How to Check the Status of a Workers’ Comp Claim
How to Check the Status of a Workers’ Comp Claim
After a workplace injury, one of the first things you do is file a workers’ compensation claim. Once the paperwork is submitted, a period of waiting begins, which can be a source of significant stress and uncertainty.
You can check the status of a workers’ comp claim by directly contacting the insurance company’s claims administrator assigned to your case or by using California’s online public search tools if a formal case has been opened with the state.
Knowing where your claim stands—whether it’s been accepted, delayed, or denied—gives you the power to act accordingly and protect your rights to benefits.
If you’re unsure how to move forward, a workers compensation lawyer can guide you through each step and help you avoid costly mistakes—contact one today to protect your claim.
Key Takeaways about Checking the Status of a Workers’ Comp Claim
- An injured worker’s primary point of contact for claim status updates is the claims administrator from the employer’s insurance company.
- California’s Division of Workers’ Compensation (DWC) offers an online public search tool for cases that have been assigned an official Adjudication (ADJ) number.
- Common claim statuses include accepted, delayed, and denied, each of which requires a different response from the injured worker.
- Claims administrators are legally required to make a decision on a claim within a 90-day period.
- Keeping detailed personal records of all communications, medical visits, and documents is vital throughout the claims process.
Understanding the Key Players in Your Claim
Before you can check on your claim, it helps to know who is involved in the process. The workers’ compensation system has several key parties, and each has a distinct role. Understanding who does what will clarify who you need to contact and why.
- You, the Injured Worker: Your role is to report your injury promptly, file the DWC-1 claim form, attend medical appointments, and follow the treatment plan prescribed by your doctor.
- Your Employer: Your employer is responsible for providing you with the claim form, reporting the injury to their insurance company, and accommodating any work restrictions you may have upon your return.
- The Claims Administrator: This is the individual or entity—usually an insurance adjuster—tasked with managing your claim. They investigate the injury, approve medical treatments, and process benefit payments. This is your main contact for status updates.
- The Division of Workers’ Compensation (DWC): This is the California state agency that oversees the entire workers’ compensation system. They provide a venue for resolving disputes through the Workers’ Compensation Appeals Board (WCAB) but do not directly pay out benefits.
Think of the claims administrator as the day-to-day manager of your file, while the DWC acts as the governing body that ensures the rules are followed, especially when disagreements arise.
Your First Point of Contact: The Claims Administrator
The most direct and common way to get an update on your claim is by communicating with the claims administrator. After your employer files a report with their insurance carrier, you should receive a letter that includes your claim number and the contact information for the administrator handling your case. This person is your single most important source of information.
When you reach out, be prepared with some basic information to help them locate your file quickly.
- Your Identifying Information: Have your full name, date of birth, and address ready.
- Date of Injury: Be specific about the day the work-related injury occurred.
- Claim Number: This is the most crucial piece of information. Always reference your claim number in every phone call, email, or letter. It instantly connects the administrator to your file.
Effective communication with the claims administrator can make a significant difference. It’s wise to keep a detailed log of every interaction, noting the date, the person you spoke with, and a summary of the conversation. Following up a phone call with a brief email confirming what was discussed creates a written record that can be valuable later.
Remember that under the California Labor Code section 5402, the insurance company has up to 90 days from the date you submitted your claim form to make a decision. If they fail to deny your claim within this period, it is generally presumed to be accepted.
Maintaining a clear and consistent record of communication helps keep everyone accountable and provides you with a timeline of your claim’s progression.
Using California’s Online Tools to Check Your Workers’ Comp Claim Status
If your claim involves a dispute that requires the DWC’s involvement—for instance, if it’s denied and you decide to appeal—it will be assigned a case number, often called an Adjudication number or ADJ number. Once this number is assigned, you can use the state’s online resources to check its status.
The Division of Workers’ Compensation (DWC) provides an online search function that allows the public to look up information on cases filed with the Workers’ Compensation Appeals Board (WCAB). This tool is especially helpful for tracking formal proceedings, such as hearing dates, filed documents, and official decisions.
Here is a general guide to using the public search tool:
- Locate Your ADJ Number: This number is typically found on official notices or forms you receive from the DWC or your attorney after a case has been opened.
- Visit the DWC Website: The DWC provides a public information search portal as part of its Electronic Adjudication Management System (EAMS).
- Enter Your Information: You can search for your case using the ADJ number. If you don’t have it, you may be able to search by your name, but having the case number is much more efficient and accurate.
- Review the Case Information: The search results will show a summary of your case, including its current status, recent activities, and any upcoming events like hearings or conferences.
These online resources can be a great way to get official updates without having to wait for a return call. Whether you’re checking from your home in Anaheim or trying to prepare for a hearing at the DWC district office in Riverside, this tool provides direct access to the court’s file.
What Do the Different Claim Statuses Mean?
When you receive an update from the claims administrator or see a status online, it will likely be one of a few standard terms. Understanding the meaning of each is essential for knowing where you stand and what to expect next.
- Accepted: This is the best-case scenario. It means the insurance company agrees that your injury is work-related and has accepted liability. They will cover reasonably necessary medical treatments and provide other benefits, such as temporary disability payments if you’re unable to work.
- Delayed: This status indicates that the claims administrator needs more time to investigate your claim. They may be waiting on medical records, a doctor’s opinion, or other information. During a delay, the administrator is still required to authorize up to $10,000 in medical care while they complete their investigation within the 90-day decision timeframe.
- Denied: A denial means the claims administrator has determined your injury is not covered by workers’ compensation. You will receive a formal denial letter explaining their reasons. Common reasons include a belief that the injury didn’t happen at work or that it was caused by something outside of your job duties.
- Open: This is a general term indicating that your claim is active. You might be receiving medical treatment or benefits, and the claim has not yet been fully resolved through a settlement or a judge’s decision.
- Closed: A closed claim means that a final resolution has been reached. This usually happens after you have agreed to a settlement, such as a Stipulated Award or a Compromise and Release, or when a judge has issued a final order in your case.
Receiving a “Delayed” or “Denied” notice can be disheartening, but it is important to remember that these are not necessarily the final word. You have rights and options to challenge the insurance company’s decision.
What to Do If Your Claim Is Delayed or Denied
If you learn that your workers’ compensation claim has been delayed or denied, it’s important to act thoughtfully and strategically. Your response can have a major impact on the ultimate outcome of your case.
If Your Claim Is Delayed
A delay is not a denial. It is a period for investigation. During this time, you should:
- Continue Seeking Medical Care: Do not stop your medical treatment. The insurance company is still responsible for authorizing necessary care up to the $10,000 limit while they investigate.
- Cooperate Fully: Respond to any requests for information from the claims administrator as quickly and accurately as possible. This might include attending a medical evaluation with a doctor of their choosing.
- Document Everything: Keep meticulous notes about your symptoms, your doctor visits, and any limitations your injury places on your daily life. This information will be helpful as the investigation proceeds.
If Your Claim Is Denied
A denied claim requires a more formal response. The denial letter you receive must state the specific reasons for the decision.
- Review the Denial Letter Carefully: Understand why the insurance company denied your claim. The reasons they provide will be the foundation of your appeal.
- File an Application for Adjudication of Claim: To formally challenge the denial, you must file this application with the DWC. This opens a case before the Workers’ Compensation Appeals Board and begins the legal process of fighting the denial.
- Gather Supporting Evidence: Work with your doctor to gather medical evidence that supports your claim that the injury is work-related. You may also need to collect witness statements or other documents that prove your case.
Challenging a denial involves strict deadlines and legal procedures. The process of litigation, from filing documents to attending hearings, can be complex, and missing a deadline can jeopardize your ability to receive benefits.
The Importance of Documentation and Keeping Records
Regardless of your claim’s status, maintaining thorough records is one of the most powerful things you can do to protect yourself. The workers’ compensation process is heavily dependent on documentation, and having your own organized file can prevent confusion and support your case.
Imagine being stuck in traffic on the 405 freeway near Newport Beach; just as the traffic requires careful attention, so does your claim’s paperwork. A well-kept file is your roadmap.
Here are some essential documents to keep in a dedicated folder:
- A copy of your completed DWC-1 claim form.
- All correspondence (letters, emails, notices) from the claims administrator and insurance company.
- All medical reports, doctor’s notes, bills, and receipts for any out-of-pocket expenses.
- A personal journal detailing your daily pain levels, physical limitations, and any missed work time.
This collection of documents provides a comprehensive history of your injury and claim, serving as a powerful reference if disputes arise or if you need to recall specific details weeks or months later.
Checking the Status of a Workers’ Comp Claim FAQs
Here are answers to some common questions people have about monitoring their workers’ compensation claims.
How often should I check my claim status?
While you don’t need to check every day, it’s reasonable to follow up with your claims administrator every couple of weeks, especially if your claim is delayed or if you are waiting for an important authorization. If you have an attorney, they will typically handle these communications for you.
Can my employer check the status of my claim?
Your employer will be notified of major decisions, such as whether your claim is accepted or denied. However, they are not entitled to your private medical information and will not have access to the detailed, day-to-day status that you or the claims administrator have.
What if I can’t get in touch with my claims administrator?
If your claims administrator is not responding to your calls or emails, send a formal letter via certified mail. This creates a record that you attempted to make contact. If you continue to have issues, you can contact the DWC’s Information and Assistance Unit for guidance.
Does a “closed” status mean I can never get benefits for this injury again?
Not necessarily. Depending on the nature of your injury and settlement, you may have the right to reopen your claim for new and further disability within five years of the date of injury. This is a complex area, and the ability to reopen a case often depends on the type of settlement you agreed to.
What is a “stipulated award” or “compromise and release”?
These are two common types of settlements in California workers’ comp cases. A stipulated award provides ongoing medical care for your injury and sets disability payments, while a Compromise and Release is typically a lump-sum payment that closes out your right to all benefits, including future medical care.
Discuss Your Case with a Knowledgeable California Workers’ Compensation Attorney
The workers’ compensation system is filled with procedural requirements and deadlines that can be difficult for anyone to manage, especially while recovering from a serious injury. If your claim has been denied, is facing a long delay, or involves a catastrophic injury, you may want to discuss your situation with a legal professional. An experienced attorney can advocate on your behalf, handle communications with the insurance company, and build a strong case to secure the benefits you deserve.
At Bentley & More LLP, our attorneys provide aggressive and compassionate representation to injured workers throughout Southern California, from Orange County to Riverside and San Bernardino. We focus on complex and serious injury cases that require dedicated litigation experience. Many of our cases are referred to us by other lawyers who trust our ability to handle difficult claims.
If you are struggling to get answers about your claim, contact Bentley & More LLP at (949) 870-3800 or through our online form for a free consultation to tell your story and learn how we can help.