How to File a Workers’ Comp Claim in California
Under California’s Workers’ Compensation Act, California workers who sustain an injury on the job or sustain a cumulative stress injury from their job are entitled to receive workers’ compensation benefits. However, you must follow a three-step process for filing a workers’ comp claim, as well as meet strict deadlines.
The Pasadena CA workers’ comp attorneys at Dewberry Law can help you understand how to file a workers’ comp claim. Moreover, we know that sometimes employers and insurance companies deny claims in bad faith. Other times they just need more evidence before they’re willing to pay out on the claim. No matter what their reasons are, we will fight for your right to recover workers’ comp benefits while you’re recovering from your injury. Call us today to learn how we can help.
What Is the Three-Step Process for Filing a Claim?
When it comes to knowing how to file a workers’ comp claim, you need to remember this basic three-step process.
- Report the injury to someone in charge. If the injury is severe enough, you’ll want to seek medical attention immediately. Understand that insurance companies (and your employer) will be extremely suspicious of claims in which the person filing did not seek medical attention within the first 24 hours of the injury. While there may be a good reason for that, it’s a reason to deny a claim.
- File a claim with your employer. This will involve a claim form, incident report, and other workers’ comp forms that your employer can provide for you.
- File an application for adjudication of claim with the WCAB (Workers’ Compensation Appeals Board). If your claim is denied, you may have to appeal. Follow the procedures established by the WCAB to obtain compensation.
Please bear in mind that if you’re forced to file an appeal your window of time is short. It must be done within the deadline or your appeal will be denied no matter its merits.
How Does California Workers’ Comp Work?
Worker’s Comp Insurance Is Mandatory for Most Employers
Workers’ comp insurance is mandatory, meaning that most employers are required to maintain insurance for workers’ compensation in case their employees are injured or become ill on the job. Very few employers are exempt from this requirement. If your employer does not carry workers’ comp insurance, you may not be able to file a claim. However, you do have other methods to collect compensation for your injury.
Workers’ Comp Only Covers Work-Related Injuries
Workers’ comp insurance only covers work-related injuries. So only injuries that occur at your workplace “in the normal course of business” are covered. If you are walking to your car after work or engaging in horseplay, you may not be covered.
Workers’ comp is an exclusive remedy, and if you choose to file a claim, you may not be able to sue your employer further. However, there are other options if your injury was caused by a third party or your employer was intentionally negligent. If someone purposefully caused your injuries, then you may have options for compensation other than workers’ compensation.
A unique characteristic of workers’ comp is that it is a no-fault compensation system. It does not matter if you or a coworker caused your injuries. You are still eligible for workers’ comp if you were engaged in work-related activities while at your workplace. The only exception is when injuries are caused by serious or willful misconduct. Then, your employer may deny your workers’ comp claim. If someone else caused your injuries, you may be able to file another type of claim against them.
Are There Exceptions?
When you are filing a claim for workers’ comp, you must fill out a section regarding how your injury or illness occurred. It’s important to keep in mind that there are exceptions to workers’ comp. An attorney can help you complete a claim for so that you know how to file workers’ comp properly.
Deadlines for Taking Action Start on the Date of Injury
In other words, the clock begins ticking down the day you are injured. In general, there are two types of injuries. For our purposes, we can call them acute and cumulative. If an injury occurs suddenly while you’re on the job, that is an acute injury. It has a very specific start date and everyone can agree that’s when it happened.
Repetitive stress or cumulative effect injuries, however, may not have a specific start date. For that reason, these cases are more difficult to win. In addition, an insurance company might pore through your medical records in an attempt to explain your injuries using some other event. For instance, if you require carpal tunnel surgery and you claim this is due to your job, the insurance company may try to blame it on bowling, tennis, or some other injury in your past. It’s more complex to tie a single cause to a repetitive stress injury than it is something that occurs on the job, like a light fixture falling on your head.
In the event that you are filing a claim for a repetitive stress injury, the clock will begin ticking on the first date that the doctor identified the problem. Your first order of business will be to report the injury to your superiors and then proceed with your doctor’s recommendations. If your doctor recommends surgery, then you can file a workers’ comp claim.
Filling Out the DWC-1 Form
Within a day of reporting an injury to relevant parties at work, you should be given a DWC-1 form to fill out. Form DWC-1 contains sections that both you and your employer will need to fill out. If your employer neglects to give you one, you can find the forms online here. Your employer should fill out the forms, submit them to their insurance company and then provide you with a completed copy.
Waiting for Your Employer’s Insurance Company to Respond
The insurance company will authorize payment for medical treatment while it investigates your claim. They are responsible for up to $10,000 in medical bills while this investigation is underway. If you are forced to miss work because of the injury, the insurance company will begin paying benefits after around 14 days. If you don’t hear anything from the insurance company after 90 days, your claim has been approved.
Insurance companies will generally respond within the first two weeks. If they neither respond nor begin making payments, they may be forced to pay an extra 10% in addition to your claim. Typically, the insurance company will respond by asking for more information. This keeps the ball in play as far as a legitimate response, while giving them more time to investigate the claim.
Applying for Adjudication of Claim
If your injuries aren’t serious, you may find the entire process went quite smoothly. You got medical treatment you didn’t have to pay for and now you’re back at work. That’s great. Unfortunately for those who suffer serious injuries on the job, it doesn’t always work out that way. The only way to fight the insurance company is to submit an application for adjudication of claim. This basically means that you want the WCAB to oversee the case. It is especially helpful when disputes arise.
Disputes can arise at any point in the process. The insurance company may deny your claim outright or may deny your claim by cutting off your benefits at a time that you consider premature.
Talk to Dewberry Law to Learn More About How to File a Workers’ Comp Claim in Pasadena CA
Dewberry Law has successfully resolved a number of disputes between California workers and short-term disability insurance companies. If you’re having a problem, believe your workers’ comp claim has been unfairly denied, or believe that the insurance company has cut off your benefits prematurely, give our attorneys a call. We can help.