How to File a California Workers’ Compensation Claim

If you have been injured while working in California you can take advantage of the state’s no-fault workers’ compensation law. The law entitles you to benefits if you have suffered a workplace injury, even if your employer is not found to be at fault.

While your rights to workers’ compensation are protected by state law, not all employers or insurers are willing to provide compensation for on-the-job injuries. That is why the California Workers Injury Law Center strives to help its clients get the benefits they deserve.

Who Can File a Claim?

California law requires all employers, no matter how large or small, to carry a workers’ compensation insurance policy. In addition, state law requires that all such policies provide benefits to all workers who can show that they were injured while performing their duties, regardless of who was at fault.

Policies must cover all workplace injuries from accidents, repetitive motions, or prolonged exposure to harmful conditions. Policies must also cover some stress-related or psychological injuries. That means benefits go beyond just workplace accidents and that you may be entitled to workers’ compensation if the injury results from the day-to-day stresses and strains of performing your job properly.

Additionally, California’s workers’ compensation law does not limit benefits to just full-time employees who have been injured while working. In some cases, part-time employees, temporary employees, and independent contractors who have gotten hurt may be eligible. Finally, California law does not require that the injured worker be a legal U.S. resident to receive workers’ compensation.

Typical Workers’ Compensation Injuries

While there is no definitive list of workplace injuries that are eligible for workers’ compensation, most injuries fall into one of the following categories:

  • Vehicle accidents while driving or riding for work-related purposes
  • Machinery accidents
  • Slipping, tripping, or falling on wet floors or icy walkways
  • Being struck by something falling off a shelf or dropped by a coworker
  • Electrocution that causes burns, nerve damage, organ damage, or brain injury
  • Exposure to dangerous substances such as chemicals, asbestos, and lead
  • Injuries from fires or explosions
  • Overexertion where a muscle or joint breaks down due to physical activity
  • Workplace violence

Workers in some professions are also more likely to suffer workplace injuries than others. For example, corrections officers, firefighters, and construction workers are more likely to suffer serious physical injury than office workers.

How to File a Claim

The California workers’ compensation process begins when an injured worker files a Workers’ Compensation Claim Form. Employers are required by law to provide you with a form within one working day of learning of your injury. You will then fill out the “employee” section of the form and return it to your employer. Failure to return the completed form could result in losing your benefits.

Your employer should then complete the form and file it with its insurance company. In most cases, the insurer has 14 days to issue you a letter informing you of your claim status. If you do not receive a copy of the letter, contact the insurance company. If your employer does not deny your claim within 90 days of receiving the claim form it is presumed that workers’ compensation covers your injury.

Your employer must authorize appropriate medical treatment within one day of receiving the claim form. You may also receive up to $10,000 in medical treatment while your employer is deciding whether to reject your claim.

How Long Do I Have to File?

It is usually recommended that you file a claim as soon as possible after being injured, but you generally have one year from the date you were injured to file a claim. However, in some cases it is not clear when the injury occurred because it resulted from repetitive exposure to working conditions. In those situations you have one year from the last date you were exposed to the conditions which caused the injury.

What if My Claim is Denied?

Many claims for workers’ compensation are resolved without any problems, but the insurance company that provides your employer’s policy will sometimes choose to deny a claim. The most common reasons for claims being denied include:

  • The workplace injury did not require medical treatment
  • There is no proof that you were injured
  • The injury was unrelated to your work
  • Your injury is not preventing you from returning to work

If your claim is denied you can still file an appeal with the Workers’ Compensation Appeals board and ask it to review the determination. If you choose to file an appeal, it is generally a good idea to seek the assistance of an attorney who is familiar with the appeals process because lawyers for the insurance company and your employer are usually involved in appeals.

What Benefits Can I Receive?

Your employer must provide for your medical care if you are injured while working, regardless of whether you miss any work. Additionally, injured workers may be eligible for the following workers’ compensation benefits, depending on the extent of their injuries and the nature of their jobs:

  • The cost of medical treatment, as well as expenses for traveling to and from treatment
  • Temporary disability payments for missed work
  • Permanent disability payments for workers who can no longer participate in the job market
  • Vocational retraining for workers who cannot return to their previous employer
  • Death benefits for spouses and dependents
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