Claims

Medical Providers

If An Injury Occurs
If an injury on the job occurs, the injury should be reported to the employer immediately.  If more than first aid is required, the employer will provide a claim form to the injured worker.  It should be completed and returned to the employer as soon as possible.  This claim form will be used to make sure that benefits are properly coordinated.  The employer will provide copies of the completed claim form to the employee, to the Insurance Carrier, and to the Basic Crafts program.

Workers’ Compensation Benefits

The Alternative Dispute Prevention and Resolution System (“ADR”)

Workers’ Compensation Benefits  ^TOP

Medical Care
Those that sustain work-related injuries are entitled to medical treatment to cure or relieve from the effects of the injury.  This medical treatment will be provided by physicians approved by the Trustees of the Basic Crafts Trust.  These physicians are listed on the “Exclusive List of Medical Providers”.  If you have been treated by one of the listed physicians previously, you can chose to continue to be treated by that physician. 

Temporary Disability Payments
If time is lost from work as a result of the injury, the employee will be entitled to temporary disability indemnity payments equal to 2/3 of the employee’s average weekly earnings, up to a maximum set by California law.  

Permanent Disability Payments
Permanent disability payments will be paid if permanent impairment results from the injury.  The extent of these payments will be based upon a medical evaluation after recovery and will be based upon a number of factors in addition to impairment, including age and occupation.  

Further, if where the disability results in an inability to return to the employee’s usual and customary occupation a job displacement benefit will be made available in the form of a voucher with which to obtain education-related retraining and/or skill enhancement.

The Alternative Dispute Prevention and Resolution System (“ADR”)  ^TOP

Ombudsman
The Ombudsman is skilled in workers’ compensation matters and is responsible for aiding and counseling members so as to prevent or limit disputes at the earliest possible time.  The Ombudsman is a neutral workers’ compensation professional, employed by the Basic Crafts trust, who will be available to explain the law and act as a liaison between the injured worker and the insurance company.  If you have been injured on the job and filed a claim with your employer and you have not heard from the Ombudsman already, please contact the Ombudsman at (510) 568-5920 or (800) 526-0888.

Mediation/Conciliation
If the Ombudsman is not able to bring about a satisfactory resolution to a dispute involving a claim, the employee may request Informal Conciliation by filing a Grievance within 10 days of a response from the insurance carrier that has been conveyed through the Ombudsman.  A Grievance form may be obtained from the Union or the Basic Crafts.  The Informal Conciliation will be conducted by a mediator who is either a retired workers’ compensation judge or a private attorney trained in mediation.  The purpose of the Informal Conciliation will be to seek a resolution of the dispute in question, and the Ombudsman will attend at the request of the injured employee.  Either party may hire an attorney to provide legal representation at any point in the proceedings.

Arbitration
If Informal Conciliation is unsuccessful in resolving the dispute, Arbitration may be requested by filing an Arbitration Request within 20 days of the Informal Conciliation.  Attorneys may participate in this proceeding.  A decision will issue from the Arbitrator within 30 days after the arbitration hearing.

Remedies Other Than Workers’ Compensation
Where an injured worker has a potential claim for benefits, compensation or damages that do not arise from the workers’ compensation system, these remedies must be pursued in a timely fashion outside of the Basic Crafts program.  For example, where an injury is due to the negligence of an entity other than the employer, such as a defective product, a civil lawsuit must be timely filed in Superior Court or other appropriate venue.  Social security disability benefits, unemployment benefits, long-term disability benefits, and retirement benefits, must be pursued outside of the Basic Crafts Program.