California Workers' Compensation Lawyers

Attorneys Helping Injured Employees with the Workers' Comp Claims Process in Gilroy and Santa Clara County

Although California law is clear that employers must provide workers' compensation benefits for any employees who are injured at work or as a result of their job responsibilities, the process employees must go through in order to obtain benefits is rarely straightforward. Every case is different, and even an individual case can often evolve and change over time. If you are in the process of filing a claim, it can be hard to understand what happens at each step, let alone be sure that you are handling it correctly.

Fortunately, injured workers do not have to go through the workers' compensation process alone. With more than 20 years of combined experience, the attorneys at Cramer & Martinez, LLP, are prepared to advise, support, and represent you from the time of your initial injury throughout any subsequent legal challenges that arise. We will give your case the attention it deserves and strive to help you obtain the greatest possible benefits to aid in your physical and financial recovery.

Steps in the California Workers' Compensation Process

The workers' compensation process can look different for each employee depending on the nature and severity of the injury, the short-term and long-term effects on work abilities, and the way the employer and claims administrator respond to the claim. You may find that not all of the following steps are relevant to your case, but understanding the entire process can help you prepare for any possibility. Here is what you may expect, starting with the initial injury.

1. A work-related injury occurs.This could be an immediate injury caused by a one-time accident, or anoccupational illness,orrepetitive stress injurythat accumulates over months or years of work. As long as the injury happened at work or because of your work, you have a case for workers' compensation. If you need emergency medical attention for an injury that happens at work, your employer should help you arrange for it.
2. Notify your employer and submit a claim form. You should tell your employer as soon as possible after suffering a work-related injury or becoming aware of it. Your employer should provide you with a Workers' Compensation Claim Form that you will need to complete and return. Your claim will then be reviewed by your employer's claims administrator.
3. Determine your primary treating physician. If you have predesignated a doctor or healthcare provider in writing with your employer before your injury, that doctor can serve as the primary treating physician for your work-related injury. Otherwise, you will need to choose a physician from your employers' medical provider network (MPN) or health care organization (HCO), or your employer may select a physician for you.
4. Receive initial medical care. In addition to emergency treatment, the claims administrator should authorize care at a cost of up to $10,000 while reviewing your claim.
5. Await the claims administrator's decision. After reviewing your claim, the administrator will issue a decision to either accept or deny it. An accepted claim means that further medical care will be covered by workers' compensation benefits. A denied claim means that the administrator believes you are ineligible for benefits, and you will need to attempt to resolve the disagreement or pursue an appeal.
6. Continue your medical treatment. Once your claim is accepted, your primary treating physician will use medical guidelines to recommend reasonable treatment to aid in your recovery, the costs of which will be reimbursed by your employer. Your physician will also submit reports to the claims administrator regarding your ability to return to work.
7. Determine eligibility for disability benefits. Based on your physician's reports, the claims administrator will decide whether you are eligible for temporary or permanent disability benefits that cover a portion of your lost wages. Temporary benefits can start soon after your injury if you are unable to work for more than three days. Permanent benefits, on the other hand, can only be determined after your physician reports that you have reached maximum medical improvement, which may take several weeks or longer.
8. Ensure that all benefits are paid. The costs of medical care should be reimbursed by your employer in a timely manner, while disability benefits are paid bi-weekly throughout the time period designated by the claims administrator. You may also be eligible for a Supplemental Job Displacement Benefit if you have a permanent partial disability and your employer does not offer you suitable work.

Contact a San Benito County Workers' Compensation Attorney

Throughout the claims process, your attorney will help you file the necessary forms, keep detailed records of your treatment and communication surrounding your claim, manage disputes with the claims administrator and your primary treating physician, and ensure prompt payment of your benefits. Contact us at 408-848-1113 for a free consultation no matter where your case currently stands. We represent injured employees in Gilroy, Morgan Hill, San Jose, Salinas, Hollister, Watsonville, Los Banos, and throughout Santa Clara County, Monterey County, San Benito County, Santa Cruz County, and the surrounding areas.