How to File a Workers’ Compensation Claim in California

To receive workers’ compensation benefits, you need to follow these steps

If you suffer a work-related injury in California, you might be entitled to workers’ compensation benefits—including medical expenses and lost wages.

In order to obtain these benefits, there are certain steps you need to take. Unfortunately, one misstep could prevent you from collecting any benefits at all.

Here at Enjuris, we want you to receive all the benefits you deserve. With that goal in mind, let’s take a look at what steps you need to take to receive workers’ compensation benefits in California.

Step 1: See a doctor

If your accident results in a health emergency, seeing a doctor is the first thing you should do. However, even if you don’t see a doctor immediately, it’s important that you see a doctor at some point for medical care.

This begs the question, can you see any doctor you want? It depends.

Workers with health care coverage for conditions unrelated to their job are allowed to “predesignate” their physician by informing their employer through a written statement or using DWC Form 9783. This must be done before you suffer an injury.

If you didn’t predesignate a physician before your injury, your employer is allowed to choose the doctor you see. The doctor is usually someone in the employer’s medical provider network (MPN) or health care organization (HCO).

Your doctor is a critical piece of your workers’ compensation claim. Among other things, your doctor:

• Helps determine when (and if) you can return to work
• Helps identify kinds of work you can do safely while recovering
• Refers you to specialists if necessary
• Writes medical reports that will help determine the benefits you receive
• Testifyies in cases where the workers’ compensation claim is contested

Step 2: Report your injury to your employer

California law requires that you report your work-related injury to your supervisor or some other person in management as soon as possible. If your employer doesn’t learn about your injury within 30 days, you could lose your right to receive workers’ compensation benefits.

Step 3: Fill out the proper form

Your employer is required to give you a Workers’ Compensation Claim Form (DWC 1) within 1 day after you report your injury. This is the form you will use to request workers’ compensation benefits.

Step 4: File the form

Give the form to your employer (this is referred to as “filing” the form) and keep a copy for yourself. Consider mailing the form to your employer using certified mail with a return receipt requested. Again, the goal is to be able to prove that all necessary notices and forms were submitted timely should this fact be contested later.

Once your form is “filed,” your employer will fill out and sign the “Employer” section of the form and give the completed form to the claims administrator. Your employer must also give you a copy of the completed form within 1 day after you file it.

Once the claims administrator receives the form, they are required to inform you within a “reasonable time” whether they have accepted or denied your claim.

What to do if your claim is denied

There are a number of reasons why your workers’ compensation claim may be denied, including:

• Your employer wasn’t required to carry workers’ compensation insurance
• You missed a filing deadline
• There’s insufficient evidence that your injury is work-related
• The injury isn’t covered
• There is a discrepancy between your accident report or claims and your medical records

If you disagree with the decision reached concerning your claim, you must fill out a notice of appeal form.

Then, you must mail the form to your local Workers’ Compensation Appeals Board district office within 20 days after the service date of the determination (this date can be found in the lower right-hand corner of the determination letter)

Workers’ compensation benefits are invaluable and can help you get your life back on track after a serious accident. But, workers’ compensation benefits aren’t guaranteed. Be sure to follow all the steps necessary to file a workers’ compensation claim.

If want to hire an attorney to help, you can find one using our free online directory.