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What Is the Workers’ Compensation Process In California?

Anytime a person sustains an on-the-job injury in California, they should be entitled to various types of compensation for their losses. This includes coverage of all medical bills, travel to and from medical facilities, a portion of any lost wages, and possibly temporary or permanent disability benefits.

However, the process of securing workers’ compensation benefits in California can seem daunting. Here, we want to discuss the main details that you need to know about securing workers’ comp in California.

Seeking medical care

After any workplace injury or illness, the injured employee’s health is a top priority. All injured workers must seek appropriate medical care as soon as possible. Any delay in seeking treatment could affect the injured worker’s ability to recover their compensation. Employers are required by law to make sure that employees have access to emergency medical treatment immediately.

It is crucial for any healthcare provider to know when an injury or illness is work-related. Any person who sustains a workplace injury or illness needs to document every interaction they have with medical professionals.

Reporting the injury

The first step towards receiving workers’ compensation benefits in California is to promptly report the injury to the employer. Under California law, a work injury or illness needs to be reported within 30 days. Any injured worker should tell their direct supervisor and follow the employer’s protocol for reporting these injuries. There are a few documents that need to be filed in order for a workers’ compensation claim to be processed, including the following:

Employers know exactly what these forms are and will usually handle filing them on your behalf, but you should always follow up to make sure that they do so.

Filing the claim

Within one workday after learning about your workplace injury or illness, the employer is required to give you the DWC-1 claim form, which you need to fill out and promptly return to the employer. This form starts the process of getting you the workers’ compensation benefits you are allowed under state law, including coverage of your medical care and disability payments.

After you file this form, an adjuster from the workers’ compensation insurance carrier will contact you to take the next steps in the overall claims process, which will include submitting your medical bills and medical records.

You will need to complete and send in several forms (some of the ones listed above) and continue all follow-up care with your doctor. Unfortunately, there are times when an employer or a workers’ compensation insurance carrier denies the claim.

Resolving the claim

When a workers’ compensation claim is contested during mediation, that will usually be resolved through settlements. In these cases, there are generally two types of settlements:

  1. A Stipulated Finding and Award. This is an agreement between the employer and the injured employee and will have the same effect as a judge’s decision in a trial. This process provides compensation for the claimant’s level of disability while leaving open payments for future medical care. This is not a lump sum payment (unless any previous weekly payments are determined to be overdue).
  2. A Compromise and Release. This will completely close a workers’ compensation claim with a single lump-sum payment the covers the total estimated value of any disability award as well as future medical treatment. This type of agreement usually only happens if a person is not going to continue working for the same employer. Both the employer and the injured employee have to agree to this settlement.

Going to trial

If a settlement cannot be reached, the workers’ compensation case will have to go to trial. In California, these claims are heard before an Administrative Law Judge, meaning there will be no jury. While these trials are generally less formal than civil or criminal trials, any injured worker who makes it this far should most certainly have a skilled Orange County workers’ compensation attorney by their side.