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How To File A Workers Compensation Claim

How To File A Workers Compensation Claim

Workers’ compensation provides benefits to qualified employees if they suffer a work-related injury. If you need help understanding how to file a workers’ compensation claim, consider visiting with one of our experienced workers’ compensation attorneys at (888) 301-7795. The dedicated and compassionate workers’ compensation lawyers at Diefer Law Group can help you understand how to protect your legal and financial rights when you are filing a workers’ compensation claim.


First Seek Medical Care

The California Department of Industrial Relations reports that over 448,300 nonfatal occupational injuries occurred in 2021 (the most recent data available). Over two-thirds of those injuries resulted in workers taking days off, working with restrictions, or being transferred to another division.

The first step after a work accident is to seek emergency medical care. Doing so helps the worker’s claim by ensuring they receive the proper treatment they need to start the path to full recovery. Additionally, visiting a doctor early in the process creates a necessary paper trail to prove that the worker indeed suffered an injury and is doing what is needed to heal.

 

Notify an Employer of the Workplace Accident or Injury

The next step in filing a workers’ compensation claim is for the injured employee to report the workplace accident or injury to their employer. Initially, the worker can notify their supervisor when the accident occurs. If the worker requires medical attention beyond first aid, they must follow strict reporting rules to begin the claims process.

When Do I Have to Report My Work Injury?

Under the California Labor Code, the injured worker must report the injury to their employer within 30 days after the accident or injury. The law indicates that the worker must report the injury to their employer on a written form with their signature.

When Does the 30-Day Clock Start if My Work Injury Happened Over a Period of Time?

Not all work injuries result from a traumatic event, like a car accident or slip and fall. Unfortunately, many happen due to exposure to toxic chemicals or radiation or because of repetitive motions. For example, back injuries can develop after years of working in a manufacturing facility.

If the injury falls in this category, the worker has 30 days from when they know or have reason to know the injury is due to work. For example, if an X-Ray technician visits the doctor and discovers they have cancer due to years of radiation exposure, they most likely have 30 days from the date of this appointment.

 

Submit a Workers’ Compensation Claim Form to the Employer

Employees must notify their employer of a work accident or injury within 30 days after it occurs or becomes known to the worker. To accomplish this, the worker typically files a written claims form. The worker either uses a claims form provided by their employer or downloads an approved document on the California Department of Industrial Relations website.

A workers’ rights attorney helps injured employees understand how to file a workers’ compensation claim in California. Deifer Law Group advocates for injured workers throughout the State of California.

Use the Form Provided by Your Employer

California law requires employers to post notices about what employees should do if they suffer a work accident or injury. In a perfect world, the employer will have claims forms readily available to employees to simplify the process. If this is the case, then the worker should formally report the injury by using the employer-provided claims form.

Fill Out an Approved Claims Form Online

If the employer does not have a readily-available claims form, the worker can use an approved form found online instead. The worker can locate this form (DWC-1) on the California Department of Industrial Relations website.

 

Employer Authorizes Medical Treatment

As the Department of Industrial Relations explains, California law requires employers and claims administrators to approve authorized medical treatment within one day of receiving an injured employee’s claim. The employer is responsible for covering up to $10,000 of approved medical treatment while the case is pending.

In California, employers can choose what doctors employees see to evaluate, diagnose, and treat a work injury. Injured workers might benefit from following the medical treatment suggested by the workers’ compensation doctor. Further, employees may also benefit from regularly attending medical appointments and rescheduling only when there is a serious scheduling conflict.


An Insurance Company Investigates the Workers Comp Claim

Once the employer receives the claims form, they must fill out the employer section and submit it to their workers’ compensation insurance provider. The worker should automatically obtain a copy of the fully completed claims form, but they can request a copy if they do not get one immediately. The best practice is to save a copy of this form for their records.

Once the insurance company receives the claim, it must investigate it and issue a decision within 90 days. During this time, the insurance company may request additional information from the worker or employer (the insured). The insurance company must send the employee a status update letter within 14 days after it receives the claim.

What Happens if the Insurance Company Accepts the Workers’ Compensation Claim?

If the insurance company grants the worker’s claim, the employee should begin receiving benefits shortly thereafter. Benefits might include:

  • Wage replacement or supplementation payments
  • Medical expenses reimbursement
  • Vouchers to participate in job training programs
  • Death benefits

If the worker disagrees with the type of benefits the insurance company agrees to pay them, they can ask the insurance company to reconsider its decision.

What Happens if the Insurance Company Denies the Workers’ Compensation Claim?

If the insurance company denies the worker’s claim for benefits, it indicates that it does not believe the policy covers the injury. The employee can appeal the decision or ask that the insurance company reconsider. In some cases, a qualified medical examiner (QME) evaluates the worker to determine the extent of the injury and its effect on their ability to perform work.

 

Consider Contacting a California Workers’ Compensation Attorney

Understanding how to file a workers’ compensation claim is essential for pursuing benefits. Consider visiting with an experienced attorney to help you navigate the claims process. To learn about workers’ compensation and your legal rights, contact the experienced California workers’ compensation attorneys at Deifer Law Group today by calling (888) 301-7795.

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