Be sure to follow each step to make sure that you can receive benefits
No one expects to be injured or develop an illness at work. Yet for far too many people, workplace injuries and illnesses are a reality. Fortunately, California has a no-fault system of insurance that provides benefits in the event that you are hurt on the job. This includes coverage for both occupational illnesses and injuries.
The California Workers’ Compensation Act, an employee who has suffered a work-related illness or injury may be eligible for workers’ compensation. If the worker qualifies, their employer will be required to pay for medical treatment and partial wage replacement while they are recovering. In the event of total disability, additional benefits may be paid.
According to a California workers’ compensation attorney, employees must generally follow specific procedures in order to apply for benefits. This process usually starts with an employee filing a report about the injury or illness to their employer. The report must be in writing and should be signed either by the employee or a person acting on their behalf.
Under the California Labor Code, an employee must report their injury to their employer in writing within 30 days of its occurrence. However, if an employer finds out about the injury in some other way — such as through notice from a supervisor — it is equivalent to written notice. As a California workers’ compensation attorney can explain, even if an employee fails to provide written notice, they will still be eligible for benefits unless the delay caused significant negative consequences to the employer.
If you are injured at work, such as in a fall or a car accident, you should seek medical attention immediately. In some cases, your employer may be able to tell you where to go for treatment. Make sure to tell the medical provider that your injury happened at work.
After you file a written report of your injury or illness, your employer should provide you with claim form, California State Division of Workers’ Compensation (DWC) Form 1. Fill out this form as soon as possible so that you can to get the process underway. The insurance company has 90 days to either accept or deny the claim once it has been filed. If no action is taken within that time frame, then the claim is presumed to be accepted.
A workers’ compensation claim may be denied for a number of reasons. For example, the insurer may claim that an injury was not work-related, or perhaps that it was sustained on another job. Alternatively, the insurer may argue that the employee doesn’t need medical treatment or that they are able to return to work.
If your workers’ compensation claim has been denied, you are entitled to see a Qualified Medical Evaluator (QME) to get an additional opinion. A QME is an impartial medical expert who reviews workers’ compensation claims. If the claim is still denied after an independent evaluation, a California workers’ compensation attorney can work with you to file an appeal to the Workers’ Compensation Appeals Board. This appeal must be filed within one year of the date of injury.
The workers’ compensation process can be complicated. Having a skilled lawyer to guide you through the process can help to make it easier. For more than 50 years, PLBH has represented employees as they seek justice. Contact us today at (800) 435-7542 or info@plblaw.com to schedule a consultation.