If you suffered an injury on the job in California, know that the state’s workers’ compensation may cover your resulting medical bills. To receive the assistance you deserve, however, you must file a workers’ compensation claim.
Understanding the claims process may help ensure that you take the necessary steps to recover the benefits you need.
Step one: Complete the employee section of the claim form
After reporting your injury to your employer, they must give you or mail you a workers’ compensation claim form. If they do not, you may get one from the Division of Workers’ Compensation website or the information and assistance unit.
You must complete the employee section of the form and sign and date it. It is a good idea to keep a copy of your completed portion of the form for your records.
Step two: Return the claim form to your employer
Once you complete your portion of the claims form, you must return it to your employer so they may complete their section. You may mail the form back to your employer or return it in person. After your employer completes their section, it is their responsibility to provide you a copy of the completed form and forward the form to their insurance company.
Step three: Receive the claims administrator’s decision
Under most circumstances, you will get a written decision regarding your claim within 14 days. If your claim gets approved, you will begin receiving benefits, which may include paid medical treatment for your injury and partial wage replacement. According to the State of California Department of Industrial Relations, your workers’ compensation claim is generally considered as accepted if you do not receive a denial letter within 90 days of filing your claim.
Step four: Challenge denied claims
Should the claims administrator deny your claim on the basis that it is not an eligible injury, you may choose to challenge the decision. Working with an information and assistance officer, you may request a formal hearing before a workers’ compensation judge or the Workers’ Compensation Appeals Board.