Workers’ compensation is a protected right in the California Constitution. Here’s how to file and prove a workers’ compensation claim.
To be eligible for workers’ compensation, an individual must simply be injured while working as an employee (with exceptions). The injured worker should report the injury to their supervisor within 30 days or risk losing their right to workers’ compensation. The employer will then provide them a claim form and a workers’ comp notice. The worker must then fill out the ‘employee’ section of the claim form and return it to the employer, which constitutes filing the claim. Generally, the claim will be approved, but some instances require settlements or adjudication.
Eligibility
Workers’ compensation is an administrative proceeding in which employees are paid money in order to compensate for an on-the-job injury. Employers are mandated by law to have workers’ compensation insurance, as California Labor Code Section 3700.5 criminalizes the failure to acquire insurance for workers’ compensation.
In order to be eligible for workers’ compensation, an individual must sustain an injury “arising out of and in the course of employment” (California Labor Code Section 3600). This simply means that an employee is eligible for workers’ comp if the injury occurs while working, but Section 3600 notes some exceptions. For example, the employee is not eligible if the injury was self-inflicted or if the injury occurred while the employee was intoxicated. Notably, however, the employee is eligible for workers’ comp even if the injury was caused by their own negligence.
Process
To initiate the process of receiving workers’ compensation, the employee must report their injury to their supervisor or employer within 30 days of the injury occurring (California Labor Code Section 5400). If 30 days pass, they may lose their right to workers’ compensation. However, according to Labor Code Sections 5402 and 5403, the requirement of notice is satisfied if the employer or supervisor learns of the injury in any way from any source, and a delay in notice shall be accepted if it is found that the delay did not mislead or prejudice the employer.
Related: What to Do if Injured at Work in California
Many injuries, however, do not occur on a single date. Rather, they are cumulative, which means they develop over time. According to Labor Code Section 5412, the ‘date of injury’ in the case of a cumulative injury occurs when the employee first suffered a disability as a result of the injury and knew or should have known that the disability was the result of their occupation. Therefore, individuals have 30 days past this point to file a claim before risking the loss of their right to workers’ compensation.
After notifying their supervisor or employer, the employer is legally obligated to provide the employee with a workers’ compensation claim form and a benefits notice within 1 day if the injury caused the employee to miss work or required medical treatment beyond first aid (Labor Code Section 5401). If the employer does not provide the claim form, then the employee may download the form themselves.
The employee must fill out the ‘employee’ section of the form, which includes information such as the date of the injury. If one is unsure about the details regarding their cumulative injury and the date of injury is less obvious, the employee should contact a lawyer.
Next, the employee must either directly deliver the claim to the employer or send it through first class mail. This constitutes the ‘filing’ of the claim. After this filing of the claim, the employer or its insurer has a 90 day period to deny liability, according to Labor Code Section 5402. If this 90 day period passes without denial of liability, then the injury will be presumed to be compensable by the Division of Workers’ Compensation. The insurance company may simply accept or deny the claim at any point during this 90 day period, however.
If accepted, then the associated benefits will be provided. If denied, the employee may object to the denial by filing a case with the Division of Workers’ Compensation. This will initiate the settlement process by scheduling a hearing with a judge. If a settlement is not reached, then the case will head to trial.
In any case in which a workers’ comp claim is denied, it is always recommended that the employee seek legal representation to assist in the settlement process. If you are in need of an attorney for your workers’ compensation claim, contact Her Lawyer to be put in touch with a workers’ rights lawyer who will help ensure that you receive the benefits that you are entitled to.
Statute of Limitations
According to California Labor Code Section 5405, workers have exactly one year from the date of the injury, or in the case of a cumulative injury, one year from the date in which the worker first suffered a disability from the injury or should have known that the disability was caused by their occupation, to file a claim. In addition, the statute of limitations for applying for additional benefits is one year after the date of the last payment of disability benefits.
FAQs
Am I entitled to workers’ compensation for my injury?
If you were injured while working, then you are most likely eligible for workers’ compensation.
What are the exceptions to workers’ compensation eligibility?
You are not eligible for compensation if the injury occurred while you were intoxicated, if the injury was due to your own will and volition, or if the injury was due to a fight that you started.
How do I file a workers’ compensation claim?
Notify your supervisor or employer within 30 days of the injury. They will provide you with a claim form, which you will then fill out and return to the employer. This constitutes filing a claim.
What do I do if my claim is denied?
If your claim is denied and you wish to object, you may start a case with the Division of Workers’ Compensation. You should also contact a lawyer.
What is the statute of limitations on filing a workers’ compensation claim?
Workers have one year from the date of the injury to file their workers’ compensation claim.
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If you have any more questions about workers’ compensation in California, contact us. We’ll get you in touch with the most qualified attorneys for your unique legal matter. Get your free consultation with one of our Work Injury Attorneys in California today!