Employees who have been injured while working in Santa Ana must follow California laws and guidelines for filing a workers’ compensation claim to qualify for benefits. It’s important to take the right steps and to meet the filing deadlines to ensure the claim is fairly considered and compensated. Once the claim has been filed, a workers’ compensation attorney in Santa Ana can help injured employees navigate the complex legal system and obtain the benefits they deserve.
How to File a Workers’ Comp Claim in Santa Ana
An injured worker must notify their employer in writing within 30 days of the injury. Notifying a supervisor of the injury is also acceptable. Typically, failure to provide a notice doesn’t disqualify workers from receiving benefits unless the delay causes negative consequences for the employer.
Within one business day of being notified of the injury, the employer is required to provide the worker with a claim form that requires the worker to detail the following information:
- Date, time, and address of the accident or injury
- Description of the accident scene
- Injury and parts of the body affected
- Social security number
The employer is then required to complete their portion of the form with the following information:
- Name of the employer
- Business address
- Date the employer was notified of the injury
- Date the claim form was provided to the employee
- Insurance policy number
- Name and address of the insurance company
The injured worker and employer must both sign the form. The employer will then send the completed form to their insurance company, which will in turn mail notices to the injured worker covering important information, such as:
- The workers’ compensation process
- Description of the different types of workers’ compensation benefits
- Healthcare facilities and professionals the worker may be treated by
- The role and responsibility of the primary treating physician
- The worker’s rights to change their treating physician
- How to obtain medical care while the claim is pending
- Protections against discrimination
- The worker’s right to disagree with the insurance carrier’s decisions about the claim
The statute of limitations for filing a workers’ comp claim is typically one year, but various circumstances can delay it. If the employer doesn’t notify the worker of their right to file a workers’ compensation claim or fails to provide a claim form, the statute of limitations may not apply.
Once the claim has been filed, the insurance company has 90 days to make a decision. If the decision is not made within 90 days, then the injury is automatically accepted. The insurance company is required to provide up to $10,000 in medical coverage while the claim is being investigated, even if it is eventually denied.
If the claim is denied, a workers’ compensation attorney in Santa Ana can help workers take the right steps to appeal the decision and pursue benefits.
How to Resolve Disputes In Workers’ Compensation Claims
The worker may disagree with the insurance company about the injury, their medical treatment, disability status, and other aspects of the case.
To resolve any disputes, the worker should consider hiring a workers’ compensation attorney in Santa Ana. The attorney will file an Application for Adjudication of Claim in the local Appeals Board office to have the issue heard by a judge.
The next step is to file a Declaration of Readiness to Proceed to request a hearing. While the worker is waiting for the Notice of Hearing, the attorney will ensure their client is receiving the best medical care available.
If the insurance company is unreasonably delaying or denying benefits, injured workers may obtain a 25% penalty of up to $10,000, for any benefit that a judge finds was unreasonably delayed. Even if benefits for the temporary or permanent disability are accidentally delayed, the insurance company must automatically pay a 10% penalty for the delayed amount.
Reasons A Workers’ Comp Claim May Be Denied
An insurance company may give a number of reasons for denying a claim. In each of these instances, it helps to have an experienced workers’ compensation attorney in Santa Ana representing the injured worker.
- The injury was self-inflicted or intentional.
Workers’ compensation insurance is for workers who were accidentally injured while on the job. If the worker intentionally harmed themselves to receive benefits, the claim may be denied and they may face fraud charges. However, the insurance company must have concrete evidence of fraud to deny a claim for this reason.
- The injury is not causally linked to employment.
Typically, injuries sustained during a commute to or from work or during a lunch break don’t qualify for workers’ compensation benefits. This defense also applies to instances in which a worker sustains a minor injury while on the job and:
- Engages in activities outside of their normal scope of work that worsen the injury, or
- Fails to seek medical attention for the minor injury.
Workers who are injured while on a business trip are within the scope of their normal job duties, but must show proof that the injury is related to their job responsibilities.
- The employee engaged in willful negligence or horseplay.
If the worker was injured while displaying reckless behavior or violating company policy, they may be disqualified from workers’ compensation benefits. An injury that occurs while the working employee is intoxicated may also be denied.
In some cases, an insurance company may use this defense even if the worker didn’t engage in horseplay. An experienced workers’ compensation attorney in Santa Ana can help defend the worker and secure benefits.
- The employee failed to attend doctor appointments.
Injured workers cannot unjustifiably refuse medical treatment because the insurance company needs to review the findings of an independent medical examination to determine the amount of benefits a worker is entitled to.
Why Hire Santa Ana Workers’ Compensation Attorney Thomas F. Martin, PLC
To receive benefits, injured workers must seek medical treatment while adjusting to life with serious injuries. As a result, it can be difficult to balance the demands of legal proceedings with personal responsibilities. An experienced workers’ compensation attorney can ease the burden by taking care of the paperwork and communication with the insurance company and legal system.
Thomas F. Martin PLC has helped many injured workers in Santa Ana obtain the benefits and compensation they deserve so that clients can focus on treatment and recovery. Call his office today to schedule a consultation.
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