Stockton Workers’ Compensation Attorneys

Five Important Workers’ Comp Benefits

Workers’ compensation is designed to help injured workers get the rest they need so that they can enjoy a quick, comfortable recovery. In this way, workers’ comp helps the employer just as much as the employee because it helps them keep their workforce fully staffed with as little downtime as possible. When a workers’ comp case is challenged or the benefits are reduced, it is the insurance company that causes trouble more often than it is the employer for this reason.

Five benefits you might get through workers’ compensation insurance are:

1. Medical treatments: All necessary medical treatments to get you back to how you were before your accident should be covered entirely by workers’ compensation. Furthermore, there should be no cap on how much medical care you can receive at no cost, as long as it is all medically necessary and not elective.
2. Temporary disability pay: When an injury is too severe to let you return to work within a day or two, you can get temporary disability pay equal to two-thirds of your typical wages. You can only be on temporary disability pay for 104 weeks before it expires.
3. Permanent disability pay: If your injury causes a permanent disability, then you can be transferred off temporary disability to permanent disability payments. The amount you can receive through this benefit is based on the severity of your disability and it can last until retirement.
4. Life pension: Injured workers who are not completely disabled but are significantly disabled – which translates to a disability rating between 70 and 99% - can earn additional life pension payments through workers’ comp.
5. Vocational rehabilitation: You can receive supplemental job displacement benefits that help you train for a new job in a different career if you cannot return to your previous role due to a disability.

How to File a Workers' Compensation Claim

Filing for workers' compensation involves the following steps:

1. Seek Medical Attention: If injured, seek immediate medical care. Inform the medical professional that the injury is work-related. Promptly reporting and documenting the injury is crucial.
2. Notify Your Employer: Report the injury to your employer as soon as possible. California law requires employees to notify their employer within 30 days of the injury to be eligible for workers' compensation benefits.
3. Complete DWC-1 Form: Your employer should provide you with a DWC-1 form (Workers' Compensation Claim Form) upon learning about your injury. Fill it out accurately and thoroughly. Keep a copy for your records and submit the completed form to your employer.
4. Employer's Responsibility: Once notified, your employer should provide you with a claim form and forward the claim to their workers' compensation insurance company.
5. Medical Evaluation: Your employer's insurance company may require you to be evaluated by a doctor they select. You have the right to seek medical treatment from your preferred doctor as well, but it should be from a healthcare provider within the employer's Medical Provider Network (MPN).
6. Filing the Claim: The insurance company will investigate your claim. They may accept or deny it based on the provided information and their investigation.
7. Wait for a Decision: After filing the claim, the insurance company has 90 days to decide whether to accept or deny the claim. They might provide benefits or issue a denial letter explaining the reasons if they choose not to accept the claim.
8. Appeal if Denied: If your claim is denied, you have the right to appeal. File an Application for Adjudication of Claim with the Workers' Compensation Appeals Board (WCAB) and attend the hearing.
9. Legal Assistance: Consider seeking legal advice or hiring a workers' compensation attorney if your claim is denied or if you encounter difficulties during the process. An attorney can help navigate the appeals process and represent your interests.

Common Reasons Your Claim Can Be Denied

Workers' compensation claims can be denied for various reasons, some of which include:

• Failure to Report in Time: Delay in reporting the injury or filing the claim within the specified timeframe can lead to denial. Reporting the incident promptly is crucial.
• Lack of Witness or Evidence: If there were no witnesses to the accident or insufficient evidence to support the claim, it might get denied due to a lack of substantiating information.
• Injury Not Work-Related: The injury or illness must be directly connected to the job. If it occurred outside work hours or during an unrelated activity, the claim might be denied.
• Pre-existing Conditions: If the injury aggravates a pre-existing condition, proving that the workplace significantly worsened the condition can be challenging, leading to denial.
• Dispute over Treatment: Disagreement between the employee and the workers' compensation insurer regarding the appropriate medical treatment can sometimes result in denial.
• Missed Deadlines or Paperwork Errors: Failing to meet specific deadlines or making mistakes on the required paperwork can lead to a denial. Accuracy and timeliness are critical.
• Violation of Company Policy: If the injury occurred while violating company policies (e.g., substance abuse policy), the claim might be denied.
• Independent Medical Examination (IME) Results: If the results of an independent medical examination conflict with the initial diagnosis or severity of the injury, it could lead to a denial.
• Employer Disputes the Claim: Sometimes, the employer may dispute the claim, stating the injury didn’t happen at work or questioning the severity of the injury.
• Incomplete Medical Records: Inadequate or incomplete medical records can result in a denial as it becomes difficult to establish the nature and extent of the injury.

Who Qualifies for Workers’ Comp in California?

In California, most employees who work for most employers should have workers’ compensation insurance coverage due to the broadness of the law. Full-time, part-time, seasonal, and newly hired workers are all eligible for workers’ compensation benefits.

You can file a workers’ compensation claim if you:

• Are hurt while working or carrying out a job-related duty.
• Get injured or fall ill due to your typical job expectations.

Importantly, independent contractors are not afforded workers’ compensation insurance benefits from an employer in nearly all situations. If you are contracted to work for a company but are not classified as an employee, then you likely do not have those benefits. Our attorneys can help you figure things out, though, if you don’t have workers’ compensation but feel like you should be based on your job expectations and regular duties.