Here's a simple, but comprehensive guide for anyone in California who suffers an injury at work and wants to claim compensation. Whether you're already going through this process or just researching to understand your rights, this article will cover the basics.
Should you get involved in a work accident or learn about a condition you developed because of your work activities, your priority must be notifying your supervisor as soon as possible. This is to both initiate the actual process of filing a claim, and establishing causality between your work activity and your injury.
California law establishes a 30 period starting at the moment of the injury, where workers are expected to file a workers compensation California claim. If this period expires before a compensation claim is filed, you simply lose this right. Even you simply take your time to file a claim that will always work against your interests, making the process less believable and not as likely to be resolved successfully.
If your injury requires emergency treatment or raises the need for a doctor appointment, always tell the medical staff that your injury was caused by a work related incident. Having this information written down in the doctor's notes will be instrumental to placing a successful claim.
Filing a claim is the first step to making sure your rights of getting workers compensation in California are covered. Your employer is required to provide with a form (either printed or digitally) within a day after you report your injury. If for some reason your employer fails to supply a form, you can download a template from the DWC website.
Once you fill in the "Employee" section of the form, you sign it, make a copy and pass the original to your employers - who will fill in their respective section. You can simply give them the form personally, but for the sake of caution it's a good idea to arrange proof that you actually submitted the form within the allotted timeframe of 30 days after the injury. One way of doing this is to submit the claim by registered mail, or making a copy and mailing that to yourself by registered mail, keeping the closed envelope in case a dispute arises surrounding the timings of the claim. You can also submit the file digitally to ensure the timestamp of the e-mails will be usable as records of the transaction.
You should also make sure you get a copy of the finished form, after your employer has finished writing their section. If your employer doesn't voluntarily submit this record, make sure to ask for it and keep in on file.
Once the workers compensation California form is submitted by your employer to the insurance company, they are required to get back to you within 14 days to let you know about the status of your claim.
From when you submit the form to your employer, there is a 90 days period where they must inform you about the resolution if your claim - otherwise your injury will presumably be covered.
The benefits you are entitled to under workers compensation California laws include medical care, temporary disability benefits, permanent disability benefits (in case you don't recover completely), supplemental job displacement benefits (in case you don't recover completely and/or don't return to the same work). There are also death benefits which are offered to the spouse, children of dependents of a worker whose life is lost in the course of a work related injury or illness.
If your claim was rejected, it likely means that your employer disputed its validity. In this case - provided you're confident you're right - you must act immediately and challenge the decision. When you do this, your case will be forwarded to a worker's compensation administrative law judge (WCJ). In that case, you can either represent yourself in court or get the help of an attorney.
If there is a disagreement regarding the extent that your claim is covered by workers compensation California, a physician who's a qualified medical evaluator (QME) will be brought in to settle it. In case you have an attorney, they might agree with your claims administrator to get the intervention of an agreed medical advisor (AME) to settle medical disputes.
The timeframe for when you should get back to work will be established by several people involved in reviewing your workers compensation California claim. This includes your doctor, your employer, the claims administrator and your attorney (if you hired one). To make this decision, they'll evaluate the work you did before the injury as well as your medical condition and your ensuing ability to keep doing the same work.
If your capabilities to keep the same duties have been compromised, your employer will be asked about the possibility of adjusting your job function. Keep in mind that employers actually have benefits to get you back to work as quickly as possible, which is meant to ensure your reintegration in the work force.
If at some point there are disagreements about specific benefits or rights or the timeframe of your recovery, an external agent will be called in to settle the dispute (either a qualified medical evaluator - QME - or an agreed medical evaluator (AME).
When a case is fully resolved, there will be a settlement establishing your rights to workers compensation in California and medical care. The parties involved in reviewing your case will specify this information, so it's wise to get it reviewed by a third party to make sure everything is adequate. Whether or not you have a lawyer, you can ask for the intervention of a worker's compensation administrative law judge, who will determine if everything seems in order.
There are two main types of settlements that can be achieved: Stips and C&R.
Stips is short for "Stipulations with request for Award"; in this case the agreement includes a plan for disability payments (temporary or permanent), as well as employer coverage for medical care.
This involves the settlement of a lump sum that will resolve the claim when paid by your employer. In this case, you will be expected to pay for all future medical care by using part of that money.
If for some reason you can't reach an agreement with your claims administrator, you can forward your dispute to a worker's compensation judge who will mediate the dealings until a verdict is reached and your rights (as well as your employer's) have been mediated.