California employers are required to carry workers’ compensation insurance coverage. So, if you’re injured at work in California, you will receive medical and other benefits for that injury. But to get your benefits, you need to follow all the required steps, and you may need the assistance of an experienced workers’ comp attorney.
What Coverage Does Workers’ Comp Provide?
California requires your employer to give you a lot of workers’ comp benefits, not just pay your medical bills. The mandatory coverage in California includes:
- Medical bills and treatments
- Temporary disability payments
- Permanent disability benefits
- Supplement job displacement funding – if you can work, but not at your old kind of work
- Death benefits for the family if a worker dies from a work-related injury.
As you can see, pretty much anything you need for your work-related injury will be covered by workers’ compensation. But you will need to follow each of the required steps to get all your benefits – and to get them as soon as you need them.
How Does a Workers’ Comp Claim Work?
When you’re injured at work, you will need to take some specific steps to claim benefits under workers’ compensation. These steps are:
- Report the injury to your employer – no matter how small it seems, report the injury right away
- Get immediate medical treatment – don’t wait to feel better; visit the doctor as soon as you can
- File the claim with your employer – notify your employer that you’re filing for workers’ comp right away. The sooner you do this, the sooner you get paid, and the harder it is for your employer to dispute your claim.
- File an “Application for Adjudication of Claim” with the Workers’ Comp Appeals Board (WCAB) – assuming that you need to, of course. If you’re getting all your benefits and your employer isn’t disputing your claim, this step won’t be necessary. It often is, however.
Kinds of Injuries
There are different kinds of injuries covered by workers’ comp. There are obvious injuries from a workplace accident, and then there are repetitive strain injuries or others that do not result from a single incident. Both are compensable by workers’ compensation benefits.
Immediate Clear Injury
Some injuries are pretty clear on when and how they happened. For example, you were working with heavy equipment, and you dropped it on your foot, breaking some bones. The injury happened when you dropped the equipment, and there would be no dispute about that.
Less Obvious Injury
Other injuries are less apparent on timing. For example, a repetitive stress injury like carpal tunnel or an occupational disease like black lung can take years to appear. So timing is an issue. Some of the more common injuries and diseases in this area include:
- Vibration injuries from machines
- Tendonitis in elbows or knees
- Shoulder injuries such as a rotator cuff repair
- Bursitis in hips, elbows, or shoulders
- Carpal tunnel syndrome in wrists or hands
- Back injuries from lifting, bending, or twisting
- Work-related diseases arising from your employment conditions like cancer or hearing loss.
Once you become aware of the condition you should report it to your employer right away. Then go back to your doctor right away. That way, it will be harder for your employer to claim that the injuries happened away from work. An experienced workers’ comp attorney can help you with this if it doesn’t seem to be working out with your employer’s insurance company.
When Does My Clock Start Ticking?
If you had an injury, like a fall, that has an exact date, then the date when your clock starts is pretty straightforward. You must file an application with the Workers Compensation Appeals Board within one year of knowledge that your illness or injury is related to your work. There are some exceptions, especially if your employer or your supervisor knew about the injury.
What Happens Next
Within one day of your report, your employer’s workers’ comp coverage company should begin authorizing payment for your medical treatment while it investigates your claim. Until it decides your claim is good, the insurer must cover up to $10,000 in medical bills. If the company doesn’t reject it within 90 days after submitting the form, the claim is considered to be approved.
If you’re missing work because of your injury, the insurance company will begin paying temporary disability within 14 days after learning about the disability. However, if they don’t start payments by then, or deny the claim, or ask for additional information, then they will have to pay an additional 10% late penalty on the late payments.
COVID-19 Related Claims
If you filed a claim based on COVID-19 and it’s apparently work-related, your employer may have shorter window for deciding if your claim is valid.
I’m Getting Money – Am I Done?
No, unless your injuries were minor and you’re basically back to work, fully recovered, and happy with what you got. In the highly likely event that that isn’t the case, you will need to file for adjudication of your claim. If you have any disputes about your coverage, you can only resolve them by going through the WCAB with an Application for Adjudication of Claims. That has to be filed within one year of:
- The date of the injury
- The last day your employer provided medical benefits or
- The day when your temporary disability benefits ended
There are rare circumstances where you may have more time, but basically, the requirement to dispute the claim is one year after the insurer has announced that it is denying the claim.
What to Do If You Missed a Deadline
If you missed a deadline, you should not try to resolve everything yourself. Workers’ comp can be quite complex once you get beyond the initial claim. You should call an attorney who concentrates his or her practice in workers’ compensation cases so that the firm can bring its knowledge and experience to bear on your claim and help you get all the benefits to which you’re entitled.
A knowledgeable El Monte workers’ compensation attorney can keep you from getting injured a second time – by your mistake. Contact our legal team today.