How to Understand California Workers’ Compensation Law
California workers’ compensation law is an incredibly complex and confusing area of law, especially for individuals who are not licensed lawyers with years of experience such as myself. While this short post will provide you with some background on California workers’ compensation claims, it is not a substitute for hiring an attorney to guide you through the claims process and advocate for your just compensation.
The Claims Process
California workers’ compensation law requires employers to carry workers’ compensation insurance coverage. These insurance providers act as a safety net for employers if and when accidents occur. The insurance providers accept claims, review them, make decisions, negotiate payments and medical care, and pay benefits.
When you are injured, you report the accident to your employer. The employer gives you a special claim form to fill out. You should detail what happened and the extent of your injuries. The employer will then complete their portion and send it to their insurance provider. The insurance provider then acts as the claim administrator. While your claim is being reviewed, you can seek medical care and treatment, paid by the insurance company.
When your claim is accepted, you then need to work out payment. There are a variety of different payment plans available, though the payment plan you enter into will be determined by the type and extent of the injury, as well as other factors. One type of payment plan is the compromise and release, which is a lump sum payment for your injury. You are limited only to this agreed-upon amount. You cannot later seek more money for future medical expenses. Another type of payment plan is the claim stipulation and award. Under this agreement, the insurance company makes periodic payments to you to cover the cost of the temporary or permanent disability caused by the accident. The insurance provider also oversees all future medical care. You are entitled to medical treatment for the life of your disability, though insurance companies are notorious for rejecting recommended treatment.
Appealing a Denial
If the insurance company rejects your claim or refuses to pay you the full benefits you think you deserve, you can file a claim with the court. The workers’ compensation court in California is comprised of workers’ compensation administrative judges (WCJs). The WCJs conduct bench trials to decide the merits of claims. When your claim is denied, you first file a claim with the Division of Workers’ Compensation and serve a copy of your claim on the insurance company. At this time, the insurance company may agree to a favorable settlement. If not, you can then file a readiness form that states you are prepared to litigate. At this point, the WCJ will schedule a master settlement hearing. At the hearing, the WCJ will determine whether the parties are capable of mediating. If so, you and the provider will attend mediation and attempt to negotiate. If not, the WCJ will schedule a trial date.
At the trial, you and the insurance provider will submit evidence into the record and call witnesses to testify. You will also make arguments about how the WCJ should interpret the facts and California workers’ compensation law.
If your claim is still denied, you can appeal this decision by filing a petition for review.
Sacramento Workers’ Compensation Lawyer
I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. If you have suffered an injury at work, please call me at 916-921-6400 for free, friendly advice. Read more about us on our website, http://www.AutoAccident.com.
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