Guide for Injury and Loss
If you were injured and you believe it may have been someone else’s fault, you may have what is referred to as a claim for personal injury. When someone suffers harms and/or losses as a result of the wrongful conduct of someone else, the person(s) harmed may be entitled to compensation from the at fault party or their insurance company for medical bills, lost wages as well as for the emotional pain and suffering associated with the injuries and changes in their life. Sometimes the at fault party does not have insurance, but you still may be covered by your own insurance policy through what is called “med pay” and/or “uninsured or underinsured” coverage. In any event you only have a limited time to make a formal claim before your rights are forever lost. You must file your claim in the proper format and with the right court usually within 2 years, but in some cases, such as those against medical providers in 1 year, and those against public entities are as short as 6 months. Since time is so important to your ability to even pursue you claim, it is important that you contact an attorney who specializes in personal injury matters as soon as you think you have claim. Even if you are not ready to hire an attorney, a free consultation can at least advise of the time limit in which your must file your claim.
If you or someone you love has experienced an injury or illness which has cause you to lose income or left you with unpaid medical bills, an experience personal injury attorney can help you with the documents needed to protect your interests but until then here is a list of resources which might be of assistance.
Were you hurt while you were on the job?
If you were hurt while working, you are probably entitled to worker’s compensation benefits. Worker’s Compensation benefits provide for medical treatment, disability payments and may even provide retraining. If you are injured at work, immediately report your injury to your employer. If you are hurt at work, but your employer does not have insurance, you still may be able to obtain benefits for the California Uninsured Employer’s Fund and/or sue your employer. If your employer did not have insurance, you can file a claim with the Uninsured Employers’ Fund at www.dir.ca.gov/dwc/IWguides/IWguide16.pdf.
If your employer did have insurance, your employer will put you in contact with their insurance carrier. For more detailed information, there are attorneys who specialize in workers’ compensation cases. For information regarding how to file a workers’ compensation claim see www.dir.ca.gov/dwc/iwguides.html.
If you don’t have health insurance, how do you get your medical bills paid?
Often times there is “med pay” on the homeowners policy of the place you were injured or on the vehicle policy which will provide $1,000-$5,000 or more towards medical treatment or funeral expenses without regard to who was at fault . For a resource explaining insurance terms see www.insurance.ca.gov/0100-consumers/0060-information-guides/0010-automobile/Auto-insurance-101.cfm
If you don’t have “med pay” or if it has run out, there are some medical providers who will see you on a lien, which means the provider will agree to wait to be paid until after your lawsuit has been resolved. A lawyer can help you reach such a lien agreement with a medical provider. This is one of the more expensive ways to obtain medical treatment, and if your lawsuit is not successful you will still owe this bill, so liens should be considered carefully with the advice of a lawyer you trust.
Understanding Insurance (Health, Liability, Auto, Uninsured and Uninsured Motorist)
The California Department of Insurance maintains a website explaining all about insurance as well as the responsibilities of the insurance companies and the different types of insurance available. www.insurance.ca.gov/0100-consumers/
Often your insurance policies will provide for a right to reimbursement, which generally means if your insurance company, such as your health insurance company, has paid your medical bills as a result of the wrongful conduct of someone and you recover money from the at fault party, you are obligated to pay your insurance company back. It is important that you understand your insurance company’s right to reimbursement.
A trusted personal injury lawyer can review your available coverages and ensure all possible sources of recovery are explored.
Medi-Cal is a State program, patterned after the Federal Medicaid program, designed to provide no-cost or low-cost medical benefits to low income families. CalWORKs recipients are automatically eligible for no-cost benefits. Other families qualify based on income, and may qualify for benefits on a share-of-cost basis. Benefits are also available to qualified individuals, including undocumented aliens, for medical emergencies. www.mybenefitscalwin.org/
Assistance and Job Opportunities
If you are disabled and meet income requirements, the CalWORKS program may provide you with financial assistance and employment opportunities. Cash assistance is limited to 60 months total in a lifetime for most adults,and you may be required to participate in an employment services program in order to be eligible.
For more information on CalWORKS, visit www.cdss.ca.gov/calworks/default.htm.
Temporary Continuation of Group Health Insurance
If you lose your job, most group health plans must allow you to temporarily continue your group health insurance. For information on COBRA, see the U.S.Department of Labor’s website at www.dol.gov/dol/topic/health-plans/cobra.htm.
Food Stamps/Cal Fresh
If you have a low income, whether or not you were injured or disabled, you may be eligible for food stamp benefits, which average $200 per month per household. For more information on California’s Food Stamp program, see the California Department of Social Services website at www.co.fresno.ca.us/DepartmentPage.aspx?id=13797
If you are in danger of losing your home to foreclosure, the federal government has a program to help homeowners who are trying to keep their homes and are making good faith efforts to do so. For more information on the program, see the U.S. Department of Treasury’s website at www.makinghomeaffordable.gov.
Medi-Cal is a public health-insurance program that provides health-care services for low-income individuals, including families with children,seniors, persons with disabilities, pregnant women, and low-income individuals with specific diseases.For more information, see the California Department of Health Care Services website at www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx
Medical Indigent Service Program (MISP)
Whether you are Undocumented, a Legal Permanent Resident, or United States Citizen, you may be eligible for the Medical Indigent Service Program (MISP) at Community Regional Medical Center. You can be married or single, with or without children. To receive these benefits, you must be between the ages of 21 and 65 and meet income, expense, and/or property requirements. For more details and a downloadable brochure, see www.co.fresno.ca.us/DivisionPage.aspx?id=48797
Fresno County Low Income Medical Clinics
For a list of local clinics which serve low income patients and some of the eligibility requirements see www.fresnometmin.org
State of California Disability Insurance
If you are out of work due to a non-work related injury or illness, you may be entitled to disability
insurance. Disability insurance provides partial wage replacement to eligible workers who are unable to work because of a disability. A disability is any mental or physical illness or injury that prevents you from performing your regular or customary work. For more information, visit www.edd.ca.gov/Disability.
If you have lost your job through no fault of your own, you are entitled to unemployment benefits. You must be able to work and must be looking for work. The amount of benefits available is based on your former earnings. For more information, visit www.edd.ca.gov/Unemployment.
Crime Victim Compensation
If you were injured as a result of a violent crime, you may be able to obtain money for help with medical bills, compensation for lost income, and reimbursement for therapy costs for you and your family. The fund also provides benefits for job retraining and, when needed,funeral and burial expenses. To apply for compensation, you must submit a claim within one year of the crime. For more information, see the California Attorney General’s website at www.oag.ca.gov/victimservices/contact or the Fresno County site at www.co.fresno.ca.us/uploadedFiles/Departments/Probation/Crime_Victim_Services/CVAC%20Brochure_2008.pdf
Fresno County General Relief
General Relief is a County funded program that provides cash or in-kind services to needy individuals and families who are not eligible for assistance under any other categorical aid program. Grants are intended to cover the costs of food, shelter, personal needs and other living expenses. See www.co.fresno.ca.us/DepartmentPage.aspx?id=12523
Fresno County Department of Social Services
The Fresno County Department of Social Services (DSS) serves some of the most ethnically and culturally diverse communities in the State of California. Our programs are designed to promote services to ensure that individuals and families will be safe, self sufficient, healthy, out of trouble at home, in school or at work. See www.co.fresno.ca.us/DepartmentPage.aspx?id=47207
Federal Social Security Benefits
1-800-772-1213 (TTY 1-800-325-0778)
Medicare is the U.S. government’s health insurance program for people age 65 or older. It is also vailable to individuals who are determined to be totally temporarily or permanently disabled by the Social Security Administration. Medicare benefits may be provided to such persons one year after the date Social Security rules that their disability began. For more information, visit www.medicare.gov.
If a family member dies, certain members of the family may be eligible for survivors’benefits. For more information, visit www.ssa.gov/pubs/EN-05-10084.pdf.
You may be entitled to Social Security disability benefits even if you are receiving workers’ compensation benefits. You must be disabled from all work with a condition expected to last one year or more or result in death. Although benefits are only paid after you have been disabled for a period of time, it often takes five months or more to process your application. To learn more about applying for benefits, visit www.socialsecurity.gov/pgm/disability.htmpdf.
The federal Social Security program pays benefits to retired workers and their families. To be eligible for Social Security retirement benefits, an individual must be at least 62 years old, have worked, paid Social Security taxes, earned at least 40 credits (10 years of work), and apply. To learn more, visit www.socialsecurity.gov/pgm/retirement.htm
Supplemental Social Security Income Benefits
Even if you or your spouse have no income history, you may be entitled to federal supplemental Social Security assistance if you or your spouse is elderly, blind, or disabled. This program provides cash for basic needs like food, clothing and shelter. For more information or to make a claim, visit www.ssa.gov/pubs/EN-05-10035.pdf.