You’ve made an appointment to talk with a workers’ comp attorney in San Diego. Now what? It’s most likely your first work-related injury and you don’t know a lot about which steps to take next. Failing to know what to do is one reason so many people’s claims are initially denied. Some common reasons for denied claims include:
- Injury not reported to employer within the required time frame
- Workers’ comp claim not filed within the time frame determined by the state
- The employer disputes the claim either due to the injury having happened away from work or during a disqualifying activity such as horseplay or drinking alcohol
- The claimant failed to seek medical treatment
- Lack of evidence the accident was work-related
What You Don’t Know Can Hurt You!
Since you aren’t required by law to have a workers’ comp attorney, many people decide to file a claim on their own. What seems like a straightforward process on the surface is really a difficult one with a number of conditions and limits attached. In California, the employee must file all of the following documents to make a workers’ comp claim:
- DWC-1 Claim– The workers’ comp claim form where you provide your personal information and the details of your injury.
- Application for Adjudication of Claim – This document goes to the Workers’ Comp Appeals Board. It requires the name of your employer’s insurance company and information from the DWC-1.
- Declaration Pursuant to Labor Code 4906(g) – You use this document to swear that you haven’t requested any fraudulent information to be given to the DWC from any medical provider, hospital, or other medical facility.
- Document Cover Sheet – One document cover sheet, found at the DWC website, is required for the package of documents you will submit.
- Document Separator Sheets – This is a specific cover sheet located on the DWC website that you must place between each form.
Once you file the documents, the workers’ comp insurance company has 14 days to respond. If they deny your claim, they will send you a letter to let you know. Otherwise, they must begin making temporary payments.
The insurance company also has the right to investigate your claim further for 90 days before denying or accepting it. During this period, the claims administrator is required to authorize payment up to a maximum of $10,000 for your medical treatment. If they fail to meet any of these conditions, your workers’ comp attorney in San Diego will help you get the money you need for your treatment.
There are no shortcuts and no room for error when submitting these forms. Your attorney is familiar with each form and the requirements for completing and submitting them on-time. Filing them correctly the first time will reduce the likelihood of having your claim denied.
A qualified workers’ comp attorney in San Diego knows the time limits associated with workers’ compensation claims. They know how to secure evidence and prove that your injury resulted from the accident at work. Their work begins as soon as you schedule a consultation to discuss your case. Throughout the claim process, the attorney will act as your guide. They will make sure you don’t make any of the common mistakes that result in denied claims. Your legal representative will work to negotiate a fair settlement. If they can’t reach a settlement with the insurance company, they will have the evidence needed to represent you in a hearing or trial.
The evidence your attorney collects includes your medical records and acquiring testimony by medical experts. It also extends to expert testimony about the physical demands of your job and statements from friends and family members who know your regular daily activities. An experienced attorney knows which evidence is pertinent to your case and will optimize your chances of an accepted claim.
The Initial Consultation
During your initial consultation with the workers’ comp attorney, they will ask questions about all of the related issues. These questions include details about the accident, your injury, and the medical treatment you have obtained. They will also want to know about your finances and the impact your related medical bills has had on them.
There are other circumstances that could influence your case. For example, if you receive Social Security disability benefits or plan to apply for them in the near future, failing to draft the settlement agreement properly could cost you a great deal. Your attorney knows how to draft a settlement that will get you the best settlement without impacting your benefits.
People often believe that workers file workers’ compensation claims as a means to obtain large settlements that they don’t deserve. This couldn’t be farther from the truth! The high cost of medical care ensures that even a short-term injury can result in medical bills for thousands of dollars. If you require a hospital stay or long-term treatment, the cost will be exponentially higher. Your attorney will use all of this information and the loss of wages due to your time off from work to determine a fair settlement for you.
Third Party Claims
Workers’ comp is insurance designed to protect the employee and employer alike. It provides compensation to cover medical costs and lost wages by the employee. It also protects the employer from lawsuits. However, if a third party contributed to your injury, you can file a third-party claim for damages, including pain and suffering. A common example is the manufacturer of faulty equipment which caused the accident.
Your workers’ comp attorney in San Diego can advise you on whether you need to pursue a third-party claim. This type of personal injury claim often results in higher compensation because it includes pain and suffering.
The House of Workers’ Compensation offers a free initial consultation to discuss your workers’ comp claim. They can help, even if the insurance company already denied your claim. If they fail to get you a recovery, you pay nothing. Contact The House of Workers’ Compensation today even if you have already missed the deadline for filing a claim. They offer professional, specialized representation for workers’ compensation clients at a lower fee than most of their competitors.