Getting injured at work in California means there is no need to prove fault for your injuries in order to be eligible for benefits via workers’ compensation. However, there is a statute of limitations to be aware of. As well, you will need to ensure that you’ve notified your employer and go through the process of form completion in order to receive compensation. This article will take a look at how to file a workers’ comp claim, as well as what your options are if your compensation claim is denied.
What Constitutes an Eligible Work-Related Injury?
California’s Department of Industrial Relations defines a work-related injury as a physical injury mental suffering, or illness as the result of working at your job. It also includes injuries sustained as the result of a crime that took place at your job. Death from work-related injuries such as stroke, vascular injury, heart attack or other injuries caused by catastrophic means can yield benefits for family members when the deceased employee was the primary wage-earner.
Get Treatment Before You Do Anything Else
As soon as possible after having become injured, you should seek medical care. Serious injuries should be treated as top priority, so getting yourself to emergency care is best. Once in the hospital, it’s important to tell the doctor that your injury occurred at work. If your injury is less serious, treatment in some form should occur on site, with follow-up by your doctor if further treatment is required.
If you are in doubt as to whether the injury was related to your job, your doctor may be able to answer this question. The doctor should also submit a medical report to your employer’s insurance company.
It’s very important that you keep detailed records of the history of your injury, starting from the day you were injured or the day you sought treatment. Ensure that all correspondence, receipts, and items related to your injury, such as x-rays are kept in a single folder or box. Whenever you receive any injury-related information, ensure it’s stored as soon as possible after receiving it. This will help you to stay organized with dates and times in the event that you need to present any evidence in a court setting.
As stated previously, there is a statute of limitations involved in filing California workers’ compensation claims. California workers’ compensation law states that reporting should occur as soon as possible after a single accident has occurred. If you cannot report the accident right away for any reason, you should ensure that it’s reported within 30 days of the date of the accident, or you may not remain eligible for benefits.
In some cases, the statute of limitations may be extended. For example, if your work-related injury developed over a long period of time, such as with repetitive strain injuries, the 30 days begins from the day you identified the injury was related to your job. Another exception is age; if you were under 18 years old when you became injured, the statute of limitations wouldn’t begin until the day you turned 18 and became a legal adult.
If you’re already receiving benefits or medical treatment for a work-related injury, but that injury has caused a new injury that has disabled you further, you have five years from the date of the original injury to file your claim for compensation. While reporting your injury to your employer is a crucial component of the process, you will still need to make it official, which can be done by filing a workers’ comp claim.
Filing Your Workers’ Compensation Claim
Your employer should provide you with a claim form within one working day after you reported your injury. This claim form, called Form DWC-1, should be accompanied by information which explains your rights, benefits eligibility, and the steps you’ll need to take to obtain those benefits, among other details. A form can be obtained online if you didn’t receive it from your employer.
Form DWC-1 will have instructions about how to fill out the employee portion. In order to ensure total completion, you will need to list all parts of the body where you became injured, as well as details about the circumstances surrounding your injury. For example, you will want to be as descriptive as possible about the location where you became injured, as well as the condition that caused the injury, and then ensure that you sign the form at the bottom.
Next, you will need to give the form to your employer so that they can complete their portion and send the form to their insurance company. They should then provide you with a copy of the completed form for your records. You should receive a letter from your employer’s insurance company within two weeks from the day the form was submitted.
Your claim will be presumed to have been accepted if your employer does not respond about its acceptance or denial within 90 days of submitting Form DWC-1 to their insurance company.
When filling out your portion of the form, it’s important to remember to be as honest as possible. It is punishable by law to exaggerate the circumstances under which you became injured and to lie about injuries you’re claiming to have received while on the job.
What You Will Receive
Workers’ compensation provides five types of basic benefits. These are:
- Money for medical care
- Benefits for temporary disability
- Benefits for permanent disability
- Benefits for supplemental job displacement if you can’t recover completely and don’t return to work
- Death benefits to a spouse, children, or other dependents if a job injury causes death
Workers’ Compensation vs. Disability
Disability insurance pays for non-work-related injuries on a weekly basis, but for a short amount of time. Workers’ compensation pays for work-related injuries, and the benefits received can include benefits for temporary or permanent disability, as well as job retraining and medical coverage. If you were injured on the job, you can file a disability claim, but you typically will not be paid both disability and compensation benefits for the same period of time.
Continued Care Costs
Once Form DWC-1 has been submitted, your employer’s insurance company is bound by law to provide authorization for any medical treatment that may be necessary—up to $10,000—until such time as the investigation into your claim has been completed. This authorization should occur within one working day of having submitted a DWC-1. If your injury has forced you to miss work, your employer’s insurance company should begin sending you payments for temporary disability within 14 days of learning of your injury.
Insurers who don’t begin the payments within 14 days, or who don’t respond to your claim by either requesting more information or denying it, face a late penalty of 10%. You may also need to travel a fair distance to receive medical care, and the costs of that should also be covered by your employer through your claims administrator.
Who Should Treat You?
If you have your own doctor or are with a medical group, you can see either of these for treatment following your injury. If your employer uses an HCO (health care organization) or an MPN (medical provider network), you will likely be treated by these, unless you have indicated a preference for your own doctor or medical group.
If your employer doesn’t have an HCO or MPN and you have not indicated a preference for who should treat you, it will be up to the claims administrator to choose a doctor.
If Your Employers Disputes or Denies Your Claim
If you received notice from your employer that your claim was denied, this means that you will not be receiving any benefits from them. If this happens, the first step is to contact and meet with a Qualified Medical Evaluator, who will review your claim on an impartial basis and provide a second opinion on your injury.
Get the Right Attorney for Your Injury Claim
The next step to take if you believe your claim is valid will be to complete and submit an Adjudication of Claim form and ensure your employers also receive a copy. Once you’ve received a case number, it’s a good idea to consider hiring a work comp attorney who can help you prepare for your hearing.
Workers’ compensation trials can be complex and overwhelming, which is why it’s so important to hire an attorney with long experience. The Law Office of Jim T. Rademacher will put 15 years of experience to work for you; learn more by claiming your free consultation today.