How do workers’ comp claims work
When you are injured, it’s important that you know how a workers’ comp claim works; in essence, you need to understand the process. So, how do you file a workers’ compensation claim? This starts with immediately notifying your employer of your injury. Telling a coworker is not enough; you must inform a supervisor, manager, HR representative, or owner of the business. Although you’re supposed to tell your employer about the injury in writing, this is not required in all circumstances. The sooner you let your employer know about the injury, the better. Generally, you have 30 days to let them know about it.
Your employer has 24 hours from the time you notify them of the injury to provide you with this claim form (click here).
Can a claim be denied?
The short answer is yes. The employer has 90 days from the “date of knowledge” of the injury to decide whether to accept or deny your claim. This should be based upon a variety of factors. If you have a witness to your injury, that’s great, but it’s not necessary in order to have a valid claim.
Can a denied claim be appealed?
Yes, you can appeal by filing an application with your local Workers’ Compensation Appeals Board (“WCAB”). The government has a lot of resources available for you here. Typically, you have one year from your injury to file an application with the WCAB. This is the workers’ comp claim deadline.
How long is the process?
You may be wondering, “How long is the process once I file a work comp claim?” The length of your case once you file an application can vary widely depending not only on the facts but also on your goals as well as the goals of the employer or insurance carrier. Cases can be settled at any time (even the same day that you are injured). Conversely, cases can last decades. It is important that you and your attorney work out a plan that is consistent with your goals and your best interests, but you also want your attorney to give you a realistic picture of how the California workers’ compensation scheme limits your rights against your employer. For instance, there is no monetary recovery that is available for “pain and suffering” as an injured worker against your employer, even though damages for “pain and suffering” are available when you’re in an accident that does not involve your work.
What happens after you file a workers’ comp claim?
What happens after you file a workers’ comp claim or an application with the WCAB usually depends on whether you get an attorney. Injured workers do not need to pay their attorneys upfront, so you shouldn’t let any lack of funds prevent you from reaching out for help.
If you decide to obtain a lawyer, then the employer or insurance carrier will usually retain their own counsel at that time, and the litigation process will begin. Litigation often includes having your deposition taken, having your medical records subpoenaed, and going to court. Some employers and carriers also look at your social media, conduct thorough investigations of you, and will even hire private companies to follow you around with a camera. So, when you file a claim, make sure that you’re being as honest as you can be.
If you do not retain an attorney, then the claims adjuster (who works for the employer or insurance carrier involved) will often try to settle the case with you. If you want to know whether you are getting a fair shake without retaining an attorney, you may go to your local WCAB and ask to speak with an Information & Assistance Officer, which the court has available for you.
Navigating the world of the California workers’ compensation system can be a web of confusion. If you need help, you should consider reaching out to a workers’ comp lawyer, and you should further consider reaching out to a lawyer who is a certified specialist in workers’ comp; this won’t cost you anything extra. According to one website, workers who had lawyers “received nearly one-third more in benefits than workers without lawyers.”
The important thing is that you receive all of the benefits you’re entitled to so that you can move forward. If you would like me to help you with your case, please feel free to contact me at any time.