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Filing a Workers’ Compensation Claim

Injured at work?

You may be entitled to workers’ compensation benefits. You can use these benefits to help you recover. Filing a claim can be a confusing, time-sensitive, and multi-step process. It can be helpful to speak with a Sacramento workers’ compensation attorney. Our experienced lawyers fully understand the workers’ compensation process. If you need help filing a claim, or your claim is delayed or denied, contact Sacramento Workers’ Compensation Attorneys, P.C. today.

Where do I start when filing a Workers’ Compensation Claim? 

You should report your injury to your employer as soon as possible, ideally in less than 30 days.  It can be verbal or in writing, but we recommend you notify them in writing. A simple text message or email will typically suffice.   

Once you give your employer an informal notice of your claim, you formally report the claim. An employer is required to give you the claim form within one business day of learning of your injury. If they don’t, you can also download a DWC1 claim form from the California Department of Industrial Relations Division of Workers’ Compensation website. Once you have a claim form, sometimes called a “DWC1 form”, fill it out with the following information: 

  • Your name, address, and social security number 
  • An email address
  • The date and time of the injury 
  • A description and location of where the injury occurred
  • A description of the injury 
  • Your signature

After filing a claim, your employer is required to submit that claim to the insurance company and return a completed copy to you. If the claim is accepted as a work-related injury, the insurance company must authorize appropriate and adequate medical treatment. Your employer’s insurance company has 90 days to accept or reject your claim. During that time, you could receive up to $10,000 for medical treatment. However, if your employer’s insurance company does not deny your claim within 90 days, your injury may be considered admitted. 

What happens if my claim is denied or delayed? 

There are many reasons your claim may be delayed. If you did not seek timely medical care or file the claim on time, your claim might be delayed. Sometimes the claim administrator just needs more information from your doctor. 

There are also many reasons why your claim may be denied. The claim administrator may have determined your claim was not severe enough to receive workers’ compensation benefits or the circumstances surrounding your injuries were not considered to be work-related. You may still have options even if your claim was denied or delayed. Contact a Sacramento workers’ compensation attorney to hear about your options.

WHAT TYPE OF BENEFITS CAN YOU RECIEVE?

Your employer pays the medical care benefits used for treating your work-related injury. After filing a claim, the injured worker must see a doctor in the Medical Provider Network. Treatment is decided through a utilization review.

Temporary disability benefits are paid by the employer of an injured worker who is unable to continue working while recovering from the injury. Up to statutory maximums, the amount paid is two-thirds of the worker’s average weekly pay. A doctor will generally want to see the injured worker every 45 days to determine if he or she cannot continue working. However, these benefits are limited to 104 weeks and within five years of the injury date.

Permanent disability benefits are paid when the injured worker has obtained a lasting disability and cannot recover from their injuries. Permanent disability benefits are calculated based on the date of injury, impairment level, age, and occupation. Diminished future earning capacity is only considered for injuries that occurred between April 19, 2004, and January 1, 2013. Benefits are calculated by a disability evaluator or a judge with a maximum of $290 a week (as of January 1, 2019) for most disabilities.

Supplemental job displacement benefits are paid to an injured worker whose condition has stabilized. An injured employee can qualify for supplemental job displacement benefits if their injury caused permanent disability and their employer doesn’t offer modified or alternative work within 60 days of the evaluation of the employee’s injury. An injured worker whose condition has stabilized but cannot return to work may be eligible to receive a $6000 voucher for retraining and additional funds from the State of California.

Death benefits are paid to spouses, children, or other dependents if a work-related injury or illness caused the death of an employee. Death benefits are determined by the number of dependents and include burial expenses that do not exceed $10,000.

Contact Sacramento Workers’ Compensation Attorneys, P.C. today if you need help filing a claim, understanding why your claim was delayed or denied, understanding the Employment Development Department, or what benefits you can receive. Our team of accomplished workers’ compensation attorneys are happy to provide you with a free consultation to help you determine your entitled benefits.