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Work Injury Compensation Claim Process

In California, most employers are required to carry workers' compensation insurance to cover employees who are injured on the job. In order to recover this type of compensation, employees don't have to prove fault. However, the benefits are also not automatically provided to injured workers.

In general, employees are required to notify their employer as well as the workers' compensation carrier.

It is always a good idea to file a workers' compensation claim, even if you might have considered accessing state disability benefits or filing a third-party injury claim in civil court. Regardless of which route you plan to take to claim work injury compensation for your losses, there are several steps you would be well advised to take in order to protect your legal rights.

Get Medical Attention Right Away

Before filing a claim, make sure you get prompt medical attention, treatment and care for your injury or illness. Some workers' compensation policies may require injured workers to go to a specific doctor. So, you may want to ask your employer or supervisor which doctor you need to go to.

California personal injury laws do allow you to get a second opinion if you are not satisfied with the diagnosis or treatment options provided by the insurance company-recommended doctor. Your health comes first.

Even if you feel like you don't need medical attention, it is better that you see a doctor as soon as possible because it is required for the workers' compensation claim process.

Remember, in addition to making sure your health and well-being are taken care of, a medical report also serves as an official record of your injuries and as the basis for any workers' comp reimbursement. It provides documentation for the type of injuries you suffered, the treatment and care you received and the medical expenses you incurred as a result.

This will be very useful when you are trying to obtain a work injury settlement or verdict.

Notify Your Employer or Supervisor

Make sure you notify your employer or supervisor within the required deadline. Under California law, injured employees are required to notify their employers or supervisors about their injuries within 30 days.

If you wait more than 30 days, your employer might not be required to provide workers' compensation benefits. Employees do not always lose their workers' compensation benefits if they don't report their injuries within the required 30 days. But, there is no reason for workers to take that chance.

It's a good idea to report all workplace accidents even if you don't suspect an injury, just in case an injury is discovered after the deadline passes. These incidents and injuries must be formally reported. This means you should notify your supervisor in writing. Even if you provide verbal notification first, a written follow-up notification will provide an official record.

Filling Out a Claim Form

If your employer doesn't give you an official injury claim form as part of the workers' comp process, request one from the state workers' compensation board. Generally, you will need to provide the following information for your injury claim process:

  • Type of accident that occurred
  • Date, location and time of the accident
  • Type of injuries you suffered and affected areas of the body
  • Parties involved in the accident
  • How the accident occurred
  • Any medical treatment and care you've received.

What the Claim Process Looks Like

Employers are not only required under the law to provide workers' compensation coverage, but they may also not retaliate against a worker who claims workers' compensation.

Typically, employers will file an injury claim with their insurer and the state workers' compensation board office. Once your claim has been evaluated by the insurer, an administrator will inform you about whether your injury claim has been accepted and the amount of workers' compensation benefits to which you will be entitled.

Regardless of how your claim process unfolds, it is important that you keep detailed records. Be sure to save receipts for out-of-pocket expenses and proof of any other hardships caused by the injury.

If your workers' compensation claim is rejected, you will have the opportunity to appeal in most cases. Once you have your evidence compiled, you will also have other options such as filing a personal injury lawsuit against a third party (other than the employer) who may have caused your accident and injuries.

Workers' Compensation Versus Civil Lawsuits

Under California law, injured victims have two years to file a personal injury lawsuit. If you have been injured at work because of negligence on the part of someone other than your employer, you may be able to file what is known as a third-party lawsuit against that person or entity. This is filed in civil courts and will be adjudicated as a personal injury lawsuit.

While workers' compensation is a "no-fault" process, in a third-party personal injury lawsuit, workers will bear the burden of proof. This means injured workers must prove or show evidence that the third party's negligence caused the accident and injuries.

For example, if a general contractor at a construction site failed to maintain a safe environment or failed to provide workers with fall safety devices and the accident occurred as a result, they could be held liable with a third-party lawsuit. Similarly, if your injuries were caused by a defective product, you may be able to file a product liability personal injury lawsuit against the manufacturer of the defective product.

Filing a Workers' Compensation Claim (Form DWC-1)

Within 24 hours of reporting your on-the-job injury, your employer is required to provide you with a workers' compensation claim form, also known as Form DWC-1. They must also provide you with information about your rights and potential eligibility for benefits, the steps you need to take to obtain those benefits, and other critical information about the workers' compensation claim process. If your employer did not provide you with Form DWC-1, you can also download it from the California Workers' Compensation website's forms page.

It is important that you closely follow the instructions on the form to fill it out correctly. On the form you must list the part of the body that was injured. Once you are done filling the form, you must hand the form to your employer in person or send it via first-class or certified mail. Your employer will then fill out their portion and submit the completed form to the insurance company. Be sure to obtain a copy of the filing for your records.

Application for Adjudication of Claim

If your work-related injuries were relatively minor and your claim was quickly resolved, you may not have much to worry about. However, if you suffered major injuries and/or disabilities or if your medical condition changed, you may be unable to resolve any disputes unless you also open a case with the Workers' Compensation Appeal Board by filing an Application for Adjudication of Claim. This Form WCAB-1 is also available on the California Workers' Compensation website's forms page. You will need the following details to fill out this form:

  • The date of injury
  • The last day your employer provided medical benefits or
  • The day when your temporary disability benefits come to an end

If you are seeking death benefits because you lost a loved one in a workplace accident, you have a year from your loved one's date of death to file this application for adjudication of claim. The DWC Information and Assistance Unit can help you complete the form. Your Los Angeles work injury attorney can also help you with this process.

Missing Deadlines Could Jeopardize Your Claim

If you failed to file a workers' compensation claim or the application for adjudication of claim in a timely manner, it is important that you reach out to a California workers' compensation lawyer. Workers' comp and personal injury laws in California are complex. If you fail to file claims on time, you may lose your rights. There are also circumstances where the deadline may be extended. An experienced Los Angeles work injury lawyer can help you understand how the law applies to your specific situation.

Contacting an Experienced Work Injury Lawyer

The most important step you could take after suffering an injury at work is to contact an experienced Los Angeles work injury lawyer who will help compile all evidence in your case, bring expert witnesses if required and help you secure maximum compensation and wage replacement for your losses.

Oftentimes, workers' compensation benefits are extremely inadequate to cover significant losses, especially in cases where workers have suffered catastrophic injuries or when families have lost a primary wage earner. Such a loss could be financially devastating for a worker's family.

The experienced Los Angeles work injury lawyers at Greenberg And Ruby Injury Attorneys, APC have a long and successful track record of representing the rights of injured workers and their families. If you have been injured on the job, don't wait for the workers' compensation process to take its course. You may be entitled to additional, significant compensation and not even know about it. Call Greenberg & Ruby at (323) 782-0535 to schedule your free consultation and comprehensive case evaluation.

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