If you are an employee working in California, then you are entitled to compensation if you have been injured or fallen ill as a result of doing your job. However, the process is not a simple one and there are initial and ongoing requirements that you may need to meet in order to ensure that you receive the benefits you are entitled to. Some of the most common questions you may want to ask a California workers compensation lawyer are:
With the advent of the gig economy, the definition of “employee” has become more important than ever. If you have agreed to a contract with a business where you operate as an independent contractor, you are responsible for any injuries you suffer during the course of completing work for them. In all other situations, however, state law requires employers to carry California workers’ compensation coverage for all of their employees. This may be through a state-regulated benefits provider or the state’s own plan.
If you are hurt on the job, you need to notify your employer within 30 days of the initial injury. They should provide you with a DWC-1 (Division of Workers’ Compensation) form that you will need to submit within 24 hours. You will need to take this form and see a doctor that is in your workers’ compensation insurance network in order to assess your injury or illness.
The insurance company has up to 90 days to investigate your claim. You may be under observation or have your medical records reviewed during this time, so be mindful of any posts you make on social media or in other public forums.
There are dozens of statutes that govern workers’ compensation benefits for employees who have been injured on the job. Generally speaking, you are entitled to:
In order to receive those benefits, you must be able to file a timely claim, usually within 30 days of the reported injury. You need to be able to establish to a doctor hired by the insurance company that you have suffered the injury as a result of your work and moreover that you cannot continue to work without medical treatment.
One reason that many people consider a California workers’ compensation attorney is that the medical examiners are working on the insurer’s behalf, not your own. Along with any investigators, they have a vested interest in making sure that your claim is denied, rather than ensuring that you get any care and benefits that you need. This is especially true if you suffer from a cumulative injury that occurs due to frequent work activities or need to re-open a claim based on a prior injury.
The first step if you have become sick or hurt while working as an employee is to notify your supervisor. They or someone else at the company should provide you with a DWC-1 form. You will need to fill out this form and submit it to the insurance company your employer uses. In addition, if you seek medical care, you will need to use a doctor within the insurer’s network. While seeking care, you must submit the form to the insurer within 30 days of the original injury.
It can take up to 90 days for the insurer to review your claim and decide whether to approve or deny your claim for benefits. You will still receive up to $10,000 in coverage for medical care regardless, but you may face other bills and costs while you wait. If you are approved, you will receive a portion of your original weekly wage for up to two years as well as other benefits.
If your employer is compliant with the law, he or she will have purchased a policy from a licensed insurer or through the state’s workplace compensation insurance fund. In these cases, those entities will be the ones who pay out benefits on your claim for workers’ compensation in California.
If your employer did not have valid workers’ compensation insurance at the time of your injury or illness, they will be liable for a $10,000 fine. You will receive benefits based on a documented claim from the state’s Uninsured Employers Benefit Trust Fund.
The extent of workers’ compensation benefits in California depends on your level of disability at the time you initially file the claim. For example, you may be able to receive up to two-thirds of your weekly wage (on average), for a period of up to two years from the time that the insurance company receives a medical report indicating that you are unable to perform your normal duties.
If you can perform other work for the company, you may receive a combination of wages and workers’ compensation benefits. At the other extreme, if you are unable to work in any fashion, you may apply for permanent disability prior to the two-year period of your workers’ compensation benefits in California.
In order to re-establish benefits, you must file a petition to re-open a workers compensation claim in California. You must do so within five years of the original injury. The facts of your case may vary and you may want to consult with a California workers’ compensation attorney to see whether or not you have a good shot of receiving benefits again. Specifically, the petition must show that you need one of either two things: additional medical treatment for the original injury or benefits due to the disability becoming worse since the claim was initially closed.
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