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How to File a Worker’s Compensation Claim

The California workers’ compensation program provides financial benefits to injured workers without requiring the worker to prove anyone else’s negligence. Filing a workers’ compensation claim will result in payment for accident-related medical costs and two-thirds lost wages, without the worker needing to pursue a lawsuit. If you suffer an injury at work, you or your lawyer must obey the state’s filing requirements to obtain an insurance settlement in a timely manner – starting with reporting the accident to the employer.

Notify a Supervisor of the Accident

In California, you have 30 days to report your injury or illness to your employer or supervisor. This is the time frame in most states. You should always notify your employer immediately, but if you wait longer than 30 days you could lose your right to any workers’ compensation benefits. Your employer could use your delay as a reason to deny your claim. The only exception is if you realize your injury or illness after the 30-day mark. In these situations, the deadline begins the day you first missed work because of the injury or the day you should have known work caused your injury or illness.

Get Emergency Medical Treatment

Request an ambulance or visit the closest hospital right away for serious workplace injuries. Your employer cannot stipulate a specific physician if it is an emergency. If it is not an emergency, however, your employer may have the power to control where you go for medical care. Many employers have lists of approved providers for workers’ compensation purposes. You may have to choose a doctor in your employer’s network to qualify for workers’ comp.

File Your Workers’ Comp Claim

Once you have received treatment for your work-related injury or illness, work with your employer to file the actual workers’ compensation claim. In most cases, your employer will file the claim for you. Your employer must legally give you the claim form within one working day of learning about your accident. You and your employer will need to fill out Form DWC-1 and file it with the California Division of Workers’ Compensation. You will need to fill out at least a portion of the paperwork, while your employer will do the rest and give you a copy.

Wait for a Response

After submitting the official claim, your employer’s workers’ compensation insurance company has 14 days to respond. The insurance company must send you a letter giving you an update on the status of your claim within this time limit. If you do not receive the letter, call to ask about your claim status. The insurance company then has 90 days to issue its response.

  • Claim acceptance. If the insurer accepts the claim, you will receive a settlement offer. In California, workers’ comp benefits may cover medical care, temporary or permanent disability benefits, supplemental job displacement benefits, and death benefits.
  • Claim denial. If the insurer denies the claim, it must give its reason for the denial. The reason could be a missed deadline, or that the insurer believes your injuries did not occur at work.

If you receive a claim denial, you have the right to appeal the decision. Do this quickly, so you do not miss your deadline. A workers’ compensation lawyer can help you with the appeal process. You may need to provide further documentation of your accident or injuries, or evidence such as eyewitness statements.

Learn Your Options

Workers’ compensation is often the simplest outlet for financial recovery after an on-the-job injury. However, it may not be your only choice. If someone else’s negligence caused or contributed to your injury or illness, you may have grounds for a personal injury lawsuit instead of or in addition to your workers’ comp claim. After a severe workplace accident, speak to an attorney about your options.