At Ghitterman, Ghitterman & Feld, our Santa Barbara workers’ compensation lawyers know that getting hurt at work can lead to a lot of confusion. Depending on the severity of the incident, the injured California worker may need immediate medical attention. In other cases, they may be able to seek help on their own. In different scenarios — and countless others that can occur — some guidelines and processes dictate how workplace injuries should be reported, giving the employee the best chance of pursuing workers’ compensation benefits without delay.
Best Practices for Pursuing a California Workers’ Compensation Claim
After a work-related injury occurs in California — whether it is an immediate injury caused by a one-time incident, an occupation illness, or a repetitive stress injury that accumulates over time — employees may be eligible to pursue workers’ compensation benefits when they follow the proper steps.
- Reporting the Injury to the Employer
With limited exceptions, injured California employees must report a work-related injury to their employer within 30 days of the injury occurring or becoming aware of it — although the sooner, the better. The employer must provide the employee with a workers’ compensation claim form, called a Form DWC-1, and include information about their rights and potential eligibility for benefits.
The employee should complete the “employee” section of the form, sign and date it, and keep a copy for their records. The employer’s claim administrator should review the claim and submit it to their insurance provider.
- Seeking Medical Care Immediately
The employer should authorize care up to $10,000 while reviewing the claim.
If the employer has a medical provider network (MPN) or health care organization (HCO) outlined in their workers’ compensation package, the injured employee must seek primary medical care from the designated provider unless emergency treatment is required.
If there is no designation for medical care, the employee can see a physician of their choice. Be sure to tell the treating physician that your injury or illness is job-related.
- Awaiting the Employer’s Internal Claims Administrator’s Decision
Based on the physician’s reports, the employer’s internal claims administrator will decide whether the employee is eligible for workers’ compensation lost wage benefits. If so, the employer will send the completed form to the workers’ compensation insurance carrier, which will render a decision regarding lost wage benefits.
Temporary benefits can start soon after the injury leaves the employee out of work for more than three days.
Permanent benefits can only be determined after the physician reports the employee has reached maximum medical improvement, which may take several weeks or longer.
What Happens if a California’s Workers’ Compensation Claim is Denied?
If a California workers’ compensation claim is disputed or denied, the employee must attempt to pursue an appeal. If the employee has not contacted an experienced California workers’ compensation attorney, now is the time to do so, as the process will only become more difficult going forward.
At Ghitterman, Ghitterman & Feld, our lawyers have protected workers’ rights since 1956.
We have six physical offices in Bakersfield, Fresno, Santa Barbara, Santa Maria, Ventura, and Visalia, and our top-tier technologies provide a virtual reach to serve clients throughout California. We offer free in-person, telephone, and virtual consultations to offer straightforward legal advice for your unique needs. Contact us today to learn more.