Under California law, workers compensation coverage protects employees. This no-fault insurance system works to help you receive benefits to cover medical bills and make up for lost wages. It’s there to help you. However, there are a few steps you should take to protect your rights to receiving workers comp. To make the process easier, a workers compensation attorney in San Francisco can be your advocate and help you pursue your claim.
To begin, here are a few initial considerations and steps to know about.
Who Can Get Workers Comp?
Anyone with employee status is eligible for these benefits, including temporary and part-time workers. While falls and accidents are common reasons for receiving workers comp, these benefits also cover work-related illnesses (like black lung). Workers comp also covers injuries that result from performing repetitive motions (such as developing arthritis from typing at a computer all day).
However, workers comp claims are usually denied if the injury occurred while you were under the influence of drugs or alcohol. Medical issues that come from work-related stress are also not covered. If you aren’t sure if your problem would be covered, a workers compensation attorney in San Francisco can clarify.
Let Your Employer Know About the Injury Right Away
Unless you need emergency medical treatment, your first step should be to notify your employer. You should report the injury as soon as you can.
In California, employees have 30 days to report an injury sustained on the job. If you wait longer than a month, you will forfeit your rights to receiving workers comp. If you’re experiencing a work-related illness or a repetitive motion injury, you should notify your employer as soon as you have to miss work because of your symptoms or as soon as you see a Bay Area doctor.
The best way to report your injury is to reach out to a supervisor. You should also write down the names and contact information of any witnesses to the incident.
Seek Medical Treatment
You should receive the medical attention you need as quickly as possible. If you wait to seek medical care, your employer could argue that the injury or illness wasn’t work-related. Plus, the sooner you get medical help, the sooner you can get the care you need to feel better. In fact, even if you think your injury isn’t bad, it’s a good idea to seek medical attention regardless. You may have hidden injuries or problems that could get worse with time.
There are a few items to keep in mind when selecting a doctor in San Francisco. In the context of a workers comp case, your doctor is your treating doctor.
Under California law, you need to establish in advance that your primary care provider will treat you for work-related injuries or illnesses. Your employer should have received a written notice designating this physician as your treating doctor.
If you didn’t indicate a treating doctor before the incident, you will have to use a healthcare professional who belongs to your employer’s medical provider network. Note that these rules don’t apply if you need to go to an emergency room. If you need help figuring out a doctor, a workers compensation attorney in San Francisco can assist.
Make sure you keep a copy of the medical report and medical bills. Also, tell your treating doctor that the injury or illness is work-related so they can fill out their appropriate forms.
File a Claim With Your Employer
Your employer will begin this process as soon as you report the injury or illness. If you have to miss work or need medical attention beyond first aid, your employer is legally required to fill out Form 5020, a Report of Occupational Injury or Illness.
Your employer will also give you form DWC-1 and a notice that covers the benefits you might be eligible for. You should fill out the claim form and either give it to your employer in person or send it back via first-class or certified mail.
Afterward, your employer’s insurance provider will review your claim. The insurer can take up to 90 days to investigate the claim. They will cover up to $10,000 in medical bills while you wait. You can expect to receive temporary disability to make up for lost wages within 14 days of filing your claim.
If your employer is uninsured, they will face a steep fine and you will be eligible for benefits from the Uninsured Employers Benefits Trust Fund. As you navigate the claims process, you can seek out a workers compensation attorney in San Francisco to help you determine what forms to fill out and what steps to take next.
More About Your Benefits
You’re eligible to receive two-thirds of your gross wage before taxes with a weekly cap of $1,356 as of 2021. You can receive these benefits for up to two years or 104 weeks. However, you don’t have to receive your benefits continuously. If you sustained an injury that resulted in chronic pain, you can stretch out these 104 weeks over five years.
With that in mind, in California, employers aren’t required to carry coverage for long-term disability benefits. If your employer offers this coverage as a perk, you can apply for long-term benefits that make up for a portion of lost wages or ongoing medical needs. Your best option is to apply for Social Security benefits if your employer doesn’t have this type of coverage.
File an Application With the Workers’ Compensation Appeals Board
If your employer’s insurer denies your claim or a dispute arises with your employer, your next step should be to pursue a case with the Workers’ Compensation Appeals Board. After you file form WCAB-1 (an application for Adjudication of Claim), a claim administrator will review your case.
You should file form WCAB-1 within a year of the date of the injury, or within a year of the date when you stopped receiving temporary disability benefits.
Should You Get Help From a Workers Compensation Attorney in San Francisco?
If your claim gets denied or you run into a dispute with your employer, a workers compensation attorney in San Francisco can help you move forward.
While it’s sometimes possible to resolve workers comp claims without a legal professional, a workers comp lawyer can help you obtain the records and documents needed to support your case. They can also deal with the Appeals Board on your behalf. They’ll work to get you the compensation you deserve so you can recover with more peace of mind.
Remember you only have 30 days to report the injury and begin the claims process. So, don’t hesitate to contact a lawyer for assistance.