Being hurt at work is never an easy situation to manage, especially when facing high medical costs and drawn-out recovery times. Employers are required to provide workers’ compensation benefits to their workforce to allow those who suffer these injuries to concentrate more on their recuperation than their return to work. Starting a workers’ compensation claim can be intimidating, but understanding the process and how the claims process works is the first step toward addressing your issues.
What Is Workers’ Compensation?
When you get hurt on the job, workers’ compensation, commonly referred to as workers’ comp, payments are made by your employer as a way to compensate for the costs and medical bills associated with your injuries. The nature of the work in some industries, including construction or employment involving physical labor, can make injuries more likely than in traditional office jobs or less physically intensive positions.
Payments from workers’ compensation may go toward paying medical bills, replacing lost wages while recovering, covering the cost of a permanent disability, and, in rare situations, providing death benefits for unfortunate deaths that happened on the job. For more catastrophic injuries, no amount of money will reverse the circumstances that led to these payments. However, financial stability during these uncertain and stressful times can help you put your rehabilitation ahead of worrying about making ends meet.
How the Workers’ Compensation Process Works
The workers’ compensation process may seem cut and dry, starting with an injury and speaking to your employer and your insurance. However, there are intricate parts of the process that go beyond reporting injuries and speaking to your employer. These crucial steps must be taken to create a viable, worthwhile claim:
- Address Your Accident: This could be a recent accident-related injury or a repetitive stress injury that develops over months or years of employment. You may be eligible for workers’ compensation if the injury occurred at work or because of your employment.
- Notify Your Employer: As soon as you become aware of or experience a work-related injury, you should inform your employer. You should receive a Workers’ Compensation Claim Form from your employer, which you must fill out and submit. The claims administrator for your employer will next examine your claim.
- Find a Primary Care Physician: The primary treating physician for your work-related injury can be the physician you had previously specified in writing with your employer before the injury. If not, you will need to select a doctor from the medical provider network (MPN) or health care organization (HCO) of your employer.
- Wait to Hear Back About Your Claim: The administrator will decide whether to accept or reject your claim after reviewing it. If a claim is approved, workers’ compensation money will be used to pay for any additional medical care. If it is denied, you may need to try to work things out with your employer or file an appeal.
- Continue Treatment: Once your claim has been approved, your primary physician will propose appropriate care to speed up your recovery, with the associated costs covered by your employer. The claims administrator will also receive reports from your doctor regarding your readiness to resume employment.
- Figure Out Disability Eligibility: Along with your doctor’s evaluation, the claims administrator will determine your disability benefit eligibility to compensate you for some of your missed payments. If you are unable to work for more than three days following your injury, temporary compensation may begin right away. Permanent benefits, however, cannot be determined until your doctor certifies that you cannot return to your pre-accident state.
- Verify Received Benefits: Your employer is responsible for the timely reimbursement of medical expenses, while the claims administrator will pay disability payments on a bi-weekly basis for the duration of the claim. If your employer does not provide you with acceptable work, and you have a permanent partial impairment, you may also be qualified for a Supplemental Job Displacement Benefit.
FAQs About Workers’ Comp Claim in California
How Do I Start a Workers’ Comp Claim in California?
To begin the workers’ compensation process, you must submit a claim form with your insurance. As soon as you have completed the “employee” part of your claim, your employer must fill out their portion as well. Make sure you sign, date, and save a copy of the claim form for your records. The insurance provider typically has two weeks to issue you a letter outlining the progress of your claim.
How Long Do I Have to File a Workers’ Comp Claim in California?
To minimize issues and hold-ups in collecting benefits, including medical care, report your injuries as soon as possible. For any medical care you receive after your accident, make sure to save the forms and doctor’s reports for your claim. If you delay reporting, you risk losing your entitlement to workers’ compensation payments and will likely lose your opportunity after thirty days.
What Qualifies for Workers’ Comp in California?
Only workplace accidents that occur naturally are covered by insurance. This includes short-term injuries, like slips and falls, along with those that take time to affect you, like carpal tunnel. Any company with employees in California must buy workers’ compensation insurance, either from a private insurer or the State Compensation Insurance Fund.
What Does Workers’ Compensation Not Cover?
Workers’ compensation is intended to cover injuries that will partially or completely prevent you from doing your assigned work tasks as normal. These injuries are typically physical injuries, excluding any illnesses or pre-existing conditions, and are caused by factors present in the workplace. For example, a broken pallet or leaking container that causes a trip or fall resulting in injuries would warrant workers’ compensation payments.
Starting Your Workers’ Comp Claim
Any workers’ compensation case can be extremely stressful to handle, especially if you have to deal with unwilling employers who won’t admit any involvement in your injury. Fortunately, getting strong legal counsel for these issues can help you feel secure and stable as you deal with your injuries. To find the legal help you need to start the claims process, contact Ali Law Group, P.C., today.