If you have suffered an injury at work in California, you could be eligible for benefits offered by California’s Workers Compensation Act. If you’re an eligible employee with a job-related illness or injury, California law requires your employer to pay for medical treatment and wage loss during recovery.
It’s very important to correctly apply for these benefits. Speaking with a trusted California workers’ compensation lawyer will help
A basic understanding of Workers’ Comp Claim filings may help achieve a better outcome for a qualifying claim. In short, you don’t want deadlines to be the reason for your denial. In this article we are going to take a look at what’s involved in applying for Workers’ Comp claims in California.
Submitting a Workers’ Comp Claim in California
Since every case is unique, it’s difficult to limit everyone’s experience to a cookie-cutter process. However, most claims do fall under a similar pattern of submitting a workers’ comp claim in California under a basic 4-step process:
Step 1: Report the Injury
As soon as you can, you need to report your injury or disease to your employer. You could lose your right to Workers’ Comp benefits if you do not give your company written notification within 30 days of injury.
Any delay could hold up your benefits– so the earlier the better.
Step 2: Submit the Claim with Your Employer
Within one working day, your employer will provide you a claim form (Form DWC-1). You will also receive information about: (a) your rights to eligibility, (b) requirements to receive benefits, and (c) provide information about the company’s internal claim procedure.
If you didn’t receive a DWC-1 form from your employer, you can download it from the California Workers’ Comp website.
Step 3: After the Claim Is Submitted
As soon as you have the form, your company’s insurance company should authorize payment for your medical treatment while it’s investigating the claim for validity. Until it makes a decision, the insurance provider is accountable for as much as $10,000 in medical costs.
If you miss work, the insurance provider will pay short-term disability within 14 days after learning about the injury and financial needs. If the insurance provider doesn’t begin payments at that point or respond to the claim by rejecting it or asking you for more details, a late fee of 10% of disability benefits will be incurred.
Step 4: Submitting an Application for Adjudication of Claim
If your company’s insurance company has started to provide medical and wage benefits, you will reasonably believe that all is well. Sometimes, insurance companies will stop paying benefits because they believe they have met their obligation, and the injured person is still recovering.
What should you do then?
Usually, you must file an Application for Adjudication of Claim within 1 year from:
- the date of injury
- the date when medical benefits stopped
- the date when any short-term disability ended
Courts have discovered that an employee might have longer to file if future payments for medical expenses are connected to a prospective workers’ compensation claim. Because of this, the worker has 5 years from the date of injury to file the application. Once the insurance company notifies that the claim is denied, the employee then has 1 year to file the application.
When Your Claim Is Denied or Filed Late
If you didn’t file a claim or application for adjudication on time, speaking with a Southern California Workers’ Compensation attorney can help. The legal landscape in this area is complicated. A knowledgeable workers’ comp lawyer can explain your circumstance and protect your rights. An attorney can also represent you in an appeal if your employer rejects your claim for any reason.
Contact us at Visionary Law Group today and schedule a free, no-obligation consultation about your California workers’ compensation claim. We are here to help.