker’s compensation insurance is generally available. This helps minimize the burden on the taxpayers and helps sustain Medicare funds.

How Much Will I Get?

The amount of a WCMSA settlement depends on the individual context of the case. After you get a settlement in a worker’s compensation or personal injury case, a certain amount must be set aside in a separate account for future medical expenses. Once you spend all the money in your MSA account for qualified expenses following the proper rules for reporting, Medicare will kick in and pay for your medical care.

A WCMSA makes every attempt to calculate every future medical expense that might be related to your illness or injury. It includes money for:

  • Prescriptions
  • Surgeries
  • Diagnostic tests
  • Doctor’s visits and copays
  • Medical supplies and equipment

What Are The Reporting Rules and Regulations?

All WCMSA accounts must follow certain reporting and recordkeeping guidelines in accordance with the Centers for Medicare and Medicaid Services. There are also restrictions regarding how the money can and cannot be used. You must keep all copies of records and receipts and report all expenses to Medicare. Any mistake could result in losing Medicare as a secondary payer. It’s essential that you follow all rules and keep up with your reporting with the CMS so you can receive timely payment for your medical treatments when the WCSMA runs out.

A WCSMA can be a valuable asset to an injured worker, though you must monitor your accounts carefully. Only use the money for approved expenses. If you follow all the rules closely, you will be able to accept Medicare as a secondary payer and obtain compensation for your medical bills.

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What is the FEHA?

California is one of the most progressive states in the country when it comes to anti-discrimination law and equal rights for all. One of the landmark pieces of legislation regarding discrimination in California is the Fair Employment and Housing Act. This is a sweeping law that addresses unfair conduct in the course of hiring, employment, and securing housing. Here’s what you need to know.

History of the Act

The FEHA was passed on September 18, 1959. It is the main statute in California that prohibits employment discrimination and applies to employers, labor unions, apprenticeship programs, employment agencies, and more. It forbids employment discrimination on the following grounds:

  • Race
  • Religion
  • National origin
  • Sexual orientation
  • Sex
  • Marital status
  • Physical disability
  • Mental disability
  • Medical condition
  • Age
  • Pregnancy or childbirth, or any related medical condition

The Act also prohibits retaliation against anyone who opposes conduct that is forbidden by the Act. This includes such activity as filing a complaint, testifying, or assisting in any FEHA-related proceeding.

In 1978, the California government passed an amendment that also required employers to provide unpaid protected leave for individuals who were disabled by pregnancy, for a term up to 4 months.

Why Is It Necessary?

While federal law does have some antidiscrimination statutes on the books, none are as comprehensive as the FEHA. Many states in the U.S. have expanded upon the current federal statutes to provide more avenues for recourse when victims have endured workplace discrimination.

The FEHA is much like federal statues Title VII and the Americans with Disabilities Act, but it extends further and offers further protections. Examples of additional protections include payment of attorney’s fees and reimbursements to prevailing plaintiffs, and looser criteria regarding definition of workplace harassment, retaliation, and discrimination.

Lastly, the FEHA allows for the award of punitive damages when a corporation or its agents engage discrimination or harassment, or they consciously allow misconduct by lower-level employees. Punitive damages are specifically designed to punish the defendant for wrongdoing and discourage future incidents.

Filing a FEHA Complaint

If you believe you have been a victim of workplace discrimination or harassment under the criteria listed above, California provides an important avenue for recourse. FEHA works to protect employees in California from the misconduct and discrimination of others. These proceedings are typically complex and require the assistance of an attorney familiar with the law. While you can file you’re own lawsuit with the courts, having an attorney by your side helps ensure that you meet all filing deadlines and attach relevant supporting documentation.

If you win a FEHA case, you may be entitled to any number of damages, which may include:

  • Back pay for any lost wages
  • Front pay to compensate for any future lost earnings
  • Rehiring or reinstatement
  • Promotion
  • Policy changes for the company
  • Mandated training for the defendant
  • Reasonable accommodation
  • Awarding of general damages for emotional distress
  • Attorney’s fees reimbursement

A FEHA violation is a serious matter, and as a victim of discrimination you may be entitled to compensation. Talk with an attorney for more details.

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