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Everything you need to know about filing a Workers’ Comp Claim

Everything about Workers’ Comp Claim

To get injured at the workplace is very common, especially for Californians who engage in physical work such as truck drivers, carpenters, etc. Luckily, there are measures in place. Measures such as California Workers’ Compensation, ensure that injured workers don’t miss out on wages or pay exorbitant medical fees.

In California, workers do not need to prove the fault of the injury to receive Workers’ Compensation Benefits. But given that, there is also a Statute of Limitations that makes it mandatory for workers to notify their employer of the injury within 30 days. The 30 days count from the date of the accident or the discovery of injury. Also, you need to fill the Workers’ Compensation Claim form within 30 days. If not, it could cost the worker his/her lost wages alongside overwhelming medical charges.

What qualifies as a Workplace Injury: 

The California Department of Industrial Relations has 3 categories of injury. These are work-related physical injury, mental suffering/trauma, or any illness due to pressure or harsh conditions. 

In case of work-related death, family members also have an entitlement to death benefits. For family members to claim death benefits, the deceased must have been a permanent employee.

workers compensation claim checklist

What should I do after a Workplace Injury?

 

  • Seek Immediate Medical Treatment: Medical intervention is the most significant part of the process. After any work-related injury, it is important to seek medical treatment. You also need to inform your doctor that the injury was work-related. Then the doctor can submit the medical examination report to your employer’s workers’ compensation insurance agency. 

If medical treatment is readily available at the workplace, you should take it then and there, but you should also be in constant contact with the doctor about the treatment. Also, if you are unsure about the nature of your injury, let your doctor have the final word about it.

  • Contact a Trusted Workers’ Comp Lawyer: It is recommended to consult a workers’ compensation lawyer as soon as you feel you are entitled to compensation for damages. A top workers’ compensation attorney will help you through the process. They will make sure you receive the proper remedies. Often, workman’s compensation lawyers offer free consultations. It is a great way for workers to make sure they know their rights. 
  • Maintain Records: Record maintenance is integral. The records and documents can be a part of the evidence, if necessary. From the day you survived the injury, to the day you were admitted to the hospital or started receiving treatment, keep a record of any documents, emails, or records. Whether it’s an X-ray, the final bill, a consultation bill, or a medicinal prescription—keep it all in one place. 

These will be of great importance to help you receive Workers’ Compensation Benefits. It may also act as evidence in the worst-case scenario.

  • Report it to the Employer: You should inform the employer of the injury as soon as possible. Since the California Statute of Limitations is in force, it is necessary to complete the procedure on time. You must inform an employer within 30 days of the injury or the discovery of it to be eligible for compensation.

*EXCEPTIONS

Statute of Limitations: The statute of limitations may be extended in some exceptional cases. For instance, if the injury developed over a certain period and not at once. In that case, it happens with repetitive motion and strain injuries. This implies that the 30 days begin with the day when you identified your injury. Also, the fact that it occurred while you were performing your job role is very significant. 

Age: Age is another essential factor. If you got injured on the job before you completed 18 years of age, you aren’t an adult legally. The days count only from the day when you turn 18 years of age.

Consecutive Injury: What if you get injured further due to an injury arising out of your previous work-related injury? Then you have 5 years from the date of the original injury to file a claim for workers’ compensation. 

Steps to file a Workers’ Compensation claim:

 

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  • All about the claim form: As you report your injury, your employer should give you the claim form within 24 working hours. You can obtain the form online through the California Department of Industrial Relations. The DWC-1 form should have all the details about rights, benefits eligibility, and the steps you’ll need to take to obtain those benefits, among other details. 

Be as descriptive about the issue as you can. It will add gravity to the case. You’ll remain eligible to file your claim for 1 year. But it is always best to file your claim as soon as possible.

  • Form to be filled by the employer: After you have filled out the form, give it to your employer to fill in the necessary details. Your employer will be responsible for filing the claim with their insurance agency. Make sure that your employer does it within 5 business days once you return the form to them.

    The employer should also provide you with a copy of the completed form.

    According to Labor Code Section 5405, the claim must be filed with the Workers’ Compensation Appeals Board within 1 year from the date of injury/last date of benefits, including medical treatment, whichever is later.

    If the claim is not filed within 1 year, the application is void by the Statute of Limitations. However, filing a DWC-1 form with an employer overrides the Statute of Limitations. 

Choice of Doctor

The doctor who is instrumental in your treatment of work-related injury is also important. If you have your doctor treating you, or if you are with a medical group; both are fine. If you indicate your preference beforehand for the doctor of your choice, you may have that. Otherwise, your employer might provide you with a Healthcare Organization (HCO) or a Medical Provider Network (MPN) for treatment. 

If both circumstances don’t follow, then the choice of the doctor for your treatment will lay in the hands of the claims administrator. 

Benefits you will receive: 

As you claim your compensation amount, you hold the entitlement to the following benefits, depending on the nature of the injury and circumstances. 

  • Money for medical treatment
  • Death benefits
  • Benefits for permanent/temporary disability
  • Supplemental job benefits in case your injury is chronic and you don’t recover fully to get back to work

What if your claim is denied?

In the rarest cases, the employers also deny the worker’s compensation claim. Mostly it happens when you cannot convince your employer that your injury happened at the workplace or is a work-related injury. Here’s what you can do in such a condition:

  • You will receive a notice from your employer which will denote that your claim is not approved
  • In that case, you will cease to hold the entitlement to any of the benefits
  • You should immediately consult a doctor
  • Your doctor has to review your case. Further, he/she will provide a second opinion after medical deliberation. This opinion will determine if your injury deserves workers’ compensation benefits or not.

Khanuja’s Law Firm to your rescue:

Are you undergoing a similar situation? Just book a free consultation with Khanuja Law Firm today. As one of the top employment lawyers in California, we will represent you in the best possible manner to get the justice you deserve.

For More: Law Article

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