Both employees and employers have a lot to worry about when an injury occurs on the job. For employees, they may face time off work and medical bills alongside the pain from the injury itself. For employers, they may face increased insurance premiums, which can be a serious matter for smaller employers. As an employee, you want to maximize the workers' compensation payout while the employer may want to minimize it. These contrary goals create tension that can result in delayed worker compensation claims.
At the LAW OFFICE OF SHANE P. BRADLEY, APC, our workers' compensation attorney in Sacramento help clients through the workers' compensation process to obtain a positive outcome. Workers' compensation should not be difficult, but when challenges arise, strategy is needed. Contact our workers' comp lawyer in California today by calling us at (916) 755-5929 to schedule a Free Consultation.
California's Basic Process to File a Workers' Compensation Claim
Below is a description of three basic steps employees must take to file a workers' compensation claim:
1. Obtaining Medical Treatment & Reporting the Injury to the Employer
Of course, when an employee is severely hurt, immediate medical assistance by calling 9-1-1 is necessary. When an injury is not an emergency, the employee should first notify their employer before seeking medical attention. This is because the employer will have certain providers that the employee should see for their medical care.
To whom the employee reports their injury varies by state and by employer. It can include their supervisor or a human resources representative. It is best that the employee makes the notification both orally and in writing by completing a DWC-1 claim form provided by the employer. If the employer does not provide a claim form after reporting an injury, one can be found on the RESOURCES page.
2. Reporting the Injury to the Insurance Carrier
The next step in the process is for the employer to notify their workers' compensation insurance carrier of the injury. The employer may request certain documentation from the employee to assist with this part of the process.
3. Accepting or Denying the Workers' Comp Claim
At this point, the workers' compensation insurance carrier will either approve or deny the claim for benefits within 90 days of the reported injury. If the claim is approved, the carrier will notify the employee, and the benefits of Medical Treatment and possibly Temporary Disability will commence.
If the claim is denied, the employee should seek medical care through there personal provider until a Qualified Medical Examiner can be consulted to help determine the compensability of the injury.
Challenges to the Workers' Comp Claims Process
Unfortunately, problems often arise in the workers' compensation process. Some of the most common challenges involve situations where an employee fails to timely report an injury, the injury is not adequately demonstrated, the claims process takes too long, or the claim gets denied.
Injury Not Reported
The workers' compensation process is driven by a timeline. To kick off the process of obtaining compensation, the employee must timely notify the employer of their injury, and the employer must timely notify the insurance carrier. When either of these notifications does not happen in a timely manner, it can be detrimental to the employee receiving the benefits they need. The time limits can be specific to state law and/or specific to the workers' comp insurance policy.
Injury Not Proven
There are several issues that can arise with the injury itself. First of all, the employee may have a problem proving that the injury actually occurred, or if it did occur, that it happened during the course of their employment. A lack of witnesses to the accident can hurt an employee's claim that the injury happened at work. In extreme cases where the employee suffers significant harm, it may be necessary to bring in experts to testify as to how the accident occurred.
Another problem that occurs is the employer or workers' compensation attorney will admit that an injury took place, they just disagree as to the extent of that injury. Because of this discrepancy, employees need to be intentional in proving the extent of their injuries from day one. This means holding on to all medical documentation, including doctor's notes and prescription information. Pictures and videos of the injuries are very helpful as well.
There are many reasons why a claim can drag on or be delayed, including a failure between two or more parties to communicate. Whenever a claim for benefits drags on, an injured employee is often left without the benefits they need to receive proper medical attention, and the compensation they need to provide for themselves and their families.
Having a legitimate claim for benefits denied by the workers' compensation carrier is extremely frustrating for an injured employee. There are many reasons why this happens, from simple clerical errors to a denial based on lack of evidence. The good news is that a denial does not have to be the end of the road for the employee. They are able to take steps to have the denial appealed or reconsidered. A workers' compensation attorney is generally very helpful when this happens.
Time Limit to File a Workers' Comp Claim in California?
The amount of time an employee has to file a workers' compensation claim is limited 1 year. An injured party should not wait to file their claim, and it is best to seek legal assistance to determine the exact amount of time available to file the claim.
Reasons to Hire a Workers' Comp Lawyer in California
There are many reasons to retain a workers' comp attorney in California when you file, appeal, or request reconsideration for a workers' compensation claim. Here are just a few reasons why an attorney can be in your best interests.
- A workers' comp attorney knows how to negotiate with insurance companies.
- Statistics show that retaining an attorney strengthens your workers' comp claim and increases your chances of a better outcome.
- If you need to sue to have your rights upheld and then decide to settle your workers' comp claim, an attorney will know how to draft the settlement agreement to ensure it does not negatively impact your ability to obtain Social Security Disability Insurance (SSDI), if you intend to apply for the latter, too.
Contact a Workers' Comp Attorney in Sacramento Today
Injuries that affect your ability to work can dramatically affect your life, and so if you suffer a work-related injury, you should be compensated for it. At the same time, if an employee is not injured on the job, employers are not responsible for it. The line determining responsibility can often be blurred, and so tension often arises between the employee and employer. When that happens, workers' compensation may be delayed or denied.
At the LAW OFFICE OF SHANE P. BRADLEY, APC, our workers' compensation lawyer in California will work with you to ensure you get workers' compensation when you are entitled to it. Contact us by filling out the online form or calling us at (916) 755-5929 to schedule a Free Consultation. We are here to help you through this process.