The California workers’ compensation system offers benefits for all employees who get an injury at work. Although these benefits are limited, they can go a long way for helping an injured employee. The only requirement for eligibility is that you get injured while being at work. For example, if your job involves making deliveries or driving a vehicle, you can apply for these benefits if you get into an accident while driving for work-related reasons.
If you are wondering whether your workplace injury qualifies for workers’ compensation, here is a general rule of thumb: if you sustained the injury at work and needed medical attention, it should qualify for compensation benefits.
Some of the most common workplace injuries include:
Slip and falls
Strains and sprains
Repetitive stress injuries
Equipment malfunction injuries
Steps to File a Workers’ Compensation Claim in California
Here is a step-by-step approach to file a Workers’ Compensation claim.
Seeking Medical Attention
If you receive a job-related injury, the first step is to seek immediate medical attention. The longer you wait for the treatment, the fewer chances you will have for approval. If the injury is serious, you can ask someone to take you to the emergency room so you can receive medical attention.
Many Californian employers recommend visiting a specific doctor or hospital only. However, you can get a second opinion in case the doctor fails to diagnose the problem or does not give you the treatment you need for getting better.
Reporting the Injury
In some cases, the injury is severe, and you don’t have the time to report it to your employer. In that case, make sure you report the injury to your employer once you receive medical treatment. Again, don’t wait for too long to report the injury to your employer, or you may lose your chance of qualifying for workers’ compensation benefits. According to California’s workers’ compensation laws, an employee should report his/her injury to the employer within 30 days of the injury. Failure to report the workplace injury in this timeframe can affect your chances of qualifying for these benefits.
Filing a Claim
Now is the time to fill a workers’ compensation claim, which means you have to fill the Form DWC-1. While your employer will provide this form once you report the injury, you can also download it directly from the official website of the Department of Industrial Relations. Once you fill the form, hand it over to your employer, who will file it with their workers’ compensation insurance company. Don’t forget to ask for a copy of this form.
Keeping Communication Records with Your Employer
Make sure you keep all communication records related to the workplace accident, injury, or incident with your employer. This step will ensure a smooth claim process and prevent any attempts by your employer to deny you the benefits you deserve.
What Happens after your Employer Files the Claim?
An injured employee has a year from the date of his/her injury to guarantee the submission of the DWC-1 claim form. However, we recommend you initiate the process as soon as you can without any delay. Your employer will complete the employer’s section and forward the form to their insurance company.
Remember, Californian law requires your employer to authorize the medical treatment you need for treating the injury or illness a day after you submit the claim to your employer. According to the law, you can receive up to $10,000 in medical treatment while you wait for the final decision of the workers’ compensation claim.
After your employer submits the claim, the insurance company will decide on the claim within the next 14 days. You can expect three outcomes: the company will accept the claim to offer the benefits and services you deserve, the insurance company investigates the claim within 90 days, or the company rejects the claim.
What are the Reasons for Denial?
Here are some reasons why you may face a rejection for your claim.
Your employer or the insurance company determines that your job is not the cause of your illness or injury
Any mistakes in filing the paperwork
You failed to file the claim on time
According to California law, in case the insurance company doesn’t approve a workers’ compensation claim, the employee can make an appeal before the Workers’ Compensation Appeals Board (WCAB).
For that, you will have to request a hearing. File and submit an Adjudication of the Claim form, after which you will receive a workers’ compensation case number. You will also file a Declaration of Readiness to Proceed form to receive a hearing date from WCAB.
Benefits you Receive When your Claim is Accepted
Once the insurance company accepts your claim, you are entitled to the following benefits.
Medical care: Such benefits help you pay the medical expenses you need for treating a work-related illness or injury.
Supplemental Job Displacement Benefits: Such benefits include vouchers for funding retraining or skill enhancement in case you’re unable to resume work with your employer or don’t recover.
Permanent Disability Benefits: These benefits help you in case you don’t recover completely from the injury or illness.
Temporary Disability Benefits: These temporary payments are beneficial for covering lost wages during the recovery.
Death benefits: All such benefits comprise financial payments to the spouse, kids, or dependents of the deceased worker who lost his/her life due to a work-related illness or injury.
If you don’t have any law experience, filing a Workers’ Compensation Claim in California that has maximum chances of approval can be challenging. That’s why finding a trusted law firm or lawyer that takes care of your Workers Compensation Claim can make a difference.
If you want to increase your chances of getting approval, getting professional help from a credible lawyer who specializes in workers’ compensation claims is a great idea. A qualified and experienced attorney from the Law Offices of James E. Latimer can represent your case to help you qualify for the compensation and benefits you deserve. Get in touch today to find out more.