What Happens Once My Claim is Accepted?

Workplace injuries, including overuse injuries and illnesses, occur every day in California. They can leave many employees wondering how they will recover from their injuries or pay their bills. Thankfully, many injured employees are covered by the California workers’ compensation system. Waiting to find out if your workers’ comp claim has been accepted can be an extremely stressful time. You may be trying to recover from your physical injuries and making contingency plans for the future. Learning that your claim is accepted might be one of the best days of your life, but what happens now?

What Does it Mean if Your Claim is Accepted?

After reviewing your claim, the claims administrator will decide to either accept or deny it. Your workers’ compensation benefits will cover further medical care if your claim is accepted. You may also be eligible for compensation for lost wages if your claim is approved. On the other hand, a claim denial means that the administrator determined that you are ineligible for benefits. If you want to pursue benefits further, you will need to attempt to settle your claim or pursue an appeal.

Continue Any Necessary Medical Care

Once your claim is accepted, your treating physician will use current medical guidelines to recommend and prescribe appropriate treatments to help your recovery. They will also submit reports to the claims administrator regarding your ability to return to work. Your employer will cover the costs of your medical treatments and care. It’s crucial that you follow your doctor’s instructions. For example, if they tell you to always use crutches when you walk, use them each time you walk. If they want you to return for follow-up care, be sure to do that within the timeframe they tell you to do so. Not adhering to their advice or instructions can be detrimental to your benefits.

Your Eligibility for Disability Benefits

Based on your physician’s reports, the claims administrator will determine which type of benefits you are eligible to receive. Temporary workers’ comp benefits can begin shortly after your injury or illness if you are unable to go to work for more than three days. However, your eligibility for permanent benefits can only be determined after your physician reports that you have reached maximum medical improvement (MMI), which might take several more weeks or months, depending on the type of injury or illness you suffer.

Getting Your Benefits Paid

Your employer should reimburse the costs of your medical care in a timely manner. Your disability benefits should be paid bi-weekly during the time period chosen by the claims administrator. You may also be eligible for a Supplemental Job Displacement Benefit if you have a permanent partial disability and your employer doesn’t provide you with suitable work.

Unfortunately, workers’ comp claims don’t always go as expected. For example, suppose you are having difficulties receiving the benefits you believe you are entitled to or were recently injured on the job. In that case, it’s in your best interest to reach out to an experienced El Monte workers’ compensation attorney as soon as possible.