The California workers’ compensation exists to protect you when you have suffered a work-related injury. As straightforward as the system seems, it is often not that way in operation.
Workers’ compensation is intended to be the sole way that you can be paid for workplace injuries. Your employer is required by law to pay premiums for workers’ compensation insurance. Every company with one or more employees must have this insurance. In turn, your employer does not have to worry about being sued in a personal injury claim, even if they were negligent.
Once you have suffered an injury on the job, you have 30 days to notify your employer of your injury. You are better off putting this notice in writing, so nobody can claim that you did not provide it. Then, you have one year from the date of your injury to file the claim with the insurance company.
Work-Related Injuries in Santa Clarita
A work-related injury includes far more things than you think. Examples of work-related injuries include back injuries and repetitive motion injuries. Of course, accidents on the job, such as falls or equipment injuries, are included in the definition. You can also file a claim if you have suffered an injury from your job over time.
In addition, you can also receive benefits if you have been sickened after exposure to a toxic substance. However, your claim may be challenged if you seek benefits for anything other than an accident. We will help you fight back.
Why Are Workers’ Compensation Claims Denied?
A workers’ compensation claim means dealing with an insurance company. These companies have been paid premiums by your employer, and they stand to lose money when they must pay claims. Insurance companies often deny claims for the following reasons:
- They do not believe that you suffered an injury.
- They do not believe that your injury was work-related.
- You were not treated or diagnosed by an approved medical provider. You did not meet the time deadlines for filing the claim or providing notice.
The California Workers’ Compensation Appeals Process
Thankfully, the insurance company does not have the final say regarding your benefits. If you have the necessary evidence, you have a good chance of winning your case on appeal. California’s robust appeals process allows you to challenge the insurance company. Some denials may result from misunderstandings that can be cleared up when your employer speaks to the insurance company. Others require you to go through the legal process:
- The first step is to file an Application for Adjudication of Claim with the Division of Workers’ Compensation, either in the county where you live or where you suffered an injury
- Then, you must file a Declaration of Readiness to Proceed to request a hearing
- Before you can have a trial, you must have a mandatory settlement conference in front of a judge, where your lawyer and the claims administrator will discuss your case
- If you cannot reach a settlement agreement, you will have a hearing in front of another judge, where you can present evidence and witnesses
- You will receive a written decision 30 to 90 days after the hearing. If you are not satisfied, you can file a Request for Reconsideration. Then, you can file an appeal with the Workers’ Compensation Appeals Board.
You should not attempt to appeal a denial alone, as it is a critical legal process.
What Is Included in Your Workers’ Compensation Benefits
If you are successful, either in your initial claim or your appeal, you will receive workers’ compensation benefits. You can receive two-thirds of your pre-tax salary, up to a state-mandated cap. Most injuries can pay you benefits for a maximum of 104 weeks (although some injuries allow you to receive benefits for 240 weeks).
You will also receive medical coverage to pay for your treatment, including:
- Hospitalization costs
- Specialist care
- Physical therapy
- Surgical costs
- Medical testing
Medical care is not always straightforward. The state publishes a Medical Treatment Utilization Schedule that contains the guidelines for your care. Treatment that does not follow the Guidelines does not have to be approved. The claims administrator will have a utilization review to decide whether to cover the specific treatment. There are often disputes about medical coverage with the claims administrator that may result in litigation.
Why You Need a Workers’ Compensation Attorney in Santa Clarita
There are numerous reasons why you made need a workers’ compensation attorney:
- You have a complex injury that may lead to a denial because you may have difficulty showing how it was work-related.
- The insurance company outright denied your claim.
- You are having a dispute over whether workers’ compensation covers specific medical treatment.
- You want to reach a permanent settlement of your claim.
- You want to know whether there is a third party that you can sue in a personal injury lawsuit.
Call a Santa Clarita Workers’ Compensation Lawyer Today
If you have a complicated workers’ compensation injury or your claim has been denied, One Law Group can help you. We understand workers’ compensation claims and their medical issues, and we are not afraid to take on the insurance companies.
We offer free consultations to prospective clients. To schedule a time to speak with us, call us at (844) 626-1529 or message us online.
Workers’ Compensation FAQs
When can I file a personal injury lawsuit?
Unless minimal circumstances apply, you cannot sue an employer. You can file a lawsuit against a third party for their negligence or for a defective product.
What if my company did not have workers’ compensation?
Then, you can sue your employer in a personal injury case.
What if I was at fault for my own injuries through negligence?
Unless drugs or alcohol were involved, your own negligence does not keep you from receiving workers’ compensation benefits.