Overview of Process
At the San Mateo, California law firm DuRard, McKenna & Borg, we are dedicated to helping injured workers throughout the San Francisco Bay Area navigate the confusing workers’ compensation process. Here is an overview of the process:
1. Report the injury
All too often, employers persuade injured workers not to report injuries but instead to go home and see if it gets better. If you have suffered anything worse than a “band-aid injury,” insist on reporting it as soon as possible, and insist on getting a DWC-1 Claim Form. The California Labor Code requires that the employer provide or mail a claim form and notice of potential eligibility for benefits within one working day of receiving notice or knowledge of an injury. If the employer fails to provide the claim form, you can obtain it here. Once you receive the form, fill it out and return it to your employer as soon as possible because if you do not, you risk losing your eligibility for benefits.
2. Get medical treatment
Although recent legislation has placed restrictions on workers’ compensation benefits, employers are still required to provide medical treatment for injured workers. Employers can set up Medical Provider Networks (MPNs), or a list of employer-approved doctors. If the employer correctly complies with all of the legal requirements and sets the MPN up properly, you must be treated by an MPN physician unless you have pre-designated a treating physician. If the MPN is invalid or if your employer does not have an MPN, you may choose your own physician.
Employers have up to 90 days after a claim form is filed to investigate the injury and decide whether to accept liability. However, during this time they are required to pay for the first $10,000 of medical treatment you need even though they have not yet accepted the claim. This obligation ends when they deny the claim or when it becomes irrelevant if they accept the claim.
3. Qualified Medical Evaluator (QME)
If there is a dispute in your case about medical treatment, temporary disability, or the extent of permanent injuries, one of the parties will probably want to get a medical evaluation and report. You do not get to choose which QME performs the evaluation, and there are strict time deadlines for how long you have to object to the report. Failure to object within the time limits waives the objection and you lose your right to obtain evidence to disagree with the treating doctor’s report. The resulting report is given to the insurance company and is crucial to its decision regarding your workers’ compensation claim.
The entire QME process is complicated, filled with strict time limits, and filled with choices you must make without adequate information, knowledge, or guidance. We are dedicated to helping you throughout the process so that you meet all of the deadlines and understand your rights.
4. If your claim is denied
If the workers’ compensation insurance company denies your claim for benefits, you still have recourse. The Workers’ Compensation Appeals Board (WCAB) is the only court with jurisdiction over workers’ compensation benefits. If the employer denies that your case is a workers’ compensation case, you must file a case with the WCAB within a year of the injury or your claim may be barred.
You might also be eligible for State Disability benefits. If it appears that you will be unable to work for more than one year, we can help you apply for Social Security Disability benefits, even if you are receiving workers’ compensation benefits. For more information about other benefits that might be available to you, please see the related benefits page.
Contact Experienced Workers’ Compensation Lawyers
We understand that the workers’ compensation process can be confusing and intimidating, and are here to assist you every step of the way. We have dedicated our careers to helping injured workers, and will put this dedication into fighting for your case. We take cases on a contingency fee basis, meaning you pay no legal fees unless we successfully help you recover. To learn more, contact DuRard, McKenna & Borg today or call us at (650) 425-3278.
