Book title: California Workers' Comp: How to Take Charge When You're Injured on the Job
Book author: Attorney Christopher A. Ball

If you've been injured on the job, your workers' compensation claim will stumble and saunter its way through the workers' compensation system. It will seem that all you do is wait for something to happen. When you request medical treatment, you may wait weeks for a response. You may wait for a doctor's appointment, then wait for the medical report. And if you file for a hearing before the Workers' Compensation Appeals Board, you may wait months for your hearing date.

And so it will go. At every turn, it is likely to take months before anything is accomplished. Unfortunately, it probably won't make you feel much better to realize you are not alone. An average workers' compensation case takes two to three years to be resolved. And many cases take much, much longer.

It probably won't come as a surprise that the workers' compensation system is bureaucratic: Lots of forms, reports, and other documents are shuffled through what sometimes seems like an endless maze. Above all, the workers' compensation system is confusing. It's fraught with rules and regulations-and it sorely lacks understandable information for the injured worker.

This chapter helps take the mystery out of the workers' compensation system by clearly outlining the steps involved in a "typical" workers' compensation case. Inevitably, there will be some variations depending on your particular situation and whether or not you're represented by an attorney. But the basic steps are usually similar in all workers' compensation cases.

Death Claims. If you were totally or partially dependent upon someone who died due to an industrial injury, you may have a workers' compensation claimfor death benefits. Skip ahead to Chapter 15.

Step 1. Notify Your Employer of the Injury

If you sustain a work injury, notify your supervisor or boss of the injury at your first opportunity. If your injury developed over a period of time, as with a repetitive stress, or cumulative trauma, injury, notify your employer as soon as you have symptoms and realize you've been injured as a result of your job.

Although you may initially tell your supervisor orally of the injury, it is important that you also give your employer written notice within 30 days of the injury. This will prevent any misunderstanding about whether or not you reported the injury and will protect your right to workers' compensation benefits.

If you have a union representative, contact that person right away; you may need help obtaining additional benefits that are secured by a union contract. (Your union representative may be instrumental in protecting your legal rights should your employer attempt to terminate you because you can't return to work for a while. Also, some employers may have salary continuation agreements for union members injured at work.)

Make certain that you complete any required inhouse accident reports. Also, review any accident reports prepared by your supervisor or employer for accuracy, and obtain a copy for your records. If you disagree with the report, write your employer a letter explaining your position. (Chapter 5 takes you through all the rules and procedures involved with reporting your injury and filing a claim.)

Step 2. Get Medical Treatment If Needed

It is important to promptly seek medical treatment if needed. Not only will prompt medical treatment protect your health, but it will establish a medical record of your work injury.

If you gave your employer the name of your own doctor before your injury ("predesignated your treating physician," in workers' compensation jargon), you may go to that doctor under certain conditions (see Chapter 9, Section B1).

If not, the employer usually has the right to send you to a doctor the employer chooses, which often turns out to be the "company doctor" or "medical provider network"-a doctor or medical clinic that the employer sends its injured workers to on a regular basis.

If you have a medical emergency that requires immediate medical attention, you may go to the nearest emergency room for treatment. But after your emergency medical condition has been stabilized, you must continue follow-up medical treatment with the physician selected by your employer, unless you designated a doctor in advance. (See Chapter 9 for a detailed discussion of medical care.)

Step 3. Paying for Medical Treatment If Employer Denies Your Claim

If you report what you believe to be a work-related injury to your supervisor, your employer will most likely agree to accept responsibility. Authorization for medical treatment may be given orally or in writing to the doctor by your employer or its workers' compensation insurance company.

Within one day of your filing the DWC-1 claim form (see Step 6), your employer or its insurance company is required to authorize and agree to pay for your medical treatment until your employer or the insurance company either accepts or denies your claim. The insurance company is liable only for $10,000 in medical treatment until it accepts or denies your claim. (LC 5402(c).)

If your claim is eventually accepted, the employer or insurance company will continue to pay for your treatment. If your claim is denied, the employer or insurance company will not authorize further medical treatment. This may work to your advantage (assuming that you have a valid claim): By denying your claim, your employer gives up its right to control your medical treatment. If your claim is denied, you are not bound to go to the company doctor for treatment and may be treated by a doctor of your choice. (See Chapter 9, Section B, for details.)

If your employer denies your claim right away, seek prompt treatment by relying on private health insurance, if you have it. If you do not have medical insurance and your employer refuses to pay, you have three choices. You may pay for treatment yourself and seek reimbursement later. You may find a doctor to treat you on a "lien basis," where the doctor waits for payment until your workers' compensation case is settled. (See Chapter 9, Section B2b, for more on liens.) Or you may get a judge to order your employer's insurance company to pay for treatment. An information and assistance officer can help with this procedure. (See Step 10, below.)

Always apply for state disability insurance (SDI). Whenever you have an injury that results in your inability to work, always-and immediately-apply for SDI from the Employment Development Department (EDD). That way, you'll receive income from this source in case of a delay or denial of your claim. When your workers' compensation benefits begin, it's important that you promptly inform the EDD, so it will discontinue SDI payments. (You may also be entitled to retroactive temporary disability benefits from the insurance company if you received less in SDI payments than you would have from the workers' compensation insurance company.) We cover SDI in Chapter 17, Section A.

Step 4. Tell the Doctor About Your Injuries

The doctor's first report will often be relied upon by the insurance company to determine the extent of your injuries and whether they resulted from your employment. Tell the doctor that you injured yourself at work (if that's true) and how the injury occurred (if you know). In addition to giving the doctor a complete history of your medical problems (if asked), be sure to cover all your symptoms and sources of pain. For instance, even if most of your pain is in your back, if your arm hurts even a little, tell the doctor! You'll find detailed information on dealing with doctors in Chapter 9.

Step 5. The Doctor Decides If You Need Time Off

The first doctor you see will probably determine whether or not you need some time off from work to recover from the effects of your injury. Depending on the doctor's findings, you will receive one of the following:

- off-work order
- limited duties work order (also called a light duty work order or modified work order), or
- return to work order-that is, you can return to work with no restrictions.

Especially if you are given an off-work order, it's essential that you keep your employer advised of your medical status. If you neglect to do so, you may be fired for failing to report to work without a valid excuse. If, however, you keep your employer informed, you cannot legally be fired for injuring yourself, filing a workers' compensation claim, and obeying doctor's orders.

Visit Amazon's Labor Law page.

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