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Delay of Claims
An injured worker must generally provide written notice of injury or illness to the employer within 30 days of when it occurred or began. An employer is then obligated to provide a workers’ compensation claim form, which in injured worker must fill out and return to the employer. An employer’s workers’ compensation insurance carrier then has 90 days from the time that the injured worker returns the form to accept or deny liability for a claim.
While many claims are approved immediately, claim approval may be delayed if the insurance company sees a need to conduct an investigation into the facts and circumstances surrounding how an injury or illness occurred. As a result, it is important to be as thorough and detailed as possible when filing an initial claim to prevent a delay due to any ambiguity as to the cause of an injury or illness.
It is important to note that while a workers’ compensation claim is pending, injured workers are entitled to benefits for medical care within one day of when a claim is submitted. The cost of medical care will be covered up to $10,000 until the time that a claim is approved or denied. If a claim is neither explicitly approved nor denied after the 90 days have elapsed, under California law, liability for a claimed injury may be presumed admitted .
If liability for a claim is denied, the injured worker may receive a Notice of Denial letter from the employer or their workers’ compensation insurance carrier. An injured worker generally has one year from the date of injury or the last date on which the worker received medical benefits to appeal a denial. First, an injured worker must file an application for adjudication of claim, which will open a case with the California Workers’ Compensation Appeals Board. Then, when an injured worker is ready to proceed before a judge, the worker will file a declaration of readiness to proceed, attaching relevant medical records and documentation regarding the claim.
A mandatory settlement conference may be scheduled, during which an employer’s workers’ compensation insurance company and the injured worker may discuss the claim with a judge, who may generally try to facilitate a settlement agreement. If no settlement agreement is reached, a hearing may be held before the judge, in which each party may present evidence and arguments regarding their position. Following the hearing, the judge may issue a decision regarding a claim within about 90 days. If the judge does not rule in an injured worker’s favor, the injured worker may appeal a decision by filing a petition for reconsideration within 20 days. The Workers’ Compensation Appeals Board may determine whether to accept or deny the petition. If reconsideration is granted, the Board may then issue a decision on the previous ruling. If the ruling of the Workers’ Compensation Appeals Board is unfavorable, an injured worker may then file a petition for appeal from an unfavorable decision with the California Court of Appeals.
The process of appealing a denial of a workers’ compensation claim is extremely complex, and a failure to follow the proper process with each step may result in the loss of rights to recover benefits. Therefore, whether you have faced a denial or delay of a claim, you should seek the assistance of a skilled workers’ compensation attorney to discuss the merits of an appeal.
With the never ending changes in employment law, employment violations sometimes may be difficult to identify and understand. Employment law covers all employees, job applicants and former employees. Employee rights may vary by state, but federal regulations protect all employees in the U.S. The most common issues are:
· Wrongful Termination– It is illegal to fire an employee based on ethnicity, religion, race, among other reasons.
· Wages / Overtime – Employers are obligated to pay the state minimum. California’s minimum wage is $12 per hour, $11 per hour for businesses less than 25 employees.
· Discrimination / Harassment– Most common harassment claims include: verbal threats, physical harassment, derogatory comments, favoritism and visual harassment.
· Rest Periods / Meal Breaks– California law obligates employers to grant a 30 minute meal break if working over 5 hours.
· Workplace Safety – Employers have legal obligations to keep their employees safe while at work.
The most frequent safety hazards include falls, respiratory exposure, eye and face protection and exposure to electrical machinery.
Did you suffer an injury at your workplace? You have the right to a Workers Compensation claim; in which you receive the proper medical treatment and benefits you deserve. It can be confusing not knowing how to go about this on your own (do’s and don’ts, legal procedures and rules).
Our team here at Workers Compensation Southern California will walk you through the process and make sure you get the medical treatment and benefits you deserve.
Listed below are examples of some general workplace injuries:
-Falls from ladder, scaffolding, roofs
-Vehicle-related accidents at work
-Toxic chemical exposures
-Repetitive motion Injuries
Catastrophic workplace injuries are injuries that cause long-term, to permanent damage. These injuries can possibly alter one’s lifestyle. There are many possible long-term effects such as: changing your lifestyle and making changes to your home to meet your needs. A change in personality, which can be stressful, as well as depression and anxiety caused by severity of the injury. Due to how severe these injuries are, these types can be more complex.
Some examples of Catastrophic Workplace Injuries:
-Spinal cord, back, neck
-Paralysis of body part (arms, legs)
-Amputation of a body part (leg, arm, hand, foot)
-Second to third degree burns
-Severe brain and head injuries, which can cause communication problems, altered consciousness and many different neurological problems/ disorders
- An injury very severe that results in the injured worker unable to return to his or her work
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