What to Expect in a Claim
What To Expect When
A Work Related Injury Occurs
If an injury occurred and it was related to your employment, you may have the right to seek benefits under the California workers’ compensation laws. Although most injuries occur while at work, you are still entitled to compensation if the injury occurs outside the place of work or off the premises, nor does the injury need to stem from one single incident.
It is always recommended that a report of an injury be made with your Supervisor after an injury occurs. This is important for you so that you are able to seek medical treatment as soon as possible through your employer.
What If I Didn’t Report My Injury?
It is also acceptable to report the injury even after it occurs as you may initially believe that an injury is only minor and that will heal quickly (first aid injury).
Also sometimes symptoms of injuries do not arise until days after the incident. Employees have thirty days to report your injury.
Simply give a brief explanation of how the injury occurred and notify a manager, supervisor, or human resources that a workplace injury (or injury stemming from work) has occurred. Your manager or supervisor should then provide you a DWC-1 form to fill out. This is a simple form that briefly states when and how the injury occurred.
You await a response. Under California workers’ compensation laws,– an employer has 90 days from the date of knowledge (the date of knowledge may vary depending on individual facts and circumstances) of your injury to either accept liability or deny liability.
At times, the insurance carrier may send an initial letter delaying a decision but ultimately must accept liability within 90 day timeframe of knowledge.
If acceptance or denial letter is not provided by the insurance carrier or employer, your claim will automatically be presumed accepted. Meaning that, generally – absent evidence, your employer will be liable for injuries you have suffered relating to work.
If your claim is ACCEPTED: You will receive from the insurance, a MPN List (Medical Provider Network). The MPN List provides a list of Doctors within the insurance’s network. You may select a doctor from the list and this selected Doctor will become your PTP (Primary Treating Physician).
IF you suffer multiple types of injuries, you will require a recommendation from your Primary Treating Physician (selected doctor) in order to see other specialists.
If your claim is DENIED: The workers’ comp insurance will not pay for your medical treatment, raher you will have to seek medical attention elsewhere from a Doctor of your choosing.
You will be required to find a doctor willing to see you on a lien basis (the lien basis means that they will generally not charge you for medical services related to your workplace injury, but instead will seek their compensation through the Workers’ Comp claim which you have filed).
You will continue seeing your Doctor(s) until they have rendered a Permanent & Stationary (P&S) report. A P&S report will be rendered once your Doctor determines that your injury is permanent and stationary, meaning that the injury will not get substantially better or worse.
The P&S report addresses two key components to a Workmans’ Comp claim:
1) Permanent Disability and
2) Future Medical Care
- The P&S report is critical to a claim as it also comes with a Permanent Disability Rating. Permanent disability is determined by a percentage that estimates how much a job injury permanently limits the kinds of work you can do. It is based on your medical condition, date of injury, age when injured, occupation when injured, how much of the disability is caused by your job, and your diminished future earning capacity.
- The P&S report also should include a provision in which describes what type of medical care will be required for your injury in the future (Future Medical Care).
Throughout each step of a workers’ compensation claim, issues may arise.
- An employer’s failure to maintain workers’ compensation insurance
- inability to see a doctor on lien
- individual health insurance denying treatment due to the injury being work related
- a low-ball settlement offer, improper denial of a claim
- multiple injuries requiring seeing different medical specialists
- retaliatory termination, problems with a doctor, etc.