Critical Steps to Take in Your Workers’ Compensation Claim
Applying for workers’ compensation can be a daunting task. Even with the aid of an attorney, it is difficult to know what to do at every stage of the process — especially when you are preoccupied with your condition. However, there are a few imperative steps that must be dealt with properly to ensure everything goes smoothly in the long run. Here are three critical stages of your claim that you should not take lightly:
1. Preparing your Injury Report
It is crucial that you report any work-related injuries to your employer immediately, whether they resulted from cumulative trauma, occupational diseases, or a serious injury. California has a tight deadline of 30 days that must be met in order to prevent your claim from being barred or reduced in amount. If you suffer from an illness that developed gradually, such as carpal tunnel, the clock starts when you notice your condition and trace it back to your work.
Your employer’s official accident report is the first documentation of your accident — which is critical to your claim. You may fill out an accident report presented by your employer or provide written notice of the incident. If you do not have the opportunity to complete an accident report, you should send your employer a certified letter with all the pertinent details of the incident and your injury or illness. Whether you have a report prepared or draft a letter, be sure to keep a copy for your records.
Your report should include:
- Your name
- Your contact information
- Where the accident occurred
- The time and date of the injury
- Your symptoms
- How you were initially injured
Just remember that insurance companies depend on finding inconsistencies in accident reports so they can dispute claims. If you report anything incorrectly or you exaggerate your condition, your claim can be refused.
2. Choosing the Right Doctor
Your attending physician plays an important role in determining whether or not you are going to receive workers’ compensation benefits. In addition, he or she will assist you in recovering from your injury or illness, recommend treatment (such as surgery), refer you to specialists, minimize your income loss, and enable you to get back to work expediently. Alternately, he or she may suggest certain occupational accommodations or decide that you have a permanent disability.
In California, you may choose to see your primary care physician first for your injury or illness, but you may only do this if you have your own insurance or you have "predesignated" your physician or medical group prior to your injury using Department of Workers’ Compensation Form 9783. This is simply giving written notice. You can also see your PCP if he or she has agreed in advance to see you for work-related injuries or illnesses.
If you don't predesignate your physician, you will have to see a doctor in the employer or insurer's medical provider network. The notable exception to this is when emergency treatment is necessary.
3. What to Do When the Insurance Company Contacts You
You will probably receive a call from the workers’ compensation insurance claims adjuster within 48 hours of reporting your illness or injury. They are hired by the insurer specifically to save them money, or they wouldn’t make any profit. It’s imperative that you do not ignore this call, but also remember, he or she is not your friend.
- The Initial Investigation: The insurance claims adjuster will investigate the circumstances and facts with regard to your claim and will determine if you are entitled to workers’ compensation. The adjuster will then try to negotiate what he or she considers a fair settlement. The adjuster may even ask you for a recorded statement. This is not likely to work out to your benefit.
- The Questions: Adjusters ask certain questions knowing that your answers can be used against you. For example, he or she may be ascertaining whether you will make a credible witness at a hearing, whether you would be willing to accept a low-ball settlement because you are struggling financially, and if you have private insurance or pre-existing conditions.
- Why You Should Consult an Attorney: An experienced workers’ compensation attorney can guide you in what information you should and shouldn’t supply to the insurance company, such as a signed adjuster’s request for medical releases. These documents will allow them to access your bills and records unilaterally. It also means that the adjuster can speak with your physicians directly, which can be harmful to your case.
By understanding the above crucial steps in the workers’ compensation process along with an experienced attorney can decrease your chances of a workers’ compensation claim denial. Law Offices of Bo Katzakian understands the frustrations that come with filing a workers’ compensation claim. Call us at (844) 311-7793 to discuss how we can help with your case.