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A workplace injury can set several things in motion. Understanding the steps that need to be taken after an injury may help you prove your workers’ compensation claim or a work injury related case later on. If you are injured on the job, here are the crucial steps you need to know. Review them now, because you never know when an accident may happen:
Under workers’ compensation insurance in California, you will have access to benefits including coverage for medical expenses, temporary and permanent disability, job displacement supplements, and death benefits. Depending on your injury and circumstances, you should always be able to secure compensation to fairly cover the costs associated with your injury or illness.
If you have trouble processing your workers’ compensation claim or your employer has not provided the requisite forms or information, you may need to take legal action to obtain the compensation you rightfully deserve. Our attorneys at DiMarco | Araujo | Montevideo are here to help. Contact us to learn more about work injury law and workers’ compensation in California.Read More
If you receive a notice of denial, it doesn’t mean that your claim for workers’ compensation benefits is over. Unfortunately, it does mean that it may take longer for you to receive the benefits you need. If your claim was denied, your claims administrator has decided that your injury or illness is not covered under workers’ compensation policies in California. You should receive a decision and have a complete understanding of why your claim was denied before moving forward.
You can challenge the determination of the claims administrator by filing an appeal with the Division of Workers’ Compensation. To file a case, you will need to fill out and submit an Application for Adjudication of Claim. Once that has been filed, you will need to file a Declaration of Readiness to Proceed document to ask that your case be heard in front of a judge.
You do not have to have an attorney for the appeals process, but securing the services of an attorney might help. An attorney who understands workers’ compensation laws in the state can speak on your behalf, file the appropriate forms, and expedite the process.
Each claims case is heard at a Division of Workers’ Compensation Office by a judge and is called a “mandatory settlement conference.” During the hearing, you, your attorney, the judge, and the claims administrator or his/her attorney will present information regarding the case. If the case reaches no settlement at this time, the case will move to trial.
The reason that your claim was denied might be a simple matter to resolve. After a hearing with a judge, the claims administrator may agree to re-evaluate your claim in a new light. Your claim might have been denied because the physician’s notes were unclear regarding your injury or your representation of the accident did not accurately reflect the severity and long-lasting consequences.
For chronic pain, claims can become more complex. You may be filing a claim for years of repetitive motion-related injury, but if asked about a specific injury date, you may not list one particular date. Other claim denials may result from issues that seem suspicious to the case administrator. Unfortunately, it’s impossible to fully recreate events in a claims application. Miscommunication or misreading is often to blame for a claim denial.
A notice of delay is not necessarily an indicator that your case will be denied, but it may prolong the process and require significant back-and-forth communication to clarify the details of the claim. If there is a delay and an investigation into your claim, you are entitled to $10,000 in treatment costs. Once the administrator approves your claim, you can access the remainder of your benefits through the policy.
Although you are not required to obtain legal counsel for workers’ compensation claims, you may want to consider a consultation. If your claim is delayed or denied, the presence of legal counsel can improve the communication process and speed up the claims processing time. In some cases, the basis for a denial may not be legal. The only way to ensure that your claim is complete and properly evaluated by claims administrators may be to secure the representation of a workers’ compensation attorney.
The attorneys at DiMarco | Araujo | Montevideo understand that this may be a difficult time. Going back and forth with claims administrators may make recovery difficult. Our team can speak with insurance representatives on your behalf and provide you with peace of mind. For more information about our workers’ compensation practice, please contact our Orange County office today.Read More
In our state, employers are required to carry workers’ compensation insurance if they have 1 employee or 5,000. Interestingly, the rate of payments for workers’ compensation claims were level in 2014 and medical costs decreased, but premiums shot up by about $2 billion during the same year. Why?
One of the reasons could be that California has recently (2012) enacted provisions that provide more financial compensation while reducing medical expenses. Those provisional changes mean that insurers are responsible for more expenses and that translates to higher premiums. While injured workers can now collect around 29% more financial benefits, California has the highest cost of workers’ compensation in the nation.
Although the statistics seem to tell a story of good news for workers in the state, the reports aren’t showing the full picture. Payment rates may have been level for the last few years, but the increasing costs of workers’ compensation isn’t actually helping many people. Employers are frustrated with the ever-increasing costs, and California has continually cut benefits, making it harder for workers to qualify for benefits over the last decade.
Currently, California is one of two states that ranks worst for benefits cuts and difficult qualifications over time. Medical costs are the highest costing factor in workers’ compensation, followed by financial compensation for injured and disabled workers.
Employers obtain workers’ compensation costs based on job-risk levels. The more dangerous a job, the more insurance a company is required to carry. Some of the highest costing workers’ compensation jobs in the state include oil industry workers, construction, and manufacturing. Safety history and the existence of health insurance offerings also factor into the cost an employer pays for workers’ compensation.
All of this information can be very confusing. While California is nationally recognized for its progressive workers’ compensation statutes, in some ways, it still fails to provide adequate benefits for workers, and it is not cost effective for employers. The economy, in general, is rebounding, but ever-increasing costs of workers’ compensation insurance could put a cap on employee growth for some companies.
Unfortunately, there may not be a single party that is responsible for or that is benefitting from this ever-rising increase in expenses. However, the state has noticed these discrepancies. With more legislators and union leaders talking about the rising costs and the lack of benefits, there may be changes in policy in the next few years. As a worker, paying attention to the changes may help you understand your benefits if you get injured on the job.
Although the big picture of benefits in California is increasingly complex, you do have certain rights as an injured worker in the state. If you have been injured at work, you are entitled to benefits through your employer’s insurance policy. If your employer or the insurance company fails to help you secure adequate compensation, you may have legal recourse to obtain the compensation you deserve to start healing.
At DiMarco | Araujo | Montevideo, we specialize in workers’ compensation insurance cases. We understand that the claims process is convoluted and time-consuming, and we can protect your rights as an injured worker in California. A work injury does not have to leave you wondering about how you’re going to pay for medical expenses and your future. Let us help you get through this difficult time with strong, passionate legal representation. Contact our office in Orange County today to learn more.Read More