What would you do if you were injured at work? Do you know how a 'Claim Form' can impact your benefits? What if you procrastinated and did not report the accident right away?
California's Workers' Compensation laws were enacted to protect the rights of the injured worker. However, the worker must be proactive in reporting an accident right away or risk having his or her benefits delayed.
Everyone hopes to do their job without incident, however, sometimes things happen that are out of your control. For example, you might slip and fall on a wet floor in the bathroom at work. You may be a little embarrassed and not feel any pain at first, but later that evening, or the next morning, you may begin to feel pain and stiffness.
Using that scenario, let's say the accident occurred late Friday afternoon. You don't feel any pain so you don't report the injury. Over the weekend, you begin to feel pain and stiffness, so on Monday morning you go to your supervisor and report the injury.
The first thing your employer and their insurance company will question is why you did not report the accident immediately. Your employer may believe you when you tell them you did not feel any immediate pain, but the insurance company may not. They may have suspicions that perhaps you injured yourself over the weekend. Your claim could be delayed up to 90 days, pending an internal investigation.
If your claim is delayed, most likely the insurance company will want to take your statement and the statements of any witnesses. *You should know that any recorded or written statements taken during the investigation are not protected by any legal privilege and may be discoverable in litigation. In addition, you may be asked to disclose all previous permanent disabilities or physical impairments and sign a HIPAA (Health Insurance Portability and Accountability Act) release to access your medical records.
When you report an injury to your employer, they are required to provide you with a Claim Form (DWC1) within 1 working day. The form should include a notice of potential eligibility for benefits [LC§ 5401(b)]. It is extremely important that you complete and return the Claim Form as soon as possible.
If your claim is delayed pending an investigation, and you have returned the Claim Form, the employer must authorize medical treatment and continue to provide treatment until the claim is either accepted or rejected. The treatment is limited to a cost of $10,000.00.
If the Claim Form is not returned, the employer is not required to provide medical treatment pursuant to LC§ 5402(c).
California's No Fault System
California has established a 'no fault' system. If you are injured in the course and scope of your employment, you are entitled to Workers' Compensation benefits. Such benefits include medical treatment, wage loss payments, mileage and permanent disability compensation.
To avoid a possible delay in the provision of benefits, you should know what to do if you are injured at work:
•Report the accident immediately to your supervisor or a person in authority
•Within 1 working day of their knowledge of an accident/injury, the employer must provide the injured worker with a Claim Form. If your employer fails to comply, the insurance carrier is required to provide you with a Claim Form within 3 working days of their knowledge that one was not provided
•Complete the Claim Form. Make sure you accurately describe how the injury occurred. List all the body parts affected. Even if you are not experiencing pain in a particular area, if it was affected in any way during the accident, list it. You should also list any damage to dentures, hearing aids, eyeglasses and medical braces, resulting from the accident
•Return the completed Claim Form to your employer or insurance carrier and keep a copy for your records. You may return it by personal delivery or first-class or certified mail [LC§ 5401(c)]. If the Claim Form is returned and the claim is being investigated, the insurance company must provide medical treatment during the investigation period until a decision as to compensability is reached, up to the cost of $10,000.00. Furthermore, if the Claim Form is not returned by the injured worker, the employer still has a duty to investigate the claim, however, they do not have a duty to provide medical treatment pursuant to Labor Code§ 5402(c), and the injured worker will not be entitled to late payment supplements under Labor Code§ 4650(d)
•Have a medical examination. If you have not pre-designated a doctor, your employer should refer you to a physician or medical facility for an examination and necessary treatment. Advise the doctor of any and all body parts affected by the accident. Describe any onset of pain you have experienced since the accident
•If new medical problems develop, report them to the doctor as soon as possible and make sure they are noted and reported to the insurance company
•If your condition is not resolving or you are experience problems, you may wish to consult with an attorney who is a Certified Specialist in Workers' Compensation
Remember, California Workers' Compensation laws were enacted to protect you, the injured worker, in the event of a work related injury.
*The information contained in this article is general and not intended as a substitute for legal advice. Changes in the law or specific facts of a case may result in legal interpretations different than those presented here.
For additional information on California Worker's Compensation, see the following articles;