By purchasing and maintaining workers’ compensation insurance, employers in California automatically assume liability for certain losses suffered by any of their employees through a work-related injury or illness. However, just because workers can claim compensation, it does not mean that claims will succeed in every situation: an insurance provider that wants to maximize its own profits at the expense of injured claimants could seriously complicate matters.
Being well-informed in advance about the workers’ compensation case process in Santa Ana prior to filing a claim yourself can be helpful in many ways. It may help in minimizing stress as you fight for the benefits you need, but it could also increase your chances of actually obtaining those benefits by building the strongest possible case. Here is a brief overview of the key stages in this type of legal proceeding, each of which a skilled employee compensation attorney could help guide you through.
The claim process in Santa Ana only begins once the injured or ill worker intending to file for compensation has notified their employer in writing about their condition and the circumstances leading up to it. The employer will then provide the prospective claimant with a Workers’ Compensation Claim Form and ask them to fill out the relevant section before returning it.
Once the employer completes their portion of the claim form, they will send it to their insurance provider’s claims adjuster. The adjuster will send further information about the process to the claimant and begin investigating the workers’ compensation case in order to determine its validity in Santa Ana. Meanwhile, the claimant should seek medical care from an employer-approved physician, the costs of which should be automatically authorized by the insurance provider for a value of up to $10,000, excluding the costs of any emergency treatment already received.
The claims adjuster then has 90 days to decide whether to accept or reject the claim, and if more than 90 days pass without a decision, the claim is presumed accepted. In Santa Ana, if the claims adjuster accepts the claim, they will then continue—and often conclude—the workers’ compensation case. They will do this by reviewing records from the claimant’s treating physicians to determine what disability benefits, if any, should be awarded to the claimant based on the nature and severity of their injuries.
If the insurance company initially denies a compensation case, the claimant has one year from the date of injury to start the workers’ compensation appeals process by sending a completed Application for Adjudication of Claim Form to Santa Ana’s appeals board. There may also be alternative dispute resolution options available at this point, which a legal professional could explain in greater detail as needed.
Of course, this is far from a comprehensive summary of every single action that goes into successfully filing for workers’ compensation benefits in the Golden State. That said, it should impress upon you just how many unique opportunities there are when filing a claim for a single procedural error to sidetrack your pursuit of benefits, or even cause your claim to be denied outright.
Going through the workers’ compensation case process in Santa Ana will be much easier, and you will greatly increase your chances of success, if you have representation from a capable employee claims attorney. Call today to learn more.
