The Process of Filing a Workers’ Compensation Claim

Have you experienced an injury or illness while completing your job duties? Your employer may owe workers’ compensation for medical care, time off work, and related expenses. However, you may not fully understand the complexities of this process, including the extent of your rights and what you can and cannot ask for.

Many injured workers feel intimidated by the workers’ compensation process and avoid filing a claim for fear of employer retaliation. But if your employer offers workers’ comp benefits, you have a right to apply for them — and your employer cannot legally punish you for claiming these benefits. 

Filing a workers’ compensation claim may be simpler than you think. Review the steps below, then contact Khalil Law Group for assistance. 

Make Sure Your Injury or Illness Qualifies

Before spending time on a worker’s compensation claim, ensure that your illness or injury qualifies. If it doesn’t, you’ll end up spending a lot of time and stress on the application without gaining anything in return. 

For an injury to qualify, it must have arisen out of or in the course of your employment. Almost every injury that occurs at work or while on the job can qualify, even if the injury was technically your fault (such as if you did not follow safety protocols while using machinery). 

You may also seek compensation for “cumulative trauma,” which results from repetitive strain. If you work a labor-intensive job, you may have slowly built up an injury over time. 

Meanwhile, not every illness contracted at work qualifies for workers’ compensation benefits. You must be able to prove that a workplace hazard or condition caused your illness. 

If you’re unsure whether your medical condition qualifies for workers’ compensation, schedule a consultation with a workers’ comp attorney

Understand the Statute of Limitations

California has a few deadlines for workers’ compensation claims, and fully understanding these timeframes can prevent you from losing your medical benefits. 

First, you must alert your employer of the injury or illness within 30 days of discovering it. If this deadline has already passed, you may be able to waive it under certain circumstances. 

After alerting your employer, be sure to file the actual workers’ compensation claim within one year of the date of your injury or diagnosis. This deadline only applies to your portion of the claim form; your employer will also be responsible for filling out a section of it. 

If the insurance company denies your workers’ comp claim, you will have one year from the date of the injury or your last day of temporary disability benefits to appeal the decision.

Report Your Injury to Your Employer

Your first step in filing a workers’ compensation claim is alerting your employer to the injury or illness. Report your injury as soon as possible to start the ball rolling and avoid exceeding the 30-day deadline. The longer you wait, the more suspicious the insurance company will be that your injury caused damages. 

Don’t just mention the injury to your employer in passing; ask them to create a written report detailing the injury or diagnosis. You’ll want to have a paper or digital trail throughout this process to show that you have met appropriate deadlines and communicated with your employer. 

Hire a Workers’ Comp Lawyer

Some employers make the workers’ compensation process quick and easy, but if your boss is like many, they’ll probably make you jump through a few hoops to secure medical benefits. You don’t need to navigate a complex workers’ comp claim yourself; instead, rely on a workers’ compensation attorney who has extensive experience with the process. 

Your attorney can help you fill out the appropriate paperwork to file your claim and gather evidence that your injury happened at work. They can also prevent you from missing deadlines or making other mistakes you may not even be aware of. 

File a Claim With Your Employer

Ideally, your employer should give you a workers’ compensation claim form within one day of reporting your injury. If yours doesn’t, you can download the form yourself on the California Division of Workers’ Compensation website. 

This form has two sections: one for you and one for your employer. Record the details of your injury or illness in the “employee” section in as much detail as possible. If you experienced multiple injuries from the same incident, list them separately. Your attorney can review the form to ensure you have provided all the necessary information. 

Once you’ve finished filling out your section, give the form to your employer by mail or in person. Your employer should complete their portion within one business day and submit it to the insurance company. 

While you wait for the insurer to accept or deny your claim, the insurance company will be responsible for paying up to $10,000 for your medical treatments. This statute should encourage the insurer to make a fast decision. 

File an Appeal if Necessary

You should hear back from the insurance company within 90 days of your claim submission. If the insurer denies your claim, you can appeal the decision through an Application for Adjudication of Claim form. 

You’ll want to provide extensive evidence of your injuries and additional information beyond your initial claim as part of your appeal. You may need to attend a hearing or participate in other legal procedures while the insurance company attempts to learn the details of your claim. 

You likely won’t succeed in the appeal process without an attorney’s assistance. If you haven’t hired an attorney up to this point, now is the time to seek legal guidance. 

Do You Need Help Filing a Workers’ Compensation Claim? 

If you’re suffering from a work-related injury, don’t sacrifice the benefits your employer owes you. Work with an experienced workers’ compensation attorney in Orange County who can guide you through the claims process and provide legal advice at every turn. 

Call Khalil Law Group today at 714-617-7870 to schedule your free consultation and learn whether you may be eligible for workers’ comp benefits.

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