How to File an Injury at Work Claim: A Step-By-Step Guide

According to the Bureau of Labor Statistics, private industry employers report more than 2.5 million nonfatal work-related injuries per year. These injuries can take quite a toll on employees and thankfully there are regulations in place to ensure that employers in California have workers’ compensation insurance in place. However, the process for filing this injury at work claim can get a bit confusing and complicated when you’re unsure of your rights. 

Were you or was someone you know injured at work? Let this article serve as a guide through the process of filing your workers’ compensation claim in California. 

Let’s get started!

When Can You File a Workers Compensation Claim?

In order to obtain workers’ compensation benefits, you must prove that you were injured during the course of your employment. This means that the injury should have occurred while you were engaged in an activity that is part of your job. 

Generally, injuries that occurred during your daily commutes do not make the cut. However, if your employer specifically asked you to drive/ travel elsewhere for work purposes during which you were injured, this would be within the course of employment. 

However, you won’t qualify if:

• Your injury was a result of your own intoxicated state
• Was caused while you committed a felony or an outcome of a fight you started yourself

It also gets tricky if you are employed as an independent contractor and not a full-fledged employee, in which case it might be advisable to talk to a qualified personal injury attorney to learn more about your options. 

If you do meet the requirements, be sure to take the following steps and get started on the claims process. 

Step 1: Report Your Injury to Your Employer

While your first priority should undoubtedly be to get the medical care you require, a close second is communicating your injury to your employer. You need to notify your employer in writing about the particulars of your injury within 30 days of the incident. 

Sometimes it may be acceptable to notify your employer via some other means, but generally, it is always advisable to have evidence of communication. 

Step 2: Fill Out Necessary Forms

Next, it is upon your employer to provide you with the necessary DWC-1 form within one day of intimation to begin your claims process. If you do not get this form from your employer, you can go ahead and download a copy online. 

Be sure to fill out the worker/ employee section of your form according to the instructions mentioned therein. The information you need to provide will include things like your name, the date and time of your injury, a description of your injuries, your social security number, and so on. Your employer will then fill out their part of the form and submit it to the insurance company.

Step 3: Awaiting Authorization From the Insurance Company

The insurer must give you a notice that includes a detailed explanation of your rights and the procedure used to file your claim. The insurance company has 90 days to investigate the claim. If they do not give you an answer within this time frame, your claim is approved.

During this time, the insurance company is still required to provide you with monetary support up to $10000 even if they later choose to deny your claim. 

However, during their investigation process, they may choose to have you evaluated by a medical professional, ask you questions under oath, or ask you to disclose previous medical records through a subpoena. If you feel like your right to privacy is being needlessly violated, talk to a lawyer immediately to get the legal advice you need. 

Insurance companies are generally on the lookout for any reason to disqualify or invalidate your claim. As an employee, it is always beneficial to strengthen your position with the help of a qualified attorney who puts your interests first. 

If your claim has been accepted you get compensation for your medical treatment. In addition to that, you may also be compensated for disability benefits depending on the particulars of your injury.

What to Do When Your Injury at Work Claim Is Denied

If your injury at work claim is denied, the insurance company will send you a Notice of Denial. They could deny your claim due to various reasons including:

• Failure to file the claim within the specified deadline
• When there is dispute or ambiguity surrounding the circumstances of your injury
• Claim filed after you quit your job

Upon receiving that letter you have one year to file an appeal against their decision. 

To start off, file an Application for Adjudication (Form WCAB-1) with the Workers’ Compensation Appeal Board in your state. This process is generally time-consuming and requires you to attend hearings and partake in legal proceedings. It is generally advisable to seek out a qualified personal injury attorney or a workers compensation attorney who can represent you. 

Get the Justice You Deserve

As an injured employee, you must notify your employer of your injury within a month. After that, be sure to fill out the form provided to you by your employer to get your injury at work claim started. If your claim is denied or you feel like you don’t have a strong enough case for a claim, consider getting legal help to ensure that you get the benefits you need. 

Afraid about legal fees? At Sweet Lawyers, we offer a free first consultation to all our clients. Thereafter, you only have to pay if we win your case. 

Schedule an appointment with our top-notch attorneys right here and get the compensation you deserve.