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Workers’ Comp Claims and Benefits in the State of California

If you were injured or have otherwise suffered an illness because of a work-related activity, you will need to notify your employer immediately – as soon as you believe you have a work-related injury or illness. You will then need to file a workers’ compensation claim with your employer by completing the appropriate portion of the claim form provided to you by your employer. If you have submitted the form to your employer, this will also serve as a written notice of the nature of your claim.

Additionally, you are required to file an Application for Adjudication of claim with the Workers’ Compensation Appeals Board, typically within one year of the date of injury or last benefit provided to you, whichever is later. California’s workers’ compensation strict deadlines can be extended on very stringent circumstances.

Workers’ Compensation Benefits

If you have filed for workers’ comp benefits and your claim has been approved, you could be entitled to receive monetary support for the following:

  • Medical expenses for care and treatment related to the work-related ailment
  • Partial limited income replacement while away from job duties due to recovery
  • Permanent disability benefits for those who will not be able to make a full recovery from the work-related injury or illness.

When a worker has passed away as a result of the work-related injury or illness, any surviving dependents could be eligible for benefits.

Employers Who Do Not Have a Workers’ Compensation Insurance

Employers in California are legally required to have a workers’ compensation insurance through an insurer or self-insured program. If an employer is found to not have workers’ comp insurance, the injured worker has several remedies.  He or she may be able to file a personal injury lawsuit in civil court and they may also file a Workers Compensation claim with the Workers’ Compensation Appeals Board.

In addition, according to the California Labor Code Sections 3700 and 3706, workers filing for workers’ comp benefits can seek to obtain medical expenses and a loss of wages.

How to Handle a Denied Claim

Once you have submitted your claim to the employer, your employer will need to respond within 90 days of your submission. If you have not received a notice regarding your claim within that time frame, California law assumes that the claim has been accepted. Under the California Labor Code Section 5402, while the claim is under investigation, you could receive limited aid to cover medical expenses, even if your claim is ultimately denied.

In the event that a claims adjuster has denied your claim, you are legally entitled to appeal the decision by petitioning for adjudication of claim. Once the claim denial has been received, however, you are encouraged to seek legal representation. Insurance companies are notorious for denying claims and this can have devastating consequences for your ability to sustain the quality of life to which you have become accustomed. An experienced California workers’ comp attorney will help you protect your interests.

The attorneys at Heiting & Irwin have helped many injured workers obtain the benefits they deserve after suffering a work-related injury or illness. In addition to Richard Irwin, a certified Workers’ Compensation Specialist, the firm has many years of dedicated experience in representing clients who have been denied workers’ comp benefits. If you have been injured or have otherwise suffered an injury or illness because of your work duties, seek proficient legal representation today.

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