Filing a workers’ comp claim is an important step after a work injury. But what happens next? Your employer and its insurance company must follow certain steps to review your claim. Knowing what to expect can help you prepare for medical care and benefit decisions.
How does the insurance company review your claim?
The insurance company checks whether your injury qualifies for workers’ comp benefits. It may review medical records, examine accident reports and speak with witnesses.
California insurers generally must notify you of your claim’s status within 14 days after receiving your claim form. If the insurer needs more time, it can delay its decision while gathering evidence. However, it generally must accept or deny the claim within 90 days after you give the completed claim form to your employer. If the insurer does not deny the claim within that period, the law generally presumes the injury compensable, subject to legal exceptions.
When can you receive medical treatment?
You do not need to wait for claim approval to receive initial medical care. After your employer receives your completed claim form, it generally must authorize appropriate medical treatment within one working day. While the insurer investigates your claim, you may receive up to $10,000 in authorized medical treatment, subject to applicable treatment guidelines.
Your employer may direct you to a doctor in its workers’ comp network. You may have other options if you chose your own doctor before the injury and met the legal requirements. Seek immediate care for medical emergencies.
What benefits might you receive?
If the insurer accepts your claim, you may qualify for medical care and temporary disability payments if your injury prevents you from working while you recover.
These payments usually equal two-thirds of your lost gross wages, subject to state minimums, maximums and eligibility rules.
Some eligible public safety workers may receive salary continuation under separate state laws. These benefits do not apply to all public employees.
What if the insurer denies your claim?
You can challenge a denied claim through California’s workers’ compensation system. Gather medical records and other evidence to support your case. You can also request a hearing before a workers’ compensation judge, who reviews the evidence and decides the disputed issues.
If the insurer denies your claim or delays your benefits, a workers’ compensation attorney can explain your options and help you understand the next steps.