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How to File a Worker’s Compensation Claim

How to File a Worker’s Compensation Claim

You file a workers’ comp claim by reporting the injury to your employer and filling out the “employee” section of the claim form. You must provide notice of the injury and file the form as soon as possible, as there is generally a 30-day deadline for filing a claim after an injury.

The workers’ compensation claims process is not always simple and can be fraught with hazards. If you do not navigate this process wisely, you may not obtain the benefits you deserve for your work-related injury or illness. Allow a trusted Orange County workers’ compensation attorney to lead this process for you.

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What to Do to Ensure the Accurate Filing of Your Workers’ Comp Claim

It is critical that your workers’ comp claim is filed on time, accurately, and with all necessary information. While your employer is responsible for filing the claim with their insurance provider, you can do your part by:

Notifying Your Employer of the Work-Related Injury

You should notify your employer of your work-related injury as soon as possible. You may:

  • Explain how the injury happened (though you should be careful not to suggest the injury happened due to horseplay or impairment)
  • Explain the symptoms you are suffering because of the work-related accident
  • Provide written, dated notice of the injury (keeping a copy for your records)

You must keep a copy of this written notice for your records. If your employer or the insurance company later claims that you did not provide sufficient notice of your injuries, this documentation may prove otherwise.

Filling Out the Claim Form Accurately

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State authorities advise you to:

If you hire a lawyer, they can help you fill out this form. Your lawyer will also review the form to ensure its completion and accuracy before returning it to your employer.

Returning the Claim Form to Your Employer

You must return your completed claim form to your employer. Again, remember to keep a copy of the form for your own records.

Following Up with Your Employer to Ensure They File the Claim

You may ask your lawyer for concrete proof that they have filed the claim, and a lawyer can make this request for you. Your compensation is on the line, and you can ask for proof that the claim is filed properly.

You Should Receive a Decision from the Insurer Within 14 Days of Filing the Claim

After your employer submits the workers’ comp claim, you should hear back from the insurance company within 14 days. There may be some variance in this timeframe, but it should not take much longer than 14 days for you to receive a decision.

If you have a lawyer leading your claim, they will be in contact with the insurance company. It will prevent any unnecessary delays in the processing of your claim or the rendering of a decision.

What If I Disagree with the Insurance Company’s Decision?

The Workers’ Compensation Appeals Board (WCAB) is a judicial body that oversees workers’ compensation claims in the state. Among other duties, this body adjudicates appeals of decisions by workers’ compensation insurance providers.

You may interact with the WCAB if you:

  • Are denied workers’ compensation benefits
  • Receive fewer benefits than you deserve
  • New evidence has emerged that can affect the claim decision
  • Have any other issues related to a workers’ comp claim

Again, you should consider having a workers’ comp attorney oversee your claim. A lawyer may be especially helpful if you need to file an appeal with the WCAB.

File an Appeal with the Workers’ Compensation Appeals Board

Your attorney will lead any necessary appeal related to your claim for benefits. Your attorney will likely file a Petition for Reconsideration, and the following process may include:

  • Filing the petition
  • The opportunity to come to an agreement with the insurance company about claim-related issues, in which case you may settle with the insurer
  • A judge making a ruling if you cannot come to an agreement with the insurance company about claim-related details

The WCAB can dismiss your appeal if you file the wrong type of petition or if there are any other significant errors during the filing process. This makes it all the more important to have an experienced attorney representing you.

Can I Sue for a Work-Related Injury?

Injured and sick workers can sometimes sue for harm related to their injury or illness. Though workers’ compensation coverage generally protects employers from facing a lawsuit, you may sue if:

  • Your employer does not have active workers’ compensation insurance
  • Your health problems resulted from negligence by a third-party
  • Other circumstances make you eligible to file a lawsuit

Your attorney will review your case and explain whether you can file a lawsuit. Your lawyer’s understanding of workers’ compensation coverage, insurance rules, and civil law will allow them to provide reliable advice.

Should I Hire a Workers’ Comp Lawyer to Help with My Claim?

You should consider hiring a workers’ comp attorney for several reasons, including:

  • The cost of work-related injuries: You may be facing costly medical bills, indefinite loss of income, and other losses that prove expensive. This means that your workers’ comp claim may have significant financial stakes. If you believe a lawyer can help you recover the compensation you deserve, you should not hesitate to hire an attorney.
  • The complexity of the claims process: You have learned that the workers’ comp claims process can be complicated. The claims process is very involved, from filing your claim form to responding to the insurance company’s decision. When you hire an attorney, you don’t have to worry about any aspect of the claims process.
  • The possibility that you’ll need to appeal: If the insurance company renders a decision you don’t agree with, you’ll need to respond quickly and definitively. An attorney will be ready to appeal any adverse decision, and they’ll oversee every step in the appeals process.
  • The potential that you’ll file a lawsuit: If you are eligible to file a lawsuit, you might struggle to lead the legal process on your own. Attorneys regularly handle lawsuits for clients, and they will handle any suit you choose to file.
  • A lawyer’s experience: It is impossible to place a value on a lawyer’s legal training and experience. However, there is no doubt that experience is a massive benefit to any workers’ comp claim or lawsuit.
  • A lawyer’s financial backing: Workers’ compensation attorneys provide crucial financial support for clients’ claims and lawsuits. Your attorney may hire experts to contribute to your case. They will also cover filing fees and other claim-related expenses.
  • Your need to recover from injury or illness: Nothing should come before your recovery. Yet, your workers’ comp claim is vitally important. Ensure that both of these obligations receive due attention by letting an attorney lead your claim.

Trials can be particularly costly. If you file a lawsuit and your case goes to court, your lawyer’s financial backing will become all the more valuable.

You Can Hire a Workers’ Comp Attorney at No Out-of-Pocket Cost

Injured workers might assume they have to pay an attorney an hourly rate or flat fee, but this isn’t the case. Workers’ comp attorneys typically use contingency fees, which mean:

  • The law firm pays the entire upfront cost of completing your claim (or lawsuit)
  • You pay the law firm no upfront fee
  • The law firm only receives its fee if it obtains a settlement or verdict for you
  • There is no direct financial risk in hiring your workers’ comp attorney
  • The law firm accepts the financial risk of your case and has a direct financial incentive to obtain compensation for you

This fee structure benefits those who have suffered an injury or are sick and are facing financial uncertainty. It may describe you, and this low-risk fee structure is crucial to hiring your lawyer as soon as possible.

How a Workers’ Compensation Lawyer Will Help You

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You get much when you hire a workers’ comp attorney. Your legal team will assist you by:

Helping File Your Claim

Filing your claim is one of the first steps towards your financial recovery. Your attorney can:

  • Help you fill out the employee section of the claim form
  • Return the form to your employer
  • Ensure that your employer files the claim form with the insurance company

Specifically, your attorney will ensure you fill out the claim form completely and accurately. They will also make a copy of the form and document your submission to avoid claims that you did not file it on time.

Dealing with the Insurance Company

When an insurance company provides compensation to an injured or sick worker, they may be viewed as saving the day. However, you should never assume that the insurance company will handle your claim fairly and timely.

Your lawyer will deal with insurance representatives to:

  • Protect you from any bad-faith tactics (such as denial, lowball offer, or claim delays)
  • Ensure that the insurer receives all necessary information about your injuries and losses
  • Ensure that the insurance company resolves your claim as quickly as possible

If the insurance company issues an unjust decision, your attorney will respond with an appeal.

Detailing Your Injuries

Because your health problems will be the focus of your claim, your attorney will document your injury or illness in as much detail as possible. They may collect:

  • X-rays, MRIs, and other medical images
  • Your doctors’ diagnoses of injuries or illnesses
  • Medical bills
  • Medical experts’ relevant testimony

If any other evidence, testimony, or documentation illuminates the nature of your health problems, your lawyer will incorporate it into your case.

Documenting Your Losses

Injuries often produce several types of losses. Your lawyer may document those losses with:

  • Proof of the income you earned before becoming injured or sick (as this will prove the value of your lost income)
  • Bills for medical services and equipment
  • Documentation of any vocational retraining you require
  • Expert testimony about the nature of your losses

This documentation will be critical in proving the value of your case.

Calculating the Financial Cost of Your Losses

To succeed in representing you, your lawyer must know exactly how much compensation you deserve. When formulating this calculation, they will consider the full extent of your health problems and related losses.

You may have non-economic losses that don’t have a clear financial value. Pain and suffering is the key example of such losses. Attorneys understand how to calculate these losses in an accurate way that the courts will recognize as valid.

Overseeing Any Necessary Appeal

If you need to file any appeal with the WCAB, your lawyer will oversee the appeals process in its entirety. They will:

  • Explain any adverse decision from the insurance company to you
  • Advise you whether an appeal is necessary
  • File the appeal
  • Work with the WCAB to process your appeal
  • Handle any other appeal-related responsibilities

Your lawyer will explain the next steps if an appeal does not produce your desired outcome.

Leading Any Necessary Legal Action

If you are eligible to file a lawsuit, your attorney will:

  • Advise you whether or not filing a lawsuit is worthwhile
  • Draft and file any lawsuit you pursue
  • Negotiate with those who owe you compensation
  • Handle any pre-trial obligations
  • Argue your case in court if your case goes to trial

Lawsuits are an essential job requirement for personal injury attorneys. Whether you resolve your claim or pursue legal action, an attorney will provide all the advice and services you need.

Losses Injured Workers Can Seek Compensation For

Keith More, personal injury lawyer

Keith More, Workers’ Compensation Attorney

Your personal injury lawyer will seek compensation for all of your covered losses or damages, which may include:

  • Medical costs
  • Lost income
  • Vocational rehabilitation
  • Pain and suffering

If you have any other losses or damages that entitle you to compensation, trust your lawyer to seek fair compensation for them.

Don’t wait to hire your workers’ comp lawyer, as they may face non-negotiable deadlines related to your case. Having the right legal representation can relieve stress and improve your chances of proper financial support as you heal from your work-related injuries.

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