Frequently Asked Questions

Are you an employee who’s employer has acquired our services?

The alternative dispute resolution system was agreed upon by your Union and your employer to resolve workers’ compensation disputes early without requiring you to go through the litigation process in the statutory system at the Workers’ Compensation Appeals Board.

By the terms of the agreement between your Union and your employer, the injured worker is required to use the alternative dispute resolution process. Instead of filing at the Workers’ Compensation Appeals Board you will use the ombudsperson/member advocate, mediator, and if necessary, arbitrator to resolve all disputes rather than the Workers’ Compensation Appeals Board hearing process.

Yes. Under the California labor laws, your rights and benefits cannot be reduced by an alternative dispute resolution process and remain the same as other injured workers.

Yes, you do have the right to appeal the arbitrator's decision to the Workers’ Compensation Appeals Board.  

If your claim has been denied or delayed please contact the ombudsperson to see if the ombudsperson's office can resolve the dispute with the claims adjuster or arrange for a medical examination in accordance with the specific rules of your ADR program to resolve medical disputes, if necessary.

No. The ombudsperson must keep everything confidential. Letters or conversations between the injured worker and the ombudsperson are confidential, just as our letters and conversations between the insurance company and the ombudsperson are confidential. Permission to release information will be requested if it is necessary to resolve the dispute.

Yes.

The benefits may include…

Temporary Disability:  Temporary disability is paid by the insurance adjuster at two thirds of the injured worker’s salary based on average weekly earnings up to certain maximums. Temporary disability is paid when an injured worker is off work as a result of an industrial injury, the injured worker’s treating physician has certified the injured worker as being unable to work and the employer has not offered modified work within the restrictions prescribed by the treating physician. In any event, temporary disability cannot exceed 104 weeks.

Medical Treatment:  An injured worker is entitled to medical treatment for as long as necessary and in accordance with a medical opinion provided by an approved physician. Your employer and Union have agreed that all treatment for an industrial injury will be provided by the medical facilities authorized by both your Union and employer in this program.   The medical care will extend for as long as necessary to treat the industrial injury.

Permanent Partial Disability:  An injured worker may be entitled to permanent disability benefits which are set by the California State Legislature and based on medical evidence provided either by your treating physician, second opinions or by examining physicians called “qualified medical examiners” or “agreed medical examiners”. Permanent disability ratings can range anywhere from 0 to 100%, depending on the severity of the injury as documented by the physicians involved.

Supplemental Job Displacement Benefits:  If an injured worker is unable to return to his or her usual and customary job and no alternative job is available, then a worker may be entitled to a supplemental job displacement benefit (depending on the permanent disability rating) that ranges between $6,000 and $10,000, payable to a school to enable you to learn new skills to allow you to return to work in suitable employment.

No. The ombudsperson is not your attorney. The ombudsperson acts to protect your best interests and to help you resolve any dispute you may be having with the insurance adjuster or employer regarding your industrial injury. If the ombudsperson cannot resolve the dispute, you are entitled to mediation and, potentially, arbitration.

Yes.  You have the right to obtain the services of an attorney.