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California Workers’ Compensation Claims Process

You probably already know that you can get workers’ compensation benefits if you’ve been injured on the job, but do you know how to get them? Even if everyone at the job site, including your supervisor, witnessed the accident, don’t expect the claims process to move forward without your help. In fact, there are very specific actions you must take within very specific time frames if you want to be able to receive much-needed benefits to help with medical care and wage replacement while you are out sick or injured. See below for an outline of the California workers’ compensation claims process, and contact an experienced and successful Orange & Ontario workers’ compensation attorney for help with your claim in Orange County or Inland Empire.

How Worker’s Comp works in California, and your role in the process

As soon as possible after suffering a workplace injury or illness, you need to notify your employer of the injury or illness. While you may have up to 30 days to report the injury and still receive benefits, it is best to notify the employer as soon as you can after the accident. Once notified, your employer has one working day to put a claim form (DWC-1) in the mail to you or hand one to you directly.

Once you get this form, complete and return it to your employer. Your employer then forwards the form to its workers’ compensation insurance carrier. The insurance company should confirm receipt of the claim within 14 days. If they don’t, ask your employer about it or call the insurer directly to make sure your claim was received and is being processed. At Invictus Law, P.C., our experienced California workers’ compensation attorney can help make sure your claim form is filed correctly and can intervene on your behalf with the insurance company as needed.

Within that 14-day period, the insurance company should decide whether your claim is to be accepted, rejected, or whether a decision on the matter is to be delayed for 90 days. If your claim is delayed, the insurer will still have to pay your medical costs up to $10,000 during the 90-day period, although you won’t receive wage replacement benefits while your claim is still pending.

Getting treatment from California workers’ compensation, and fighting denials or disagreements

Your employer should send you to an appropriate doctor to begin receiving treatment. After the initial appointment, you may be able to select a different physician if you don’t like the treatment you are getting from the first doctor. You may also be sent for a Panel Qualified Medical Evaluation (PQME) in the first 90 days after the accident, and the carrier could end up denying your claim depending on the outcome of the PQME. Since this step is so significant and the consequences so important, it is recommended you talk to a workers’ comp lawyer before heading to the PQME.

If your claim is denied or you have some disagreement with the carrier over your treatment, benefits or other aspect of your claim, an important next step will be to open a case with the Workers’ Compensation Appeals Board (WCAB). Coverage disputes are not uncommon, especially if your injury or illness is significant, long-term or permanent, so don’t be shy or hesitant about being proactive in opening a case. If you haven’t retained an attorney yet, now is the time to get professional legal help from an experienced workers’ comp lawyer with a record of success battling insurance companies before the WCAB. Your attorney will know the right steps to take to resolve your claim efficiently and effectively, so you get the care and compensation you need sooner rather than later.

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