First: When you’ve been injured on the job, you should get immediate medical treatment. If it’s an emergency, you can go to any ER for medical care. Otherwise, if your employer or its insurance carrier has a medical provider network (MPN), you should go to a doctor in that network. Be sure to mention to your treating doctors that your injury is job-related, and give them an accurate account of how you were injured.
Next: As soon as you can, report your injury to your employer. If you fail to do this you could lose your right to workers’ comp benefits.
Filing Your Workers’ Comp Claim (DWC-1)
Within one day after you report your injury, your employer must give you a workers’ compensation DWC-1 claim form. This is the first step to starting your claim. If you can’t get the DWC-1 form from your employer, you should contact our office, Goforth & Lucas, for a blank copy. 925-682-9500.
Follow the instructions on the employee’s portion of the form. Be sure to accurately list each part of your body that was injured on the job. Then you must hand the form to your employer in person, or send it by mail. Your employer then must complete and submit the form to its insurance carrier. Make sure you retain a copy of the completed form. If your employer fails to do the above, contact the Goforth & Lucas Law firm (925-682-9500) for assistance in opening your workers’ compensation claim.
The Insurance Carrier’s Response to Your Workers’ Comp Claim
Once the DWC-1 is submitted, the insurance carrier must authorize payment for your medical treatment while it is investigating your claim. Then the carrier will either accept or deny your claim. Until it makes a decision, the carrier is responsible for up to $10,000 in medical bills. Your claim will be automatically approved if the carrier fails deny it in writing within 90 days.
If you have to miss work because of your injury or illness, the insurance carrier should begin paying temporary disability benefits after you report your disabling injury. Often the insurance carrier neglects to start your payments. If that happens, you should contact our office for representation and enforcement of your rights.
Application for Adjudication of Claim
Disagreements with the insurance carrier are common. The carrier may even deny your claim and refuse to pay any benefit to you. But you won’t be able to settle any disputes unless you also opened a case with the Workers’ Compensation Appeals Board (WCAB) by filing an Application for Adjudication of Claim.
Generally, you must file the Application for Adjudication of Claim within one year after the date of injury. It’s best to have a workers’ compensation attorney represent you at this point. At any time during your claim you may contact Law Office of Goforth & Lucas (925-682-9500) for a free consultation.
Your Temporary Disability Benefits
If your doctor says that you can’t do any part of your job because of your work-related injury, then you are entitled to temporary disability (TD). Generally, your TD payments won’t start until you’ve missed at least three days of work.
TD payments are meant to replace only some of your lost wages. During the time that you’re considered temporarily disabled, you’ll generally receive two-thirds of your average weekly wage.
Often the employer’s insurance carrier will miscalculate the correct TD amount or will be late in making payments to you. If this happens call Goforth & Lucas to enforce your temporary disability payments.
Your Permanent Disability (PD) Benefits
If your doctors have determined that your injury or illness (such as COVID) has left you with permanent limitations that affect your ability to work, you will qualify tor PD payments. This won’t happen until your doctor says that your medical condition reaches Maximum Medical Improvement (MMI)—meaning that you’ve reached a plateau and aren’t expected to get any better. Then your attorney may calculate your permanent disability percentage rating, taking into account your occupation and age, along with your physical and/or psychological impairments.
Your Supplemental Job Displacement Benefit (SJDB)
You may be eligible for an SJDB if your employer doesn’t offer you regular, modified, or alternative work after receiving a medical report that says your work injury resulted in partial PD. This benefit consists of a voucher for up to $6,000, which you can use to pay for training or certain other expenses for getting the training needed to enter a new line of work. You would also be eligible for a $5,000 cash benefit from the State’s Return to Work program. But using the voucher is subject to some restrictions and can be tricky, and the insurance companies are generally of little or no help. To assist you with getting the maximum value from your voucher, Goforth & Lucas works with a vocational rehabilitation specialist.
You will be entitled to a death benefit if you are a surviving dependent of an employee who died from a work-related injury. The amount of the death benefit depends on the number of survivors who are eligible to receive payments.
What To Do When the Insurance Carrier Delays, Withholds, or Denies Your Benefits
Getting your proper medical treatment and disability payments can be daunting in the workers’ comp system. The California Labor Code spells out your rights and the insurance carrier’s obligations. But insurance carriers will often wrongly withhold benefits to injured workers. If the insurance carrier refuses to pay any of your workers’ comp benefits you have an absolute right to challenge that decision at the WCAB through hearing and/or trial. However, the system for resolving workers’ comp disputes is complex. Your workers’ comp lawyer will help you navigate that system to get the benefits you deserve. To protect your rights and level the playing field against the insurance companies, contact Goforth & Lucas, 925-682-9500.