Filing a workers’ compensation claim is the first step toward getting the financial support you need after a job-related injury. However, the process doesn’t always move quickly, and there may be moments of uncertainty along the way.
Learning more about how things work can help you know what comes next so that you’re not caught off guard. Here’s what to expect.
A claim form from your employer
Once you report your injury to your employer, they must give you a claim form within one working day. This form is crucial as it officially starts the claims process. Fill it out correctly, return it to your employer and keep a copy for your records.
Medical treatment authorization
Your employer or claims administrator must authorize reasonable and necessary treatment after receiving your claim form. Under California law, you are entitled to medical treatment of up to $10,000 while your claim is under investigation. If it’s an emergency, you can visit the nearest facility. Otherwise, you must choose a physician from your employer’s medical provider network (MPN).
Insurer’s response time
Within 14 days of receiving your claim, the insurer must send you a written notice of the status of your claim – accepted, delayed or denied. If accepted, it means you’re eligible for workers’ compensation benefits. A delay means the matter is still under investigation, while a denied claim means the insurer believes you’re not entitled to benefits for reasons they will provide.
You can appeal a denial if you believe you have a valid case. It’s also worth noting that if the insurer doesn’t decide to deny or accept your claim within 90 days of receiving it, the law presumes it is covered.
The claims process isn’t always as straightforward, and you may feel lost or frustrated when navigating the paperwork, deadlines and confusing terminology. Getting qualified legal guidance through it all can make everything feel less overwhelming and increase the odds of a favorable outcome.
Subscribe To This Blog’s Feed