Workers’ compensation is an insurance system that protects injured workers by paying for costs arising from an on-the-job injury. State law requires California employers to participate in the workers’ compensation system with certain limited exceptions. Under workers’ comp, an injured worker can receive benefits for medical care, temporary disability benefits, permanent disability benefits, vocational rehabilitation services, and may give death benefits to surviving members of the worker’s household.
Workers’ compensation arose to avoid lengthy litigation between employers and employees when a worker was injured on the job. Unfortunately, due to the increasingly complicated nature of workers’ compensation, many times employees do not receive the benefits they are due under workers’ compensation after an injury. Determining the type of injury, whether it is covered under workers’ compensation and dealing with insurance companies have made it difficult for some injured workers with legitimate claims to recover under a system designed to protect them.
The Workers’ Compensation Process
An injury covered by workers’ compensation must have occurred on the job. Any worker who is injured while working should immediately contact his or her employer to report the injury. Even if the employer does not miss any time from work, his or her medical care may be covered under workers’ compensation.
After being informed about the injury, the employer must provide the injured worker with a claim form within one business day. Once this form is completed, the employer will file it with its insurance company. The employer or insurance company has 90 days to reply to the claim; if the worker receives no response within 90 days, then the law assumes that the claim is covered.
In certain circumstances a workers’ compensation claims adjuster may deny an injured worker’s claim. This means the adjuster believes that the injury is not covered under workers’ compensation. The claims adjuster may deny a claim for various reasons:
- The adjuster may believe the injury is not as severe as the treating physician reported
- The adjuster may claim the injury was not suffered in the course of employment
- The adjuster may disagree with the employee about whether he or she can return to work and in what capacity
The initial denial of a workers’ compensation claim is not the end of the story. An injured worker can appeal an initial decision denying workers’ compensation benefits. However, the law has recently changed regarding much of the process for denied claims. The new law takes effect on July 1, 2013, and includes such provisions as mandating arbitration for claim disputes. Regulations regarding the new law are not complete and may take some time to resolve.
Contact an Attorney
Because of the complicated nature of workers’ compensation claims, injured workers should consult an experienced workers’ compensation attorney to discuss their options and legal rights to ensure that they receive the maximum benefits they deserve.