What Is an Accepted Claim in a Workers’ Compensation Case?
When a worker is injured on the job in California, they must file a workers’ compensation claim to receive benefits. If the insurance company approves the claim, it is considered an accepted claim. This means the insurer agrees that the injury or illness is work-related and will provide benefits such as medical treatment, disability payments, and other necessary compensation.
How Does a Workers’ Compensation Claim Get Accepted?
After a work-related injury, the injured worker must complete a DWC-1 claim form and submit it to their employer. The employer then forwards the claim to the workers’ compensation insurance carrier. The insurance company has 90 days to investigate and decide whether to accept or deny the claim. If the claim is not denied within this period, it is automatically presumed accepted.
What Benefits Are Provided Under an Accepted Claim?
Once a claim is accepted, the injured worker may be eligible for:
- Medical treatment – Coverage for doctor visits, surgery, rehabilitation, medications, and other necessary care
- Temporary disability benefits – Wage replacement if the worker cannot return to their job while recovering
- Permanent disability benefits – Compensation if the injury results in lasting impairments
- Supplemental job displacement benefits – Vouchers for retraining if the worker cannot return to their previous job
- Death benefits – Financial support for dependents if the worker’s injury results in death
Can an Accepted Claim Be Challenged?
Even if a claim is initially accepted, disputes may still arise. The insurance company might later argue that certain treatments are unnecessary or that the worker has recovered enough to return to work. In some cases, benefits may be delayed or denied despite the claim being accepted. If this happens, the worker has the right to challenge the decision through the California Division of Workers’ Compensation (DWC).
What If a Claim Is Denied Instead of Accepted?
If an insurance company denies a claim, the injured worker can appeal the decision. This may involve requesting a Qualified Medical Evaluator (QME) or attending a hearing before a workers’ compensation judge. Legal representation can be helpful in these cases to ensure that the worker receives the benefits they are entitled to.
Need Help With Your Workers’ Compensation Claim?
If you have questions about an accepted claim or are facing delays in receiving benefits, the Law Offices of Norman J. Homen can help. Contact us today for a free consultation to discuss your case.
