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How To File A Workers Comp Claim in California?

Filing a Workers’ Compensation Claim in California

People generally do not intend to get injured. When they are injured it can be a frightening experience. Not only can an injury have a long-term impact on their ability to continue working, but it can also affect their ability to provide for themselves and their loved ones.

Fortunately for workers, the Workers Compensation Act guarantees coverage for work-related injuries. According to this Act, employers are required to cover the cost of medical expenses and to provide benefits for injured employeesbut how do you file a workers’ compensation claim in California?

Filing a claim for workers’ compensation benefits is similar to the process of filing any other type of insurance claim. However, you face an additional challenge because your employer is involved in the process. While most employers handle their employees’ work injury claims in good faith and uphold their legal duties to their injured workers, some, unfortunately, do not, and some go as far as to directly interfere with these claims or retaliate against employees who file them.

Your first steps after a work injury can influence your ability to claim benefits and the total benefits you secure in various ways. It’s important to know the value of legal counsel you can trust in this situation, and Canlas Law Group can provide the guidance and support you need through each phase of your workers’ compensation claim filing process.

How To File A Workers Comp Claim in California?

Reporting the injury

Just as there are many different jobs, there are also many different ways workers can get injured. Some injuries happen as the immediate result of an accident while others develop slowly over time. No matter what type of injury or how it happens, you need to get immediate medical care if it is needed and to report the injury to your employer as soon as you become aware of it.

After you become aware of the injury, you have 30 days to report the injury to your employer. After that 30-day period, it is possible that you can legally lose your right to get workers’ compensation benefits. It’s important to remember that the 30-day window to report your injury is separate from the one-year statute of limitations for the actual filing of your claim. While you have 30 days from the date of your injury to report the incident, you have one year from this date in which to file your workers’ compensation claim.

Filing A Workers’ Comp Claim in California?

Once you have reported your injury, the next step is to file a workers’ compensation claim. Your employer should be able to provide you with the appropriate forms, but if they do not have any available they can be found online.

Necessary forms include,

  • DWC-1
  • Application for Adjudication of Claim
  • Declaration Pursuant to Labor Code 4906(g)
  • Document cover page/separator sheets

Again, your employer should be able to provide you with all of these documents, but they can also be found on the California Department of Industrial Relations website.

A work-related injury can have a serious impact on your life and the lives of the people around you. Fortunately, you do not have to deal with it alone. There are legal professionals who specialize in these types of issues and they can provide knowledge and support as you move through the legal process.

Qualifying for Workers’ Compensation Benefits

One of the most important initial steps of a workers’ compensation claim is the medical review process. You will need to see a physician approved by your employer’s insurance carrier, and this workers’ compensation physician will review your injury and assign you a rating for your disability. This is a numerical indicator of the severity of your injury and the scope of long-term or permanent issues you may face because of it. If you don’t agree with the first physician’s assessment, you can seek a second opinion.

Once you have filled out all required forms and completed the medical evaluation, you are ready to submit your claim to the insurance company. Most insurers will respond within two to three weeks, and there is a 90-day maximum time limit for an insurance company to deliver their determination of benefits for an injured worker.

Almost every claimant who qualifies for workers’ compensation benefits will receive two types of compensation. The first benefit covers your medical expenses. The insurance company pays for all the medical care the claimant requires to fully heal from their injury. The second is disability benefits. The injured worker will qualify for either partial or total disability benefits to help offset their diminished earning power after their injury.

How an Attorney Can Help

An experienced workers’ compensation attorney can provide several valuable legal services for an injured worker. They can help complete all the preliminary steps of filing your claim for benefits, and they will be essential for resolving any disputes that arise with your employer or their insurance carrier. Once you receive your determination of benefits, your attorney can verify that it is fair and reasonable under the terms of your employer’s policy to address the scope and severity of your injury.

While most injured workers cannot sue their employers for their workplace injuries, exceptions to the rule exist. If your employer caused your injury intentionally, if you were injured because of their gross negligence, or if they do not have workers’ compensation insurance, these issues would qualify you to file a civil suit against your employer. It is more likely that you will have grounds for a claim against a third party. If any party outside of your work caused your injury, you can file both a workers’ compensation claim through your employer and a third-party personal injury claim against the party responsible for causing your injury.

Ultimately, you could have more opportunities to recover from your workplace injury than you initially expected, and the right workers’ compensation attorney is an essential asset for anyone in this situation.

FAQs About How To File A Workers Comp Claim in California

How Long Do You Have to File a Workers’ Compensation Claim?

If you suffer an injury at work, you have 30 days in which to report the injury to qualify for workers’ compensation benefits. The actual statute of limitations for filing the claim is one year from the date the injury occurred. It’s crucial to report the injury as soon as possible because failure to do so may not only interfere with your eligibility for benefits but also cause the insurance company to doubt the legitimacy of your claim because it took you so long to report the injury.

How Much Can I Receive in Workers’ Compensation Benefits?

On average, an injured worker in California will qualify for full medical coverage and income replacement benefits equal to about two-thirds of their average weekly wage. Alternatively, if they can handle lower-paying work, they may be awarded partial disability benefits to offset income differences. Your attorney can help determine the extent of workers’ compensation benefits you could qualify to receive after your work injury.

What Is the Five-Year Rule for Workers’ Compensation?

State law typically limits disability benefits to 104 weekly payments. The claimant will receive a weekly payment each week for up to 104 weeks, but these payments do not need to be consecutive. The Five-Year Rule for California workers’ compensation allows the claimant to spread their benefits payments out over a five-year term if they choose.

Can I Still File a Claim if I Caused My Injury at Work?

Yes, you are still eligible to claim workers’ compensation benefits if you caused your own injury. However, you must have done so through an honest accident in good faith. If you were engaging in horseplay at work, intentionally violated a workplace safety rule, or if you were working while under the influence of alcohol or drugs, these factors may disqualify you from workers’ compensation benefits.

Do I Need to Hire an Attorney for a Workers’ Compensation Claim?

Technically, no, but having legal counsel you can trust on your side makes every aspect of the claim filing process easier to manage, and you are more likely to secure maximum compensation. If you have sustained a work-related injury and are planning to file a workers’ compensation claim, it is recommended that you obtain the services of an experienced legal professional. An experienced Los Angeles workers comp attorney will be able to work with you to ensure the greatest possible outcome.

The appropriate attorney can be an invaluable asset after any workplace injury. Canlas Law Group has years of experience helping many injured workers in all industries secure the workers’ compensation benefits they need to recover, and we can put this experience to work for you. Contact us today and schedule a free consultation to learn more about the professional legal services we can provide after a workplace injury.

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