Work-related injuries are sometimes unavoidable in many occupations. These injuries or illnesses related to the work nature or environment can cause the injured employee to miss work and require costly medical treatments. In severe cases, the injured worker might sustain total or partial disability.
State and federal law provide protection to employees who get injured at the workplace. According to the workers' compensation act in California, employers have to purchase workers' compensation insurance to offer coverage to injured employees for disability, medical expenses, pain and suffering, lost wages, and future loss of wages.
The process of filing a workers' compensation claim can be complex that can further increase the stress of the injured worker, which is why it is ideal for getting professional help.
The Law Office of Andrea R. Herman in Los Angeles has a team of dedicated workers’ compensation lawyers who can help you file the claim efficiently and ensure you get the best possible benefits for the injuries sustained. However, it is essential to understand the process of filing a workers' compensation claim. Here are the major steps:
If you get injured at the workplace or find out that your illness has been caused due to your work, you must immediately report it to your employer. An injured worker must submit a written notice of the injuries or illness within the statute of limitation in their state. For California, you must report the injury to the employer within 30 days of sustaining the injury or finding out your illness is work-related.
Specific injuries, like breaking an arm in a slip and fall accident, require emergency medical treatment, while others, like carpal tunnel syndrome, might need a proper diagnosis and treatment.
Medical treatment is usually based on the severity and symptoms of the injuries or illness. First aid treatments are sufficient for injuries that aren’t severe. In this case, the employer has to make the report-only claim. For severe injuries, it can require extensive treatment, and the claim could be more complex.
When the employee reports the injury and gets medical treatment, the employer submits a formal report of the injury and symptoms to the workers' compensation insurance provider. The claim form might differ based on the carrier but generally requires the following information:
The worker needs to follow up on the claim and continue to organize their medical expenses. You must also continue to get the relevant treatment recommended by the doctor and follow the after-care. Be sure not to miss any follow-up appointments with the health care provider.
It's wise to keep track of how your injury or illness impacts your life and your ability to perform your work duties. Keep a record of all the medical receipts and other proof that can highlight your hardships due to the work-related injury. This might not be necessary, but these details can prove crucial in case the claim is denied and you need to appeal.
After the employer files the workers’ compensation claim, the insurer will go through the documentation and either deny or approve the claim.
Claim Approval:
If your claim has been approved, your employer will be notified, and you will be contacted regarding the payment details. You and your workers' compensation lawyer can review the offer and decide on the next steps. You can either:
Claim Denial:
If your claim is denied, you still have a few options, including:
It is recommended to consult a workers’ compensation lawyer to assist you with the claim reconsideration or appeal since it is a more complex process.
When you are ready to return to work, you have to submit a written notice to the insurance company and the employer. Depending on your case, you might be entitled to a permanent disability benefit or retraining.
Multiple employers prefer to conduct a specific return-to-work session to assist the returning employee in adjusting back to work and maintaining their productivity.
You may qualify for disability benefits if you meet the eligibility requirements. It is essential to ensure you are following all the rules and guidelines for receiving the medical treatment highlighted by the state. Your medical doctor must notify the insurance carrier about the disability.
Once the insurer is notified, you will start receiving the disability benefits in two to three weeks. However, it is best to consult a workers’ compensation lawyer in case of a dispute over the overall amount or whether or not there are lasting impairments.
It is essential to understand that permanent disability compensation might not last for a lifetime. You might receive a lifetime pension if you get permanently or totally disabled. For partial permanent disability, the state limits would determine the duration of the benefits.
The process for filing a workers' compensation claim is complex and different for each employer, insurance carrier, and the injuries sustained. While these steps clarify the overall process, the procedure might prove lengthy and exhausting for the injured employee.
Getting professional assistance from a workers' compensation lawyer is a wiser option, so you don't have to go through it alone. The Law Office of Andrea R. Herman ensures the injured worker gets the best benefits without enduring all the legwork. Our lawyers can guide you through each step and conduct the negotiations on your behalf. Since each work-related injury is different and has a chance of getting denied, having a lawyer by your side is the best way to ensure a successful claim.
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