What is the California Workers’ Compensation Process?

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At Hanning & Sacchetto, our workers’ compensation attorneys in Whittier know that getting hurt at work can be a confusing time for anyone — no matter the industry, company, or position in which the injured person is employed.

When California workers are hurt on the job, there is a reasonable belief that workers’ compensation will be there to cover their medical costs and potentially any lost wages that result from a significant injury.

However, there are certain steps an employee must take to ensure they are on the right path to receive those benefits instead of being left wondering why their workers’ compensation benefits have been denied. 

Here is how the California workers’ compensation process typically works.

A Work-Related Injury Occurs

Employee injuries can occur without notice during a one-time accident, like a slip and fall incident, getting hit by a falling object, during a machinery malfunction, or after suffering from occupational illnesses or repetitive stress injuries that occur over time.

Despite the actual injury, and how it occurred, if it happened at work or because of work, you have a case for workers’ compensation in California.

Unless you need emergency medical care, which your employer should help arrange immediately after the accident, notify them immediately that an injury occurred, and submit a claim form that your supervisor should provide.

Your claim will then be reviewed by your employer’s workers’ compensation insurance claims administrator.

Get Medical Care Right Away from an Approved Physician

Depending on your workers’ compensation coverage, your employer’s policy may outline a primary treating physician, physician network, or healthcare organization that is predesignated to treat injured employees.

If there is no such clause in your workers’ compensation coverage, you may seek medical care from the physician of your choice.

While your claim is under review, seek emergency treatment and attend all follow-up appointments and overall healthcare requirements as outlined by your physician.

Receive a Decision from the Workers’ Compensation Claims Administrator

After reviewing your workers’ compensation claim, the administrator will issue a decision to either accept or deny it.

When the claim is accepted, all further medical care and any additional workers’ compensation benefits you are entitled to will be covered by the insurance policy.

When the claim is denied, the administrator has determined your injuries are ineligible for benefits. This will require you to provide additional evidence that your injury occurred at work, and that you are, indeed, hurt. We can help you design an appeal to aid in your recovery.

Continue Attending Medical Appointments No Matter the Response

Your primary treating physician will determine what treatment is requires for you to achieve a full recovery, which will be necessary whether your claim is approved or denied.

Sometimes claims are denied because of lacking information that can be easily amended. Other times, the insurance company is putting up a fight and simply stating they either do not believe you are hurt, or that your injury did not occur at work.

If you were hurt at work, your employer’s workers’ compensation coverage is liable for all benefits that pertain to your medical care, temporary or permanent disability benefits to cover lost wages, and an assurance that those expenses will be paid.

If you have been injured at work or have already had your workers’ compensation benefits denied by the insurer, contact our experienced workers’ compensation attorneys in Los Angeles County at Hanning & Sacchetto today by calling (562) 698-6446 to learn how we can pursue the benefits you are entitled to, so you can get the medical care and time away from work you need to fully heal.