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Filing Workers’ Compensation Claim in California

All You Need to Know

Did you know filing a worker’s compensation claim in California follows a different procedure and has a separate judiciary system as compared to other states?

Compensation insurance is a must for all employees working in California. If a company fails to provide worker’s compensation insurance, it may face various criminal and civil penalties. In case you get injured at the workplace, you need to file a claim to get compensation from an insurance carrier. However, if there is any dispute related to your claim, you must deal with the Compensation Appeal Board for workers.

What Kind of Workers’ Compensation Benefits Can I Receive?

This whole process can be cumbersome for a worker experiencing injuries. You must seek the assistance of professional attorneys such as MVP Law to get fair treatment and the benefits of workers’ compensation. The experts at the reputable law firm specialize in dealing with private and public sector workers’ compensation, employment laws, and general liability.
As you read further, you can get an explanation of the process, steps, and system of a workers’ compensation claim in California for your understanding. It improves your knowledge of:

• Occupational injuries covered by workers’ compensation in California
• Reporting and claiming process
• Compensation and benefits
• Documents sent by an insurance company
• Dispute handling related to injury
• Criteria used to calculate injury
• Details of how a claim ends

Who Files a Compensation Claim in California

Workers in California do not need to prove that their injury was actually someone else’s fault to receive compensation. The reason that they are “injured during work” is enough to claim the benefits. Apart from certain conditions (related to suing an employer), workers do not need other options if they get injured at work.

Put simply, Californian laws protect you if you meet an accident or concede an injury while performing official duties. There is a Californian Constitution that gives employees the right to claim compensation and get the deserved benefits. Furthermore, workers in California get the benefit of the doubt from the laws.

You need aggressive representation to fight the insurance company and the insurance company’s attorney to get you the compensation you deserve. We will guide you through all the steps required to advance your claim, including:

Responding to denials of medical treatment
Making sure you see an independent, neutral doctor for an evaluation.
Filing all necessary workers’ compensation claim paperwork for you.

When Will I Receive My Benefits?

You can get medical care for your injury or illness immediately. If medical providers know you have a pending workers’ compensation claim, they cannot attempt to collect payment for treatment, from you directly. In order to receive other benefits, your claim must be approved by the insurance company. Unfortunately, there is no way to predict when this will happen, as offers to settle are made on the insurance company’s schedule. In some cases, we may need to take your case to court to secure the benefits you need and deserve.

(AOE) / (COE)” - What Does It Refer To?

The terms refer to finding out if an injury happened during a job course or arose out of the job site.
The purpose is to investigate the alleged claims of a worker. The requirement is to gain the benefits of compensation if the injury occurred while the employee was working. This may also include official meetings and driving to work, but not traveling to or from work. However, AOE/COE does not consider the claim acceptable if a worker was injured due to:
• Alcohol intoxication/drugs
• A dispute started by himself/herself
• Self-inclined
• Attempted felony

Injury Types to Get Compensation

An injury at the workplace refers to a health issue or injury that arises due to the completion of a work-related task. It can be psychological trauma. However, a non-work injury is different and is often caused by aggravated working conditions. Some of the common injuries include upper and lower back ailments such as carpal tunnel syndrome, which is one of the repetitive motion injuries.
The code section 3208.1 defines two general types as workers’ compensation injuries.

  • Specific Injury
    Any injury that is a result of an incident and causes workers to miss their work or need medical assistance categorized as a specific injury. It can be anything such as falling from an office building or breaking the leg while doing labor work.
  • Cumulative Trauma
    Any repetitive physical or mental injury that develops over time and causes employees to miss work or need medical assistance is considered cumulative trauma. It may include activities such as repeatedly typing or any uncomfortable activity.

Do Independent Contractors Get Workers’ Compensation?

You are a regular worker for the workers’ compensation system until your employer proves you an independent contractor to deny your compensation benefits after an injury. That is what makes it hard to understand the criteria, which the compensation system uses to differentiate regular workers and independent contractors. There are plenty of factors that this system reviews. The most important one is assessing the nature of work and the control of the employer over the worker.
Know that even if your agreement states that you work as an independent contractor, you can claim the compensation and may be entitled to receive the benefits.

Do Independent Contractors Get Workers’ Compensation?

You are a regular worker for the workers’ compensation system until your employer proves you an independent contractor to deny your compensation benefits after an injury. That is what makes it hard to understand the criteria, which the compensation system uses to differentiate regular workers and independent contractors. There are plenty of factors that this system reviews. The most important one is assessing the nature of work and the control of the employer over the worker.
Know that even if your agreement states that you work as an independent contractor, you can claim the compensation and may be entitled to receive the benefits.

Special Benefits for Public Employees

 If you fulfill the criteria of LAB Code 4850 (b), you are eligible to receive 12 months of monetary benefits instead of temporary ones. Moreover, employees with pneumonia, heart disease, hernia, etc. have this presumption to claim that aggravated work caused their injuries.   

Similarly, if a firefighter develops cancer due to constant exposure to carcinogens, he/she gets presumption. Certain kinds of public employees get special presumptions and compensation benefits, such as police officers.

A Claim Form Has A Statement:

“Anyone who makes a false accusation or fraudulent statement or presents misinterpreted material to obtain or deny compensation benefits is guilty of a criminal act.”
After receiving the form, the employer needs to fill the following details:
• His/her name
• Address
• Date when he/she learned about the injury
• Date of providing and receiving the claim form
• Details of the insurance company
• Number of the insurance policy
• Employer’s signature

Important Notices from an Insurance Company

Employers need to send the claim forms to an insurance company after receiving them. Insurance company, in response to claims, provides specific notices stating various rights and details, such as:
• The process insurance company will be using to collect workers’ compensation
• A detailed description of different compensation benefits for workers
• What happens when employers file a claim form
• The role and importance of primary treating medical professional
• How employees can get immediate medical care if the claim is in process
• Labor code sec 132a- specifying protection against employee discrimination
• Employee’s right to oppose the decisions affecting compensation claims

The Statute of Limitations for Compensation Claims

Insurance companies use the statute of limitations as their defense to deny compensation benefits. When an employee files a claim, it not only notifies the employer but also starts the process of compensation benefits. The defense system applies to employee’s legal rights to get compensation benefits within a certain period. The standard time of these limitations is one year; however, there are some situations that may delay the process.
Typically, this period is calculated from:
• The injury date
• The last payment date of disability benefits
• Date of previous healthcare treatment
The statute of limitations is not applicable if an employer does not inform its employees about their right to file a compensation claim or does not give them the claim form.

How Does Insurance Company Investigate My Claims?

An insurance company accepts or denies compensation claims within 90 days after an employee files a claim form. If the company does not decide in the given time, the injury is considered accepted.
Until the claim is under consideration, an insurance company provides injured employees with up to $10,000 for medical treatment. Many insurance companies question workers under oath, obtain their medical records, and have them evaluated by the health professionals.

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