California has been offering benefits to workers who have become ill or injured on the job for 100 years, and although these benefits are a critical lifeline when you cannot work, it could be easy to make mistakes when filing a claim. Failing to comply with the paperwork and proof required by the California Division of Workers’ Compensation (DCW) will delay your benefits or put you at risk of denial. An experienced workers’ compensation attorney knows the pitfalls you want to avoid and has experience helping other people avoid them.
Employers may drag out doing their part to give you temporary healthcare benefits. Insurers might question whether your temporary disability injury is work-related and refuse to pay or may pay you less than you are entitled. However, you have some responsibility to comply with the rules, too, and our attorneys at Silberman & Lam will identify the mistakes to avoid when making a Torrance workers’ compensation claim.
According to the California Department of Industrial Relations, an employee has 30 days to notify an employer of a workplace injury or an illness that has an industrial causation. However, workers’ compensation does not require any party to establish liability. The system works by ensuring employees receive workers’ compensation-provided medical and disability benefits and employment protection in exchange for giving up the right to sue employers for negligence.
Employers may impose their own protocols for reporting and submitting claims to insurers that employees should also follow. The biggest mistake an employee can make is to ignore the 30-day deadline and fail to comply with employers’ additional workers’ compensation policies, which could jeopardize their eligibility for benefits in Torrance.
Workers’ compensation claims adjusters review filings for accuracy and to ensure they include a full explanation of an employee’s work-related injuries that are supported by a physician’s diagnosis and prognosis stating they occurred at work.
Adjusters reviewing vague claims that do not clearly link the injuries to the workplace or indicate the employee is not following the physician’s treatment plan may deny them or insist the employee keep an appointment for a medical exam by a Qualified Medical Evaluator (QME). Adjusters can also request a QME visit if there are any questions about prospective treatment or ability to return to work. Failing to provide adequate information is another mistake injured employees must avoid in Torrance when making a workers’ compensation claim.
The DWC will generate a list of QMEs the employee can pick from for their second opinion. This is a certified physician in the field who is pertinent to the employee’s injuries or illness. They will concur with or dissent from the original physician’s opinion. It is imperative that employees attend this appointment with a QME because failing to do so can result in a denial of a claim.
If the adjuster denies an employee’s claim, the worker or their attorney can file an Application for Adjudication of Claim at the local DCW office. A judge will schedule a mandatory settlement conference where both parties will discuss their differences to reach an agreement. The judge can set a trial date if negotiations reach an impasse.
Filing for the medical and wage benefits your employer provides under state law can be daunting, especially when you are injured or ill. One misstep and the insurer’s claims adjuster will delay or deny your workers’ compensation.
An experienced workers’ compensation attorney is aware of all the pitfalls you will encounter when you try to file a claim. We will explain the process so you can understand the mistakes to avoid when making a Torrance workers’ compensation claim. Call us today for your initial consultation.
