Legal Guide

Worker’s compensation claim process in California

The worker’s compensation is a social insurance program. Many states of the United States of America including California have adopted this insurance program. The important factor to understand is that this is based upon a no-fault system. This means that an injured employee can get worker’s compensation benefits for an on-the-job injury without giving any proof that the injury was due to someone else fault. However, insurers investigate the degree of damage and scrutinize whether compensation should be given or not. In case, compensation is to be given then how much?

Injuries at the workplace are crucial because these can not only affect the career of the injured employee but also change life suddenly for a long time or even permanently. In the absence of such a compensation program, it is difficult for the injured person to get medical treatment and wages during treatment. Conditions can become worse if there is an injury leading to permanent disability. 

The workers’ compensation process includes certain rules and exceptions which make this process complicated. The employers have to Worker compensation insurance to give worker’s compensation. Many insurance companies are working to offer this type of insurance but these companies have their interests.

If you get any type of injury while on the job then the first step is to report this injury to your employer. There is a time limit of 30 days during which the employer should get the report of your injury or illness. It is advisable to notify the employer as early as possible. 

Most common types of injuries during work

Injury on the job can be anywhere but some common sites of the injuries are given below.

  • Slip and fall

  • Falling objects and crush injuries

Following types of injuries are reported as a result of falling objects and crash incidents.

  1. Traumatic brain injuries

  2. Eye injuries

  3. Severe lacerations

  4. Back/neck, and spinal cord injuries

  5. Scarring

  6. Permanent disfiguring

  • Auto and Vehicular accidents

  • Ergonomic overuse injuries

  • Overexertion

  • Finger or other parts stuck up in machines

  • Exposure to toxin environment

  • Electrocution

  • Burns due to fire, explosions

The California worker’s compensation claim process includes the following preparations.

  1. First of all, notify your employee about on job injury

  2. Complete worker’s compensation claim form

  3. File your claim

  4. Participate in settlement discussion to resolve your claim

  5. Request the resolution worker’s compensation appeal board

  6.  Review the decision of the appeal board and prepare for the trial

The following steps are involved in Worker’s compensation process in California.

  • Report to employer

First of all, notify the employer about your injury during work. This notice should be in writing and fulfill employer protocol for reporting injuries. You can send this notice dually signed by you or you can also hire the services of an attorney who can send this notice on your behalf. The employer must provide the claim form to the injured employee within one working day after receiving notice. If an injured employee is unable to report to the employer due to injury then the verbal report of the supervisor to the employer is considered as notice. In California, employees can also get claim forms of cumulative injuries. These injuries take place with some repeated action during work. 

The claim form provided by the employer must provide the following information.

  1. The worker’s compensation collection procedure

  2. The employee’s protection against discriminations

  3. Details of all forms of worker compensation benefits.

  4. Employee right to change primary doctor

  5. Name of treatment providing firm

  6. Medical care before the approval of the claim

  • Filling of worker compensation claim form

You should fill the employee section of the DW-1 claim form. This form can also be downloaded from the division or worker’s compensation websites. The employee should provide the following information on this claim form. 

  1. Employee’s name, address, and social security number

  2. Date and time of the injury

  3. Email address (optional)

  4. Description of injury including details of affected body part/parts

  5. Signature

  • Filing the claim form

Send this claim form after completing it to your employer. The employer will fill out the employer section. After completing the form, the employer will submit the form to the insurance company. Along with medical and wage benefits. Some other benefits are also available. These benefits will cover the following.

  1. Temporary disability fund

  2. Permanent disability  fund

  3. Retraining 

  4. Return to home fund

  5. Death benefits (paid to dependents )

  • Settlement discussion

Some disputes appear after submitting the claim form between the employer and the insurance company. The degree of injury is the most common issue. Provision of Mandatory Settlement Conference in California is available in which both parties discuss their issue and settle them.

In California, there are 2 types of worker’s compensation settlements.

  1. Stipulated finding and award.

Both employer and injured employee agree to weekly payments in the future for medical care. This is done in an agreement. This settlement is reviewed by the judge. This includes the amount of disability and requirements for medical dare as recommended by the doctor. The employer is bound to obey the order of the judge.

  1. Compromised release

When an employer makes a lump-sum payment to the injured employee then the case is over. This amount is sufficient to cover future medical cover or disability. After paying this amount, the employer is not responsible for any payment for future medical cover.

  • Appeal with Worker’s compensation appealing board

Worker’s compensation cases can also be settled out of court in California. The cases which are not resolved by negotiation the next step are a trial with the worker’s compensation appeals board. This appeal can be filed within a year of injury, from the last date of medical bill payment, and the date when treatment was ended. The worker’s compensation appeals board reviews the application. Contesting hearing preparations are started after the ‘Discovery” procedure. Discovery is completed before the start of the mandatory settlement conference.  The worker’s compensation appeals board requires a Declaration of Readiness to proceed with the appeal board.  A mandatory settlement conference is arranged by the appeal board. The judge of these conferences can issue stipulated findings and award a compromise and release.

If these conferences result in no settlement then the process of contested hearing can start. The pretrial statement is filed by the employer and employee to determine their issue. It can take 75 days to start hearing after the decoration of readiness. The judge will review many things like evidence given by both parties, medical reports, hospital records, and many other documents. After reviewing this, the judge will decide about these issues. The decision determines whether the sustained injury is compensable and what amount of compensation the employee should receive. Time taken by the judge to make a decision is 30 days after the trial ended. 

  • Review decision

If both parties are not satisfied with the decision then they can go for the review decision option in the appellate board. This review does not allow a second trial.

This review looks that whether orders given by the appeals board are according to law or not without addressing the correctness of any factual findings. The court will not make a second decision but only determines that if the facts used are supported by evidence. The appellate court also determines the wrong application of law while deciding the case by the worker’s compensation appeals board. Both hearings and appeals are completed within a specific period along with the strict review of evidence and procedural rules. 

The time takes to complete the worker’s compensation process depends upon many factors. These factors are given below.

  1. How quickly do employers accept responsibility

  2. Time is taken by the insurance company

  3. How quickly the injured recovered

Usually, it can take to 6 months to s years to get final settlement orders. This time can be shortened if you work with the support of a Los Angeles Workers Comp Lawyer.

Worker’s compensation law consists of many complexities including paperwork, complex language, and many more. So, many things are taken into consideration to proceed with a case regarding the worker’s compensation process. 

Insurance companies think about only their benefits. These companies usually take advantage of these complexities and intentionally delay the process.  So, the injured may get a late decision or less support. 

Understanding all these complexities and complete knowledge of all legal procedures involved in the worker’s compensation process will enable you to get results in your favor. But is extremely impossible to succeed without the support of an experienced and professional attorney. It will be better to hire the services of an experienced attorney who is an expert on all legal requirements of the worker’s compensation process. 

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