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What Is Adjudication of Claim Workers’ Compensation?

If you’re hurt on the job, workers’ compensation is supposed to be your safety net. It’s meant to provide benefits, such as paying for your medical costs and providing a partial salary while you recover. Yet, your employer or your employer’s insurance company might try to deny or partially deny your claim, leaving you adrift with no support.When this happens, you can file an application for adjudication of claim. This moves your case to a local Workers’ Compensation Appeals Board (WCAB). By filing your claim with the WCAB, you take the decision out of the hands of your employer and into the hands of a judge.

What Happens During the Adjudication of a Workers’ Compensation Claim?

Adjudication is a legal term referring to when a judge decides on your workers’ compensation case. After the judge looks at evidence brought by you and your employer’s insurance company, they rule on your case. The ruling may support your request for benefits, or it may support the insurance company’s denial of benefits.

You may request adjudication if:

  • The insurance company denied your claim.
  • There are disputes over what benefits you should receive.
  • There is a disagreement about the medical treatment you received or still require.
  • The insurance company contests the cause of your condition.
  • You have an issue with your disability rating.

During adjudication, you can have an attorney present your case and advocate for what you deserve.

The Statute of Limitations to File an Application for Adjudication of Claim

You may file an application for adjudication of claim for any dispute you have concerning your workers’ compensation case. There are specific office locations where you must file the application for adjudication. You must file your case in the county where the injury took place.

California allows you one year from the date of your injury to file a workers’ compensation claim. Once you run into any hiccups with your case, you should consider filing for adjudication. Your attorney can explain how the statute of limitations applies to your specific case.

It is always a good idea to file your application for adjudication sooner rather than later. When you call, KJT Law Group can explain more during your free case evaluation.

After You File an Application for Adjudication of Claim

Each case is unique. Generally speaking, this is what happens after you request adjudication:

  • The overseeing agency sends confirmation that it received your application for adjudication, and you get assigned a case number.
  • You file a Declaration of Readiness to Proceed, which requests a hearing with a judge. Your hearing will be called “a mandatory settlement conference.”
  • You and the other party appear in court before a judge. The judge will discuss your case’s details and help you reach a settlement. If your case can’t be resolved here, the judge will schedule a trial.
  • This trial happens before another judge. After presenting your case, you’ll generally get a decision within 30 to 90 days.
  • If you don’t agree with the decision, you can file a Petition for Reconsideration.

This initiates another series of events in which you will present your case and ask for benefits.

This legal process requires specific actions at each step. Unless you are experienced in California’s workers’ compensation laws, we encourage you to work with an attorney. Doing so could reduce any complications that prevent you from getting fairly compensated.

What Challenges Can Arise During the Adjudication of a Workers’ Comp Claim?

The workers’ compensation system in California intends to help employees make ends meet in the aftermath of a serious job-related incident. Yet, getting compensation could prove difficult if:

  • The other party contests the cause of your condition. To recoup workers’ compensation benefits, you must have suffered an injury while performing job-related tasks. Your lawyer could use security camera footage, eyewitness testimony, and the accident report to draw a connection between the accident and your work duties.
  • The other party alleges that “horseplay” led to your condition. If you were engaged in a non-work-related activity when your injury occurred, you could have a hard time securing damages. For instance, you could pursue damages if you were hurt while making deliveries. You could not pursue damages after you got rear-ended in a liquor store parking lot.
  • You have a job-related illness. Proving that you developed a job-related illness (like mesothelioma) can be more difficult to prove than an acute injury. Still, as an injured worker, you have options; you can partner with an attorney from KJT Law Group who can handle everything.

When You Should Consider Hiring a Workers’ Compensation Lawyer

You’re not required to have legal representation when you file an adjudication of claim in your workers’ compensation case. Yet, it may benefit you to work with a knowledgeable attorney if:

  • The insurance company is represented by its lawyers during adjudication. If you are not experienced in insurance or workers’ compensation law, you might not know how to present a compelling case.
  • You must provide evidence for your case. A skilled attorney will know what evidence is crucial and how to collect it.
  • You’re unsure about how to proceed. You have enough to worry about after a job-related injury. When you partner with a lawyer, they can complete your case’s necessary steps, advocating for what you need each step of the way.

Our workers’ compensation attorneys at KJT Law Group know California law. We offer a free case evaluation that helps you understand your options and how to choose the one that suits your needs.

KJT Law Group Focuses on Workers’ Compensation Law

At KJT Law Group, we focus on the worker in workers’ compensation cases. No case is too small and no odds are too daunting for our attorneys. We keep the lines of communication open throughout our partnership, offering our services in English, Spanish, and Armenian.We’re in it to win, and we never back down from a fight. Contact us  (818) 507-8525 to begin your free consultation today.

We Will Fight For You

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