How To File A Workers Compensation Claim in California
Workers’ compensation is insurance paid by companies to provide benefits to employees who become ill or injured on the job. Through this program, you are not expected or required to contribute toward this expense. It provides for the cost of medical expenses and lost wages should you become injured or ill as a direct result of your job. According to California workers compensation laws, neither you nor your employer is considered to be at fault if you file a claim. Workers’ compensation is a no-fault system in which benefits are paid for injuries on the job regardless of fault. That means that your claim will not be diminished if you were at fault. By the same token, it will not be increased if the employer is to blame.
Your claim will be paid if your employer or their insurance carrier agrees with you that you sustained work-related injuries or occupational disease. In cases of dispute, you do not receive any payments until a workers compensation law judge decides whether you or your employer are right. You might still be eligible for disability benefits, however, until the outcome is decided. If you can go back to work but cannot earn the same level of wages due to your work injury, you might be entitled to two-thirds of the difference between your former and current wages.
How Do I Know If My Illness or Injuries Are Compensable?
As soon as you develop a job-related illness or if you were injured at work, you can file a workers comp claim. The sooner you do it, the better since the employer’s insurance company can deny delayed requests. If your illness or job injuries developed over months or years, you should file a claim as soon as you recognize that the situation is work-related and as soon as you saw a doctor or took time off because of the illness or injury.
Assuming you have already received medical attention, the workers compensation claim process involves several important steps. You must notify your employer in writing; fill out an official claim form (which should be provided by your employer), and keep detailed records about your treatment.
The workers comp claim process is discussed in greater detail below.
What Should I Do If I’ve Been Injured?
- Get Immediate Medical Attention
If you have been injured, you should first seek emergency medical attention. Some workers compensation policies require injured employees to go to an approved medical provider or your predesignated physician and tell them that your injury or illness is job-related. Even if you do not feel the need to get medical attention, it may be a requirement for the workers compensation claim process. Keep in mind that a medical report will serve as an official record of your injuries and the basis for any workers’ comp reimbursement.so make sure t get the medical report from the accredited medical provider.
- Notify your employer
Unless you have a medical emergency, do this before seeking medical treatment, as your employer may refer you to a physician who is part of its medical provider network Make sure you notify your employer about the injury within the statutory deadline, preferably soon after the injury occurs. As with any legal process, make sure you notify your supervisor in writing. Even if you give verbal notification first, a written follow-up notification will provide an official record. The sooner you do this, the more details you will be able to recall. In California, you have 30 days in which to notify your employer about a job-related injury. If you fail to report your injury within 30 days, you might lose your right to collect workers comp benefits. It is a good idea to report all workplace accidents even if you don’t suspect an injury, just in case an injury is discovered after the deadline expires.
- File the required forms.
After notifying your employer and after you have received treatment, your employer then has one day to give or send you a claim form, but you can also find the workers compensation form online. Fill out DWC (Division of Workers’ Compensation) Form 1, making sure to include all the parts of your body you feel may be hurt or affected by your workplace injury or illness. Keep a copy of the completed form as your receipt and ask your employer to return the form to you with the employer section completed. By law on workers comp claims in the state of California, your employer has 24 hours to return the completed form to you. Your employer will then forward the completed claim form to the insurance carrier. .You will also need to file an Application for Adjudication of Claim within one year of your injury to officially file your workers comp claim.
You generally have one year to submit your claim form back to the employer, and you should do so in person or by certified mail.
Generally, you will need to provide the following information on your workers comp claim form:
- Describe the workplace injuries sustained and parts of the body affected;
- Date, time, and place where the injury took place;
What Happens After I File My Claim?
Most of your involvement with the workers compensation claim process is complete after filling out the necessary paperwork. But you still want to follow up on your claim and make sure you keep detailed records. For instance, you may want to keep a record of how the injury affects your work and day-to-day activities. Also, be sure to keep receipts for expenses incurred and proof of any other hardships caused by the injury.
What Should I Do if My Claim Is Denied?
Your claim may be denied because of any of the following conditions:
- There was a delay in filing the claim
- The injury was unrelated to work because it was caused by a “preexisting condition.”
- The injury happened offsite and outside of work
- There is insufficient medical evidence of an injury
- There was no effort to get medical treatment, or
- The injury is not severe enough or is not recognized by California law
In most cases, you may still appeal if your claim is rejected. You have the right to have your case heard by a judge. If you disagree with your employer or insurer about a benefits decision, including the denial of your claim, you can file a Declaration of Readiness to Proceed with the Worker’ Compensation Appeals Board (WCAB). You must also serve this form on your employer’s insurance company and include a proof of service form. The Appeals Board will hold a hearing and make a determination on your claim. Your case will be scheduled for a mandatory settlement conference and if the case is not settled there, you will have to prepare documents describing the dispute, identifying what you will present at trial, and give the names of witnesses who will testify.
An experienced injury attorney in Upland can help you prepare the appropriate documents, file on time, and represent you in front of the administrative law judge. If you disagree with the judge’s decision after this trial, you may file a Petition for Reconsideration.
Do I need a lawyer to help me with my workers compensation case in California?
Every workers compensation claim that is paid out is an expense for the insurance company. As such, they will exert all efforts to lowball you, or worse, avoid settlements altogether. It is important to seek legal counsel in order to be fully informed of your rights and the benefits you are legally entitled to as compensation for your workplace injury or occupational illness. Undoubtedly, workers comp claims are very complicated. An experienced lawyer is familiar with the California judicial system as well as the complexities of workers’ compensation law. No one, not even supervisors or family and friends who have received benefits in the past, will be as qualified to make recommendations to you about settling your case. Putting matters in the hands of someone who is not knowledgeable about workers compensation laws can be a very expensive mistake in the long run. A workers compensation lawyer will fight for the protection of all of your rights under the California Worker’s Compensation Act.
You may think that hiring an injury lawyer is expensive On the contrary, the most that you will shell out will be 20 percent of the settlement and sometimes less. You pay only if you win and contribute nothing up front. Since lawyers get compensated based on a percentage of the settlement, they are highly motivated to help you get the maximum amount of the benefits you so rightly deserve.
Contact an Upland Workers Comp Attorney
At the Law Offices of Marc Grossman, we will help you to determine if you have a legitimate case. We will never charge you unless we help you win your case, and your initial consultation is absolutely free. Call us now for a free case evaluation.