Navigating the Worker’s Comp Process
Worker’s Compensation is a long, arduous, complex and frustrating sys-tem but if you get injured on the job it is a process you are forced to endure. I know the aggravating Worker’s Comp system first-hand because I was medi-cally retired from the San Bernardino County Sheriff ’s Department far soon-er than I ever anticipated.
Now that I have come to work at SEBA as a field representative, I have taken on the task of helping our members learn, understand and navigate the process. This is an assignment I am passionate about because I feel if I had a better grasp on the Worker’s Compensation process, I may have been able to return to my work as a deputy; which has always been my dream job.
Ever since I can remember I wanted to be a Deputy Sheriff. On Career Day in high school, my report was on Law Enforcement. My family and friends will say I was obsessed. I liked to think I was focused.
At the age of 18, I joined the San Ber-nardino County Sheriff ’s Explorer Pro-gram, out of The Victorville City Station. When I turned 21, I applied with the De-partment for Deputy Sheriff Trainee. In May 1999 I was lucky enough to get hired and assigned to Class 137. Prior to patrol I worked The West Valley Detention Cen-ter, Glen Helen Rehabilitation Center and The Victor Valley Jail.
My first patrol assignment was the Victor Valley/ Adelanto Station where I worked the next 7-8 years. My last year Ispent at the Big Bear Station. I returned to West Valley following my husband’s re-tirement from The Sheriff ’s Department. During my years on patrol I was signifi-cantly injured twice. This includes being hit by a drunken driver.
At my last assignment, I was involved in a physical altercation with a violent in-mate. The altercation ended with a head and neck injury to add to my list.
Up until now there have been no advo-cates for members of law enforcement go-ing through the Worker’s Compensation process. No one expects doctors to know the Criminal Justice System. So why is law enforcement thrown into the Work-ers Compensation System and expected to know how to navigate?
The “process” can be confusing and maddening. The worker’s compensa-tion system comes with its own glossary of terms that the average person has no clue about. Those who are forced into the worker’s comp process must learn the ex-act words to say – in the specific timeline allotted to say them – in order to get the medical care, they need and deserve.
In some cases, communications be-tween the injured worker and the Claim Administrator seem to break down immediately. The worker wants the adequate medical care they are entitled to and to be able to meet their personal financial obligations. The Claim Administrator wants to be conservative; keeping in mind its own responsibilities and obligations. The employer is left somewhere in the middle with a ghost for an employee. Nothing runs smooth and delays are a constant thing. It is not unheard of for a case to last well over four years.
Everyone involved is required to follow the Labor Code and Worker’s Compensa-tion laws. Conditions of compensability, statues of limitations, and deadlines must be adhered to. Of course, all parties put self-interest first. For the injured worker, terms like Denial of Treatment and Uti-lization Review become all too familiar. This could mean feeling no choice but to obtain an attorney. That decision, in it-self, creates a whole new set of rules. At the end of the process, a whole person impairment is determined, which is the total percentage rating of your disability. The injured worker can be released from care or need lifetime medical treatment. For some, medical retirement is their only option because their permanent re-strictions prevent them from performing their regular job duties.
By Melissa Burroughs-Cheesman