Inside the Workers Compensation Process
Workplace injuries can happen at any time, in any industry. No matter where you work, the process of filing for workers’ compensation is the same. That process often includes the following steps, which you can learn more about by clicking on the highlighted text below:
You need to get started right away to get the benefits you deserve. These benefits can be the lifeline you need after your accident. They can pay your medical bills and make up for lost income if you need to take time away from work. But applying for benefits can sometimes be a challenge. And a delay or error at any step in the process could jeopardize your legal rights.
That’s where we come in. At the Law Office of Robert A. McLaughlin, we help hard-working people in San Diego and throughout Southern California move on after their workplace injury. Our attorneys can be your advocates, fighting for you at every stage of the process. We know how to deal with your employer, doctors, insurance companies and judges. Contact us today for a free consultation. Call us toll free at (866) 324-9558 (only receives calls from California numbers) or locally at 619-354-4854.
The first step toward getting your workers’ compensation benefits is to promptly report the injury to your employer. Under California law, generally you need to notify your employer and file your DWC-1 claim within 30 days of suffering an injury. Talk to your direct supervisor and make sure you follow your employer’s protocol for reporting your injury. However, this merely informs your employer that you were injured. To continue with the workers’ compensation process and officially file a claim, you need to file a few documents:
- A DWC-1 claim form
- Application for Adjudication of Claim
- Declaration Pursuant to Labor Code 4906 (g)
- Document cover sheet and document separator sheets
Sometimes, work-related illnesses or injuries develop over a period of time instead of from a single accident. In those cases, you need to inform your employer as soon as you believe your malady is work-related.
What are those forms?
With long titles and abbreviations, these documents may come off as a bit intimidating. After all, you’ve just been injured and want as little stress as you can manage. Let’s break down what documents you need to know about.
A DWC-1 claim form is your basic worker’s comp form. It’ll ask for your contact information, as well as basic information about how you were injured. You’ll need to note each body part that was affected, so be sure to keep track of problems that arise from somewhere outside of the site of the injury, as things like nerve damage can radiate and signal damage elsewhere. Your employer should then submit this form to their worker’s compensation insurance company.
An Application for Adjudication of Claim is a form you’ll file with the Worker’s Compensation Appeals Board (WCAB). For this, you’ll need the information of your employer’s worker’s compensation insurance company. It’s recommended that this form gets filed in person, but you can do it by mail with a proof form.
Document Cover Sheets and Separator Sheets are very simple. You can print out a cover sheet to include with your forms from the DWC website. The separator sheets simply go after each form that you include. Think of them as dividers, so nothing gets mixed up.
When should I file my claim?
From the moment of injury, you’re on a time limit. You have 30 days to file your first document with the DWC. California has time limits for various versions of worker’s compensation, depending on what you’re trying to claim. These limits are called statutes of limitation, and can affect how your claim is either accepted or denied for being beyond them:
- Generally, if your employer’s insurance provided injury benefits, you have five years from the date of the injury to file your claim
- If your claim was denied or ignored, you have a year after the date of injury.
- If collecting benefits from a relative who died, you have one year to file your claim.
After any injury or illness, your health should be your top priority. Seek appropriate medical attention as soon as possible. Any delay in getting treatment could affect your legal rights, as delaying seeing a health professional gives your employer reason to argue that you weren’t injured as badly as you claim. Your employer is required by law to make sure you have access to emergency medical treatment right away and may also tell you where you can go for treatment.
Tell the healthcare provider your illness or injury is job-related. And be sure to document every interaction you have with medical professionals. The doctor who tends to you plays a crucial role in determining your physical health. They’ll be able to assess whether your injuries were work related, the extent of any possible disability, and track your progress in recovery. In addition, your doctor determines how much time you need off from work, or if you just need to reduce the stress of whatever duties you perform at your job.
Within one working day of learning about your illness or injury, your employer is required to give or mail you a claim form, called a DWC 1. You need to fill out this form promptly and return it to your employer. If your employer does not give you a DWC 1, you can download it directly from the Division of Workers’ Compensation.
Filing a DWC 1 starts the process of getting the benefits you may qualify for under state law, including medical treatment and disability payments. An adjuster from the insurance company will then contact you to take the next step in the claims process, which is often submitting your medical records and bills. If your claim is denied or disputed, though, you’ll need two things: good documentation of every step you’ve taken so far, and a reliable worker’s compensation attorney.
You’ll need to complete and send in several forms, listed above, and continue to follow up with your doctor about your injury. This helps you physically, but also shows insurance and your employer that you are injured to the extent that you first reported—even if you think your injury was something minor, it can still cause problems in the long run. A pulled muscle could affect nerves later on, and what seems like a simple bump on the head could lead to a hematoma, or signal a more serious head injury that runs the risk of being overlooked. Since workers are entitled to have their medical costs covered, you shouldn’t need to worry about the medical treatment you deserve to have. In addition to this, workers are also entitled to other benefits that you will have to file for.
- Temporary disability: these are paid to a worker who has to take time off due to injury. In California, you can receive these payments for up to two years. Exceptions to this only occur if you have a condition like: burns, HIV, hepatitis B or C, or lung disease.
- Permanent disability: these payments are given to a worker who has suffered an injury that permanently affects their ability to earn. The amount is determined by age, medical evaluation to determine your level of impairment, and your occupation at time of injury, among other factors. This disability payment could span over years.
- If the disability is determined to be severe enough, workers may receive a small payment week by week for the rest of their lives.
- Retraining: Helping workers re-introduce themselves to the job market is a valuable benefit. This helps the injured party attend education retraining and can cover tuition.
- Return to Work Fund: If your injury impairs you to the point that a doctor concludes you are unable to return to your job, you may be eligible for a one-time payment from the Return-to-Work fund.
- Death: Dependents and any spouses that survive a worker killed in a job-related activity are entitled to this, and it may help cover burial expenses.
Most contested workers’ compensation claims are resolved through settlements. There are two types of settlements used in workers’ compensation cases in California:
- A Stipulated Finding and Award is an agreement between the two parties – the employer and injured employee – that has the same effect as a judge’s decision in trial. A Finding and Award provides for the applicant’s level of disability and may leave open payment for future medical care. This isn’t imposed on any party involved, and is reviewed by the judge. Much of this review falls on the degree of the disability, largely determined by a doctor’s opinion. This is not paid in a lump sum, unless the previously owed weekly payments are determined to be overdue.
- A Compromise and Release completely closes the case with a single lump-sum check that covers the estimated value of any disability award and/or future medical treatment. Usually, this agreement is only possible if you are not continuing to work for the same employer. This type of settlement can only be done when both the employer and injured worker agree to this settlement. A judge can never make the parties agree to this type of settlement.
In some cases, a settlement is not possible and your case will need to go before a judge. Learn more about resolving your claim.
Trials for workers’ compensation cases are less formal than civil or criminal trials. In California, workers’ compensation cases are tried before an Administrative Law Judge – there is no jury and no audience. If the trial is not finished on the day it begins, it will be continued to another day two or three months later – and it can be continued again if it is not finished on that day. When many aspects of a case are disputed, the trial can stretch out for years.
While California law requires the Administrative Law Judge to take a liberal interpretation of the law in favor of providing benefits, this is not always the case in the current political climate. Learn more about workers’ compensation trials.