Claims Process

When you are injured at work, you may be entitled to workers’ compensation benefits. There are several steps involved in a workers’ compensation claim. Filing a workers’ compensation claim can often be confusing. The Stockton workers’ compensation attorneys will guide you through the process, so you have the best chance of receiving the benefits you deserve.

What do I do after reporting my injury to my employer?

claims processThe first step after an injury at work is to report your injury to your employer. After reporting a work-related injury, your employer must provide you with a Workers’ Compensation Claim Form (DWC-1) within one day of reporting your injury. You must fill out the “employee” section of the form and describe your injury to the best of your ability. It is essential that you include every part of your body affected. After completing the “employee” section of the DWC-1 form, you must give your employer the form to complete. You can provide the DWC-1 form to your employer in person or by mail. If mailing the DWC-1 form to your employer, we recommend using first-class or certified mail. The Stockton workers’ compensation attorneys recommend requesting a return receipt so that you have a record of the date that it was mailed and received. It is essential to do this right away as workers’ compensation claims are time-sensitive, and failing to do so promptly can cause problems for your claim down the road.

Your employer must give the completed form to the workers’ compensation claims administrator who handles workers’ compensation claims for your employer. Usually, the workers’ compensation claims adjuster works for your employer’s workers’ compensation insurance company or works for another organization that handles workers’ compensation claims for your employer. It is your employer’s responsibility to provide the completed copy of the DWC-1 form to the claims administrator, as well as provide you with a copy of the completed form within one working day from you filing the form. If your employer does not provide the form to you, we recommend requesting a copy of your employer’s completed claim form and keeping it with all your records. After filing a claim, the next step is to wait for the claims adjuster to decide whether or not to accept or deny your claim.

What happens after filing a workers’ compensation claim?

If a workers’ compensation claims adjuster accepts your workers’ compensation claim, which means that workers’ compensation covers your injuries. When your claim is accepted, you are able to obtain paid medical care to cover doctor appointments and treatments for your work-related injury. You might also be eligible for temporary disability benefits or permanent disability benefits to help cover lost wages due to your injury.

If the workers’ compensation claims adjuster does not believe that workers’ compensation covers your injuries, then your claim is denied. In that case, you have the right to dispute that decision. If you plan on challenging your denial, you should not delay and contact a Stockton workers’ compensation attorney as soon as possible because there are deadlines to fight claims.

When do you hear if your workers’ compensation claim is accepted?

Claims adjusters must make a decision, within a reasonable period of time, whether to accept or deny your claim. In general, your employer’s workers’ compensation insurance company has 14 days to inform you of your claim’s status. In most cases, if you do not receive a letter that denies your claim within 90 days of filing your claim, then your claim is considered to be accepted.

What workers’ compensation benefits am I entitled to if my claim is accepted?

There are typically five benefits that you can receive if your workers’ compensation claim is accepted: 

  • Medical care: An injured worker is entitled to receive the adequate and appropriate medical care necessary to treat work-related injuries or illnesses.
  • Temporary disability benefits: An injured worker is entitled to temporary disability benefits that cover lost wages while recovering from your work-related injury or illness.
  • Permanent disability benefits: An injured worker is entitled to permanent disability benefits if their work-related injury resulted in a long-lasting disability that prevents the employee from working again.
  • Supplemental job displacement benefits: If an injured worker has a permanent partial disability or if the injured worker’s employer does not have alternative work, the injured employee could receive a supplemental job displacement voucher. The voucher helps to pay for retraining if the employee cannot return to work and does not completely recover from their injuries.
  • Death benefits: If a worker dies due to a work-related injury or illness, their spouse, children, or other dependents will receive payments.

Can you get other financial assistance besides workers’ compensation benefits?

You may be able to file for State Disability Insurance or unemployment insurance benefits from the Employment Development Department if you are waiting for the result of your disputed claim. You cannot receive State Disability Insurance or unemployment insurance while you are receiving workers’ compensation benefits. If your claim is accepted and you are still receiving State Disability Insurance, you will have to pay those funds back to the Employment Development Department. We recommend telling the Employment Development Department about your workers’ compensation claim to avoid problems with your claim.

Besides workers’ compensation benefits, you may also be able to receive Social Security disability benefits. However, the government may reduce your Social Security disability benefits if you receive workers’ compensation benefits.

If your injury resulted from someone other than your employer’s negligence, you might be able to file a third-party liability lawsuit against that party. Manufacturing or design defects are common situations where a third party liability claim may arise. Also, truck drivers may be able to file a third-party liability claim against a driver who caused a car accident. Our Stockton workers’ compensation attorneys can help determine if a third-party liability claim is an option for you.

Contact a Stockton workers’ compensation attorney if you have questions about the workers’ compensation claims process. Our accomplished workers’ compensation attorneys have years of experience and help you determine what benefits you are entitled to receive. Do not hesitate to reach out if you have any questions regarding the workers’ compensation claims process. To receive a FREE consultation, please call the Stockton Workers Compensation Attorneys, P.C. today.