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AFTER YOU GET HURT ON THE JOB 1. Report the injury to your employer Tell your supervisor right away. If your injury or illness developed gradually (like tendonitis or hearing loss), report it as soon as you learn it was caused by your job. Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need to avoid further injury. 2. Get emergency treatment if needed If it's a medical emergency, go to an emergency room right away. Your employer may tell you where to go for treatment. Tell the health care provider who treats you that your injury or illness is job-related. 3. Fill out a claim form and give it to your employer Your employer must give you a claim form within one working day after learning about your injury or illness. You use it to request workers' compensation benefits. Fill out and sign the "employee" portion of the claim form. Describe your injury completely. Include every part of your body affected by the injury. Give the form to your employer, which is called filing the claim form. Do this right away to avoid possible problems with your claim. 4. Contact our office We can usually see you the same day. We understand the workers' compensation process and work-related injuries. We treat all types of soft tissue injuries, ranging from back and neck injuries to carpal tunnel syndrome. We can develop a personalized treatment plan to get you quickly out of pain and back to work. THE CHOICE OF DOCTOR IS IMPORTANT! Your treating doctor:
We know how important proper care and a thorough understanding of the workers' compensation system are. You can count on us to get you quickly out of pain and back to full functional status. And, we take care of all the paperwork. QUESTIONS AND ANSWERS:
A. Your employer must fill out and sign the "employer" portion of the form and give the completed form to a claims administrator. (This person handles claims for your employer and usually works for your employer's insurance company.) Your employer must give you a copy of the completed form within one working day after you filed it. Keep this copy. The claims administrator usually must decide within 90 days whether to accept or deny your claim. Accepting the claim means the claims administrator agrees your injury is covered by workers' compensation. If your claim is accepted, you will receive paid medical care for your injury. You may also be eligible for payments to help make up for lost wages. For information on these payments, see " Temporary Disability Benefits ". Denying the claim means the claims administrator believes your injury is not covered by workers' compensation. If the claims administrator sends you a letter denying your claim, you have a right to challenge the decision. Don't delay, because there are deadlines for filing the necessary papers. To get help, " KEEPING YOUR CLAIM ON TRACK " below. Q. Can I choose the doctor who will treat me for my job injury? A. It depends on whether you predesignated your personal physician. This means that before you were injured, you gave your employer the name and address of your personal physician in writing. For more information, see " Basic W/C Info ". If you predesignated: If you didn't predesignate: Switching to another treating doctor: You or your new treating doctor must give the claims administrator the doctor's name and address. This allows the claims administrator to obtain medical reports and pay for your medical care. You may switch again if necessary. Q. I don't like the medical care I'm getting. Is there any way I can switch to a different doctor in the first 30 days? A. If you did not predesignate, speak with your employer or the claims administrator and see if they will agree to a new doctor of your choice. If agreement is not possible, you still have a right to change doctors one time during the first 30 days. Usually the claims administrator is allowed to choose the new doctor. Sometimes employers lose the right to choose who will treat an injured worker, even if the worker did not predesignate. You can see a doctor of your choice in the first 30 days if your employer:
If you believe any of these applies to you, see " KEEPING YOUR CLAIM ON TRACK " below. Q. The claims administrator hasn't accepted or denied my claim yet, but I need medical care for my injury now. What can I do? A. Sometimes an employer will pay for medical care even before a claim is accepted. Ask your supervisor or someone else in management whether your employer will pay for medical care now. If your employer won't pay, use your own health insurance to get medical care. Your health insurer will be paid later if your injury is covered by workers' compensation. If you don't have health insurance, try to find a doctor, clinic, or hospital that will treat you without immediate payment. They will be paid later if your injury is covered by workers' compensation. If you need help, see " KEEPING YOUR CLAIM ON TRACK " below. Q. Who decides what type of work I can do while recovering? A. Your treating doctor is responsible for telling your employer:
You, your treating doctor, and your employer should review your job description and discuss the changes needed in your job. For example, your employer might give you a reduced work schedule or have someone else do heavy lifting. If you disagree with your treating doctor, you must promptly write to the claims administrator about the disagreement or you may lose important rights. If you have questions or need help, see " KEEPING YOUR CLAIM ON TRACK " below. Q. It's been more than 90 days since I filed a claim form, and I have not heard from the claims administrator. Does this mean my claim is accepted? A. If the claims administrator doesn't send you a letter denying your claim within 90 days after you filed the form, your claim is considered accepted in most cases. If you have questions about this, see " KEEPING YOUR CLAIM ON TRACK " below. Q. Besides workers' compensation benefits, can I get any other financial assistance? A. Other benefits may be available. These include:
To learn more about these other benefits, see " Basic W/C Info ". Q. I filed a claim and I'm afraid I might be fired. Can my employer fire me? A. It's illegal for your employer to punish or fire you for having a job injury, or for filing a workers' compensation claim when hurt on the job. The California Labor Code (section 132a) prohibits this kind of discrimination. It's also illegal for your employer to discriminate against you because of a serious disability. The federal Americans With Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA) prohibit this. The federal Family and Medical Leave Act (FMLA) says that an employer with 50 or more employees usually must let you take unpaid leave for 12 weeks if you need time off for a serious medical condition. If you feel your job is threatened, find someone who can help. For more information, see " Basic W/C Info ". Note that there are deadlines for taking legal action. KEEPING YOUR CLAIM ON TRACK Some injured workers get their benefits quickly, with no trouble at all. Others face problems and delays. This page gives tips on how to take charge of your case and make sure your rights are protected. Whether or not you have a problem: Keep good records. You will probably fill out and receive many forms and other papers. Keep copies of everything, including envelopes showing postmarks!
Learn more about workers' compensation. The laws and procedures in workers' compensation are complicated. What applies to another injured worker may not apply to you. Learn what your rights are, and don't be afraid to ask questions. For more information, see " Basic W/C Info ". If you have a concern, speak up. See whether your employer or the claims administrator can agree to resolve the problem. If this doesn't work, don't delay getting help. Try the following: Contact an Information & Assistance officer. State I&A officers answer questions and help injured workers. They may provide information and forms and help resolve problems with your claim. They hold workshops around the state. To contact a local office, see phone numbers below or check the Government Pages at the front of the white pages of your phone book. Look under: State Government Offices/Industrial Relations/Workers' Compensation. Consult an attorney. Lawyers who specialize in helping injured workers with their workers' compensation claims are called applicants' attorneys. Their job is to plan a strategy for your case, gather information to support your claim, keep track of deadlines, and represent you in hearings before a Referee (workers' compensation judge) of the Workers' Compensation Appeals Board. Most attorneys offer one free consultation. If you hire an attorney, the attorney's fee will be taken out of benefits that you receive later. A Referee must approve the fee. For names of applicants' attorneys, call the State Bar (1-415-241-2100), a local bar association, or the California Applicants' Attorneys Association (1-800-459-1400). Contact your union. Your union may be able to help resolve problems, tell you about other benefits, negotiate changes needed in your job, and protect you from job discrimination. Represent yourself. If you can't get help from the above resources, you can prepare your own case and request a hearing before a Referee. For instructions, contact an Information & Assistance officer (see above). CALIFORNIA STATE DIVISION OF WORKERS' COMPENSATION (DWC) INFORMATION & ASSISTANCE OFFICES State Information & Assistance (I&A) officers answer questions and help injured workers. Their services are free.
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