Report Your Workers' Compensation Injury!

Jeffrey M. Shalmi, Attorney at Law, Inc. Profile Image

Jeffrey M. Shalmi, Attorney at Law, Inc.

Alhambra, CA

Practice Areas

Workers Compensation

In order to obtain the benefits to which you are lawfully entitled when you are injured at work, you must first report your injury. Sounds easy enough, but most workers are afraid to report their injuries for fear of losing their job. But did you know that it is against the law for an employer to terminate or mistreat an employee because he has filed a work injury claim or because he has made known his intention or wish to file a workers' compensation claim? It's true. And you can receive double your benefits, up to $10,000.00, and return to work with all benefits and seniority privileges.

However, If you fail to report your injury, you will receive none of the benefits or protections which the Workers' Compensation Laws provide injured employees. Benefits such as 2/3's of your pay while you cannot work and medical evaluations and treatment to cure or relieve the effects of your injury will pass you by... UNLESS YOU REPORT IT TO YOUR EMPLOYER!

If you fail to report your injury within 24 hours, you will have a harder time obtaining the benefits therafter. The employer will allege that you were derelict in your duty to report the injury on a timely basis or contest whether it happened at all. If you fail to report the injury, your claim can be denied and you may be barred from receiving any benefits, especially if you do not see a doctor. If you fail to apply to the Workers Compensation Appeals Board for benefits within one year from the date of your injury, or one year from the last date of your cumulative trauma injury, you may be forever barred from bringing your claim.

You may be fired or laid off, because your employer feels your work is no longer up to snuff. Your claim is barred, in many cases, if your bring a claim after you are terminated. Tough luck!

However, when you report your injury timely, a whole panoply of fantastic benefits open up for you and your loved ones!

Employer Knowledge.

When a manager, supervisor or lead has knowledge of an employee injury or illness that may be industrial (work-related) in nature, California state law requires that the employer provide the employee access to medical treatment and a Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility within 24 hours of your notice.

The employment manager must fully document the claim/incident, refer the injured or ill employee to the designated industrial medical clinic for evaluation, and give the employee the DWC-1 claim form--all within 24 hours of your notice... and forward the information to their Workers' Compensation insurance carrier.

On the date of injury or first date of treatment, if the employee is unable to drive themselves to the clinic, most workers' compensation carriers will arrange for transportation by taxi or ambulance, if required, to the medical facility.

If you file a claim, the claims administrator, who is responsible for handling your claim, must notify you within 14 days whether your claim is accepted or whether additional investigation is needed.

In any case, within one working day after you file a claim form, your employer or the claims administrator must authorize up to $10,000 in treatment for your injury, consistent with the applicable treating guidelines, until the claim is accepted or rejected.

If the employer or claims administrator does not authorize treatment right away, you should talk to your supervisor, someone else in management, or the claims administrator. Ask for treatment to be authorized right now, while waiting for a decision on your claim.

If the employer or claims administrator will not authorize treatment, use your own health insurance to get medical care. Your health insurer can seek reimbursement from the workers compensation claims administrator. If you do not have health insurance, there are doctors, clinics or hospitals that will treat you without immediate payment. They will seek reimbursement from the claims administrator.

If you are unclear what to do, or if you reach an immovable roadblock on your path to workers' compensation benefits, call a lawyer immediately to get fast help to move your case and your injuries throught the complex system.

Medical Care: Your claims administrator from the workers comp insurer will pay for all reasonable and necessary medical care for your work injury or illness. Medical benefits are subject to approval and may include treatment by a doctor,chiropractor, acupuncturist, physical therapist, hospital services, physical therapy, lab tests, x-rays, medicines, equipment and travel costs. Your claims administrator will pay the costs of approved medical services directly so you should NEVER see a bill.

There are limits on chiropractic (24), physical therapy (24), and other occupational therapy visits (24). This comes to a maximum of 72 visits, which should be more than enough in most cases. In extraordinary cases, should your doctor recommend more visits, your attorney can help you obtain the needed treatment and care.

If you are being treated in a Medical Provider Network (MPN), you may switch to other doctors within the MPN after the first visit.

All of these benefits and more are available to workers injured while on the job or as a result of their employment during the course and scope of employment. You may have an industrial (work) injury and not even know it (continuous or cumulative trauma claims).

But you will never receive any of these benefits and protections, unless your first REPORT your injury to your supervisor or employment manager!

[This information pertains to California employees and employers. Laws may differ in your state or jurisdiction.]

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