THINGS YOU SHOULD KNOW ABOUT…. YOUR WORKERS’ COMPENSATION CASE (PART 2)
5. WHAT TO EXPECT AT THE BEGINNING OF YOUR CASE
Workers’ Compensation law is complicated. This summary, although over-simplified, is intended to give you an idea of some things to expect at the beginning of your case. You may contact this office for further information.
If you get hurt on the job, your employer is required by law to provide workers’ compensation benefits. You could get hurt by one event at work, or repeated events or exposures at work. Once you discover your injury, you must notify your employer, immediately, and seek medical attention if needed. Your employer is required to provide you with a workers’ compensation claim form and other information about your workers’ compensation benefits.
Provide these documents to this office for filing with the employer. On receiving the completed claim form from either you or our office, the employer must provide it to its workers’ compensation insurance carrier immediately for processing. Please note, however, that if your claim is denied (in whole or part) you may not be paid any benefits, for several days and, in some case, not until a trial is held regarding this issue.
YOUR TEMPORARY DISABILITY PAYMENTS WILL NOT BEGIN UNTIL THE INSURANCE CARRIER ADMITS (if they do) LIABILITY OR A JUDGE IMPOSES LIABILITY UPON THEM FOLLOWING A HEARING ON YOUR MATTER. Admitting liability means that your employer and its workers’ compensation insurance carrier admits that you suffered an injury during your employment. This determination could take up to 90 days during which time the employer and/or insurance company is investigating your claim. During this time, it is recommended that you contact EDD and seek State Disability Benefits. In fact, we recommend that you file for State Disability even if your claim has been accepted. This initial 90 days “delay” period may be one of the most difficult for the injured person who has lost income from work.
During this time that your case is under investigation, your medical care providers may be willing to treat you on a “lien” basis, although this is happening less and in less in our current workers’ compensation environment. That means that your employers’ workers’ compensation carrier could pay them once liability is accepted. If your claim is denied, you could be responsible to pay them at a later time – although this is not common. Some typical reasons for denial include: no employment relationship, no industrial injury, or prior existing injury.
If your claim is accepted and your treater places you on disability, you will begin to receive payments equal to 2/3 of your gross income per week, up to the maximum in effect for your date of injury. You will then receive a check every two weeks, under most circumstances. Your medical care providers will also submit their bills to the insurance carrier for payment. PLEASE NOTE THAT THESE PAYMENTS ARE USUALLY LIMITED TO A MAXIMUM OF 104 WEEKS.
If for any reason your employer was not covered by workers’ compensation insurance, we will discuss all your options with you. This may require the signing of another retainer agreement with this office