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How to File A Workers Comp Case



Actions taken during the first 30 days after your workplace injury or illness occurred are critical. In the next few months your case is finalized and ideally you and your employer land on the same page regarding your benefits.


As a rule, your employer is law-bound to provide you with sufficient medical treatment following a workplace injury. But your actions early on in the process may ultimately improve the benefits and level of treatment you receive.

It’s as easy as 1, 2, 3…. 4, 5, 6, 7.


Step 1: Report the injury/illness

The deadlines for taking action in a workers’ comp case are all based on the date of your reported injury or illness. This is an important frame of reference. If you delay in reporting the incident to your employer, this could jeopardize your claim and will postpone any treatment coverage you may require.

The date of an injury is pretty obvious if you were hurt in a workplace accident (like falling down stairs) or if you were the victim in an assault. But it’s complicated to pinpoint the start date of a repetitive stress injury, work from home accident, or emotional trauma. In these situations, the insurance company will consider “Day 1” to be when you first missed work due to your injury or illness and you realized it was work-related (typically because you saw a doctor who explained that to you). But again, depending on the nature of your injury or illness, confirming an exact “start date” may be a bit tricky.

Step 2: File a claim

To officially begin the workers’ compensation process and receive benefits, you need to formerly file a claim (also known as a DWC-1) within one year from the date of your job-related injury or illness. The form asks you to describe the nature and severity of your injury, and which part of the body was affected. The description you give will be compared to the treating doctor’s diagnosis, so it’s crucial that you are as accurate as possible. If you wait too long to file for workers’ comp, then the symptoms you initially felt may no longer be apparent, affecting the overall amount of treatment you receive. This is why workers’ comp attorneys advise you to report your injury and file a claim ASAP. All California employers are required to carry workers’ comp insurance, so your employer should be able to provide you with all the proper forms if requested. But you can always download the appropriate from the Department of Industrial Relations’ Division of Workers’ Compensation. Once your claim has been filed, the insurance company decides whether to approve or deny the claim. If approved, the exact amount of compensation you will receive is finalized.


Step 3: File an Application for Adjudication of Claim


This allows you resolve any disagreements you might have with your employer about what benefits you are entitled to. Just like the workers’ comp claim, the Application for Adjudication of Claim (AKA Form WCAB-1)can be provided by your employer or downloaded from the DWC website. Also like the workers’ comp claim form, you have one year following the date of your injury or illness to file it with the Workers’ Compensation Appeals Board (WCAB).


Step 4: Receive preliminary benefits

Even if the injury or illness seems minor, your employer is required to pay for any medical treatment needed while awaiting the decision of your workers’ comp claim. This extends to pre-existing conditions that were aggravated by the nature of your job or job-related accident (think hearing loss, PTSD, and muscle strain). And in California, “medical treatment” extends to chiropractic needs, physical therapy, and occupational therapy as well.

Until a decision is made, your employer’s insurance is obligated to pay up to $10,000 towards your medical bills. The exact amount of compensation you may receive during this time will depend on the nature of your work-place injury or illness—namely whether you need medical treatment or suffer from a temporary or permanent disabilitythat prevents you from performing your normal work duties.

If no decision has been made within 90 days of your claim’s submission, it is automatically approved.


Step 5: See a doctor

Your treating physician will determine the severity of your disability, how much treatment is required, and whether you can safely return to work.

California law has certain rules about how you can select (and change) your treating doctordepending on whether your employer has contracted with a health care organization (HCO) or established its own medical provider network (MPN).


Step 6: Attend a deposition


A workers’ comp deposition is your witness testimonial before a court reporter outside of a courtroom. More precisely, it’s a recorded meeting between the insurance company’s attorney, the injured worker (i.e. you), and occasionally your employer’s representative as well. And the meeting typically takes place at an attorney’s office. Depending on the injury and particular legal style of the attorney, a deposition can last from an hour to a whole day.

This is a very common step after filing for workers’ compensation. And luckily, despite its dramatization in law films and TV shows, a deposition is rarely so intense or confrontational.

But a deposition does carry a lot of influencing power over the outcome of your case. Your testimony will help determinehow much your workers’ compensation is worth. And a good deposition means the insurance company is more likely to settle for a larger amount rather than continue with a court hearing.

NOTE: If your work-related injury is of a psychological nature, be aware that the insurance attorney has the right to ask very personal questions. They might ask about any previous therapy, problems in your social life, or about the mental health of your friends and family members. And be prepared for the deposition to go on for a while.

We recommend writing some of your answers in advance to help refresh your memory during the deposition. List your previous employers, past medications and medical providers, previous injuries, and any other important information you don’t want to forget on the day of.

Step 7: Settle your case

There are 3 ways to settle your workers’ comp case:


  • Stipulation with Request for Award – This is an agreement between you and your employer’s insurance company as to what benefits you will receive for your workplace injury treatment. The agreement is approved by a judge and you then receive said compensation (typically in biweekly payments).

  • Compromise and Release (AKA settlement) – This turns your workers’ compensation into a single, definitive payment. Your attorney will negotiate with the insurance company to assign your current injury treatments and possible future medical treatments (should the disability worsen) a monetary value. You are paid that amount, then the case is officially closed, and the insurance company is not liable for any future payments (even if your injury or illness requires more medical treatment than anticipated). This is how most workers’ comp cases end.

  • Go to Trial – Contrary to popular belief, trial is your last resort and will only occur if there’s a dispute between you and your employer that your attorneys cannot resolve. You will likely have to undergo a QME evaluation, where a certified doctor from the Division of Workers’ Compensation (DWC) Medical Unit examines your workplace injury and determines the extent of your disability.

Even if your claim was initially denied, you still have options! Depending on why your claim was rejected, you can resubmit your claim and still be approved.


In fact, you may be in a better position than before according to a Lockton study. Lockton is an insurance business insider and the company found that nearly 70% of denied workers’ comp claims are later accepted with an average 55% higher settlement amount than the original.


We got your back!


If you have suffered a work-related injury or illness, Barsoum Law can and will help. We have represented thousands of injured workers throughout California the past 25 years. Contact us today at 877-299-1555 or info@barsoumlaw.comto schedule a consultation with a member of our team.


SUMMARY:

Actions taken during the first 30 days after your workplace injury or illness occurred are critical. In the next few months your case is finalized and ideally you and your employer land on the same page regarding your benefits.

As a rule, your employer is law-bound to provide you with sufficient medical treatment following a workplace injury. But your actions early on in the process may ultimately improve the benefits and level of treatment you receive.

It’s as easy as 1, 2, 3…. 4, 5, 6, 7.

Don’t worry. Even if your claim was initially denied, you still have options. And until a decision is made, your employer’s insurance is obligated to pay up to $10,000 towards your medical bills.

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