The representative should determine whether first aid is required and can be performed on the scene or if additional emergency care is required at a health care facility. Depending on the severity of the injury, the representative may need to notify the employee's emergency contact of the incident. The employer should take immediate action to ensure that the worksite where the incident occurred is safe and secure to prevent additional incidents.
The report usually requires the following information: date of injury, the place where it occurred, a description of the injury or illness, the date the employer became aware of the injury or illness, the date that the employee received the form, the date the employee returned the form to the employer, and any other required information.
If the employee was given the report to complete, the representative should give the employee a deadline to complete it. If the employee needs to return the form via mail, the representative should direct him or her to mail it certified with a return receipt so there is a record of the date the employee returned it to the employer.
During the meeting, the representative should share with the employee the claims procedures, the benefits available to the employee and whom to contact for any concerns. Items frequently covered in this discussion include:.
Next the organization files the incident report with the company's workers' compensation carrier. Employers should check with their workers' compensation carrier for the available methods to submit the report.
Some carriers prefer electronic submissions, whereas others prefer that employers use a telephone system. Some employers may also be required by state law to submit the report to the state's workers' compensation agency. Employers should check with their workers' compensation carrier because it may file the incident report for employers.
Organizations must maintain contact with the workers' compensation carrier on the employee's claim. The employer may need to forward medical documentation to the workers' compensation carrier. Moreover, the workers' compensation carrier may have documents for the employer to complete.
These documents may request information such as the number of lost workdays, the employee's return-to-work status and any salary continuation to determine wage replacement benefits. The representative next informs the employee that the claim has been submitted and when to expect contact from the workers' compensation carrier regarding wage replacement and medical treatment.
The representative should then establish a schedule of regular follow-up on the employee's progress by telephone, mail or e-mail to let the employee know that his or her well-being and return to work are important to the organization. Establishing a timeline for the employee's return to work is imperative, as is making the determination about potential restrictions that may require accommodation and whether the employer will be able to accommodate the employee's needs.
The employer should have a policy in place that includes how leave interacts with workers' compensation. Returning an employee back to work should be one of the main focuses for the employer, even if it is in a light duty capacity. The employer's policy should be a thoughtful, well-written document that can be administered with care, taking the employee's needs into consideration. Some workers' compensation carriers have resources to assist employers with their return-to-work programs.
An employee's return to work may have doctor-directed medical restrictions that may allow the employee to return on restricted or light duty, which is typically less physically and mentally demanding than the employee's normal job. Giving the completed form to your employer opens your workers' compensation case.
It starts the process for finding all benefits you may qualify for under state law. Those benefits include, but are not limited to:. Attend a free seminar for injured workers at a local DWC office for a full explanation of workers' comp benefits, your rights and responsibilities. They are not there to act on your behalf as an attorney would, but they'll help you understand how to act on your own behalf. Attend a free seminar for injured workers at a local DWC district office for a full explanation of workers' comp benefits, your rights and responsibilities.
Check out the fact sheets and guides for injured workers. The fact sheets provide answers to frequently asked questions about issues affecting your benefits. The guides will help you fill out forms you may need to get a problem with your claim resolved at the local DWC district office. How can I find out who provides workers' compensation coverage for my employer or another business in California? In California all employers are required to either purchase a workers' compensation insurance policy from a licensed insurer authorized to write policies in California or become self insured.
The DWC does not provide workers' compensation insurance for employers and does not maintain information about employers and their respective insurers. To find out which insurer provides workers' compensation insurance for a specific employer, visit the California Workers' Compensation Coverage website.
The roster of self-insured employers can be found on the Self Insurance Plans Web page. More information about workers' compensation can be found on the DWC's Web page for injured workers. I know that independent contractors aren't covered under workers' compensation. How do I know if I really am an independent contractor? There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor.
Some employers misclassify employees as an independent contractor to avoid workers' compensation and other payroll responsibilities. Just because an employer says you are an independent contractor and doesn't need to cover you under a workers' compensation policy, doesn't make it true.
A true independent contractor has control over how their work is done. You probably are not an independent contractor when the person paying you:.
What happens to an injured worker's personal information that is requested on various DWC forms? Is it kept confidential? The division uses this information solely to administer its duties in workers' compensation claims.
For example, if an injured worker provides their Social Security number in whole or in part , DWC will use it as an identifier to ensure that documents are matched to the correct workers' comp case.
Unless authorized by law to do so, DWC cannot disclose the residence addresses of injured workers or their Social Security number.
Note that some case file information can be found by using the public information case search tool on the DWC's website. What personal information can be found in a public information search?
The search tool shows limited case data, such as an injured worker's name, case number, case status, court location, employer name, a description of events in the case, and associated dates. It may list the parts of the body that were injured, but it does not include medical records or any case documents.
The information provided in this search tool relates solely to cases in DWC's adjudication unit and is intended to help move cases through the court system efficiently. Any person requesting access to this information is required to identify themselves, state the reason for making the request and is instructed not to disclose the information to any person who is not entitled. Injured workers should be aware that, once an Application for Adjudication of Claim is filed, case file information, including case documents, may be disclosed under the California Public Records Act.
Even in this circumstance, an injured worker's address and Social Security number are not revealed to the requestor by the DWC. What are my employer's responsibilities under workers' compensation laws? Can my employer take part of my check to pay for workers' compensation insurance? Workers' compensation insurance is part of the cost of doing business.
An employer cannot ask you to help pay for the insurance premium. Your employer must post the notice to employees poster in a conspicuous place at the work site. This poster provides you with information on workers' compensation coverage and where to get medical care for work injuries.
What happens if my employer is uninsured and I'm hurt on the job? If you have a work-related injury or illness and your employer is not insured, your employer is responsible for paying all bills related to your injury or illness. Workers' compensation benefits are only the exclusive remedy for injuries suffered on the job when your employer is properly insured. If your employer is illegally uninsured and you have a work-related injury or illness, you can file a civil action against your employer in addition to filing a workers' compensation claim.
The UEBTF is a special unit within the Division of Workers' Compensation that may pay benefits to injured workers who get hurt or ill while working for an illegally uninsured employer. The UEBTF pursues reimbursement of expenditures from the responsible employer through all available avenues, including filing liens against their property. Where can I report an employer for not carrying workers' compensation insurance? You may report an uninsured employer to the nearest office of the Division of Labor Standards Enforcement.
The offices are also listed in the state government section of the white pages of your local telephone directory under industrial relations, labor standards enforcement. Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses.
Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given frequency , the extent of the treatment intensity , and for how long duration , among other things. To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule MTUS. The DWC has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
They may. Treatment guidelines are considered correct even in cases that settled before the guidelines were added to workers' compensation law in Your claims administrator may continue to pay for medical care you're accustomed to for your injury. If your medical treatment has been denied you can request an expedited hearing before a workers' compensation administrative law judge to get the situation resolved.
The claims administrator hasn't accepted or denied my claim yet, but I need medical care for my injury now. What can I do? The claims administrator is required to authorize medical treatment within one working day after you file a claim form with your employer, even while your claim is being investigated. If the claims administrator does not authorize treatment right away, speak with your supervisor, someone else in management or the claims administrator about the law requiring immediate medical treatment.
Ask for treatment to be authorized now, while waiting for a decision on your claim. If your date of injury is in or later, you are limited to a total of 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits, unless the claims administrator authorizes additional visits or you have recently had surgery and need postsurgical physical medicine.
For as long as it's medically necessary. However, some treatments are limited by law and the medical treatment you receive must be evidence-based. The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses.
It also deals with how often the treatment is given and for how long, among other things. If the treatment your doctor wants to provide goes beyond what is recommended by the MTUS, your doctor must use other evidence to show the treatment is necessary and will be effective. Additionally, your doctor's treatment plan may be reviewed by a third party hired by the claims administrator.
This process is called utilization review UR. All claims administrators are required by law to have a UR program. They use UR to decide whether or not to approve treatment recommended by your doctor. UR is the program claims administrators use to make sure the treatment you receive is medically necessary. All claims administrators are required by law to have a utilization review program.
This program will be used to decide whether or not to approve medical treatment recommended by your doctor. The state has rules about how UR must be conducted. If you believe the UR company reviewing your doctor's plan is not following those rules you can file a complaint with the DWC.
Find more information about utilization review in the factsheet. If my doctor's request for treatment is not approved, what can I do? There are specific timelines you must meet or you will lose important rights. As of July 1, , medical treatment disputes for all dates of injury will be resolved by physicians through the process of independent medical review IMR.
If UR denies or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, you can ask for a review of that decision through IMR. Along with the written determination letter that denied or modified your requested treatment, you will receive an unsigned but completed IMR form and addressed envelope. If you disagree with the decision, you must sign and send this form in the envelope to start the IMR process.
What happens if I was treated and the claims administrator won't pay for it? Do I have to pay? You most likely will not have to pay. This is a problem your doctor and the claims administrator need to work out. A medical provider network MPN is a group of health care providers set up by your employer's insurance company and approved by DWC's administrative director to treat workers injured on the job.
Each MPN includes a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. If your employer is in an MPN your workers' compensation medical needs will be taken care of by doctors in the network unless you were eligible to predesignate your personal doctor and did so before your injury happened.
A health care organization HCO is an organization certified by the DWC to provide managed medical care to injured workers. Your primary treating physician PTP is the physician with the overall responsibility for treatment of your injury or illness. Generally your employer selects the PTP you will see for the first 30 days, however, in specified conditions, you may be treated by your predesignated physician or medical group.
If a physician says you still need treatment after 30 days, you may be able to switch to the physician of your choice. This is a process you can use to tell your employer you want your personal physician to treat you for a work injury. You can predesignate your personal doctor of medicine M. The DWC has a form for predesignating a personal physician on the forms page of its website.
I would like to be treated by my personal chiropractor or acupuncturist. How does that work? If your employer or your employer's insurer does not have a MPN, you may be able to change your treating physician to your personal chiropractor or acupuncturist following a work-related injury or illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to the injury or illness.
There is a form you can use called the notice of personal chiropractor or personal acupuncturist. After your claims administrator has initiated your treatment with another doctor during the first 30 day period, you may then, upon request, have your treatment transferred to your personal chiropractor or acupuncturist. If you were injured on or after Jan.
Once you have received 24 chiropractic visits if you still require medical treatment, you will have to select a new physician who is not a chiropractor. The 24 visit cap does not apply to injuries that occurred before Jan.
Also, the cap does not apply if your employer authorizes additional visits in writing. Additionally, the cap does not apply to visits for certain postsurgical physical medicine and rehabilitation services. The State of California, for instance, requires an injured worker to file a claim within a year of sustaining the injury.
Missouri also requires an injured worker to notify their employer within 45 days of sustaining a work-related injury. Were you injured in a work-related accident? Are you expecting to receive maximum compensation for your injuries? Is your employer or their insurance carrier denying your claim? At Rosenfeld Injury Lawyers, LLC, our accident injury attorneys can fight aggressively on your behalf so that you get the rightful compensation you deserve.
Call our law firm at toll-free phone number or use the contact form today to schedule a free case evaluation.
All sensitive or personal information you share with our legal team remains private through an attorney-client relationship.
We accept all personal injury cases and wrongful death lawsuits through contingency fee agreements. This promise ensures you pay nothing until we successfully resolve your legal matter through a negotiated settlement or jury award. Medical Disability Benefit Medical disability benefits cover medical costs and expenses incurred on the injury sustained in the course of employment. The conditions for eligibility to receive disability benefits include: The injured worker is entitled to temporary total disability benefits when the disability injury sustained is for a relatively short time.
Temporary partial disability benefits arise when workers sustain a mild injury that reduces productivity but is not life-threatening. Medical professionals must declare injured workers as permanently having a disability and unable to work. In addition, a worker must be suffering from a very severe work injury to qualify.
If denied, employees typically have the opportunity to appeal or ask the insurer to review their decision. If desired, an employee can seek legal representation. If approved, employees will be notified about their compensation, which may cover costs such as medical expenses, disability, lost wages, and more.
The employee can choose to accept the compensation amount via either a lump sum or a structured settlement. Disability benefits may or may not continue once the employee has returned, depending on the severity and longevity of the injury.
To help prevent injuries and keep premiums low, businesses should prioritize employee training programs, enact workplace policies that encourage safety, and maintain a workplace culture where safety is a top priority. It is crucial that both employees and employers follow the steps in the claim process completely and quickly.
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