The Workers’ Compensation system is designed to provide benefits for those who are injured or become ill due to their job. In essence, the employer is not held liability for the injury or illness; when all goes well, the worker receives fair compensation. Unfortunately, claims are often denied for various reasons; filling out the forms and following the procedures correctly is essential.

When Should I Report My Injury to My Employer?

Employees should report any work-related injury or illness to their employer as soon as possible. California law allows only 30 days from the date of the incident to notify an employer; failing to meet this deadline can lead to a loss of benefits.

After the injury is reported, the employer is required to provide a claim form (DWC-1); once that is completed and returned to the employer, the case is opened.

What Happens After I File the Claim Form?

The employer is then responsible for submitting the completed form to their Workers’ Compensation insurance provider. This begins the investigation into the injury and its connection to the job.

During this period, the employee has the right to receive medical treatment. Up to $10,000 in medical expenses may be covered while the claim is under review, even if it has not yet been approved.

What Benefits Might Be Available Under Workers’ Compensation?

If the claim is accepted, the employee may be entitled to various benefits. These can include medical care for the work-related injury or illness, temporary disability payments if the employee is unable to work during recovery, permanent disability payments if the injury results in lasting impairment, and supplemental job displacement benefits if the worker is unable to return to their prior position.

Additionally, in cases involving fatal workplace injuries, death benefits may be available to eligible dependents.

What If the Claim Is Denied?

If a claim is denied, the employee can challenge the decision by requesting a hearing before the Workers’ Compensation Appeals Board (WCAB). This involves filing an Application for Adjudication of Claim and a Declaration of Readiness to Proceed. These documents initiate the process of having the case reviewed by a Workers’ Compensation judge.

Evidence can be presented to support the injury’s connection to the job. Medical records, witness statements, and accident reports may all play a role in the appeal process.

Is There a Deadline to File a Workers’ Compensation Claim in California?

In California, the statute of limitations for filing a Workers’ Compensation claim is one year from the date of the injury or from the last date of any benefits provided. This time frame may also start from the date the employee became aware of the job-related nature of an illness or injury.

Failing to act within the one-year limit may result in a loss of benefits. There are some exceptions, but those are limited and specific, such as cases involving minors or if the employer failed to provide the required claim form.

Can I Choose My Own Doctor?

That depends on whether the employer has a medical provider network (MPN). If an MPN exists, the employee is generally required to select a doctor within that network after the first visit. However, if the employee has predesignated a personal physician before the injury, they may be allowed to use that provider.

It is important to follow the treatment and referral guidelines set by the employer and their insurance carrier to maintain eligibility for ongoing medical care.

What Should I Do If My Employer Does Not Report My Injury?

If an employer fails to submit the claim or provide the proper forms, the employee may contact the Division of Workers’ Compensation Information and Assistance Unit. This office offers guidance on how to move forward, including steps to submit a claim independently. Keeping personal records of all communications and documents can help support the case if there is a dispute.

Ontario Workers’ Compensation Lawyers at Lerner, Moore, Silva, Cunningham & Rubel Are Here to Help

Are you facing issues with your claim? Our Ontario Workers’ Compensation lawyers at Lerner, Moore, Silva, Cunningham & Rubel are available to assist. For a free consultation, call 909-889-1131 or complete our online form. Located in Ontario and Victorville, California, we serve clients in San Bernardino County, Ontario, Victorville, Hesperia, Apple Valley, Fontana, Rancho Cucamonga, Colton, and Riverside County.