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Navigating the Complexities of Workers’ Compensation Claims: A Guide for Injured Workers

Workers’ compensation exists to provide access to medical care and other benefits in the aftermath of a job-related injury or illness. Yet, the path to compensation isn’t always easy. For whatever reason, your employer may not uphold its obligations, or the liable insurer could deny coverage. Both things could prove overwhelming during this challenging time in your life.  

That’s why it’s so important to understand the workers’ compensation process and your options as an injured employee. Here, in this injured workers’ guide, you can learn what to expect when requesting benefits and what it entails. You can also get an idea of what it’s like to partner with a abogado de compensación de trabajadores

Report Your Condition Immediately 

Según el Departamento de Relaciones Industriales de California, you should report your work-related or workplace injury or illness to your employer as soon as possible. This creates a record of what happened and sets your workers’ comp claim in motion. If you don’t report your injury within 30 days of its occurrence, you could lose the right to damages. 

When reporting your physical injuries:  

  • Do so in writing. That way, your employer can’t say they didn’t receive notification. Sending an email or filling out an accident report should suffice. 
  • Keep a copy of the notification. You should also keep a copy of your notification as another way to ensure it doesn’t get “lost.” 
  • Only offer objective information. Don’t speculate what caused your injury or illness. Only offer basic information about your diagnosis, symptoms, and medical treatment needs. 

Filing a Workers’ Compensation Claim Involves Paperwork 

After notifying your employer, you can file your reclamo de compensación para trabajadores. Only complete the “employee” section when filing your case and filling out paperwork. Your employer will also have to provide some details to get your claim processed. 

The insurance company that pays out your claim usually has 14 days to share its decision. If you don’t receive notification within that period, you could call the insurer and ask for its status directly. 

If the Insurer Approves Your Claim 

If the liable insurer approves your workers’ compensation case, you can access: 

  • Tratamiento médico 
  • Temporary disability (TD) benefits, which account for two-thirds of your average weekly wage 
  • Permanent disability benefits, which offer payment if you’re never expected to fully recover 
  • Job retraining services, if your injury prevents you from continuing work in your current field 
  • Death benefits, if you lost a loved one who suffered a work-related injury

The value of your workers’ comp benefits, along with what you can receive, depends on your situation. If you were approved for benefits but disagree with the amount, you could benefit from partnering with a workers’ compensation attorney. They can work with the insurer to ensure you get what you’re rightfully owed. 

If the Insurer Rejects Your Claim 

The insurance company may deny your claim if: 

  • It doesn’t believe your condition is work-related. 
  • It has reason to believe that horseplay or intoxication led to your condition
  • It believes that despite your injury, you could return to work. 

Don’t delay in filing an appeal after learning about your claim’s denial. There are deadlines (some of which aren’t entirely clear) that you must abide by. Appealing the insurer’s decision involves having your case heard by an Administrative Law Judge (ALJ). They will hear the details of your case and make a ruling without a jury. 

Navigating an appeal is just another reason to consider hiring a workers’ compensation lawyer. They can handle your appeal and fight for the coverage you need. 

You Can Return to Work When Your Healthcare Provider Clears You 

While receiving workers’ compensation benefits, you can’t wake up one morning and decide to clock in to work. Several professionals must give you the green light to continue working. Per the Departamento de Relaciones Industriales de California, these parties include: 

  • Your primary care physician 
  • Your employer 
  • The claims adjuster 
  • Your lawyer (if you hired one) 

These parties may clear you to continue working full-time or in a reduced capacity, depending on the status of your condition. 

How You Could Benefit From Hiring a Workers’ Compensation Lawyer 

If you have problems getting the benefits you need after getting hurt at work, you have options, including working with an attorney. A California abogado de compensación de trabajadores can file your claim, gather the evidence needed to support an approval, and help you file an appeal, if needed. 

Your legal team can also: 

  • Manage your case’s paperwork 
  • Handle communications with those involved 
  • Assess your medical expenses 
  • Combat any challenges to your case
  • Assess how much compensation you should receive 
  • Help you understand workers’ compensation laws 

Many workers’ compensation attorneys work on a contingency-fee basis. For you, as the client, that means you wouldn’t pay anything upfront or out of pocket to get legal help. A portion of your final settlement would account for your lawyer’s time, services, and efforts. 

Comience su revisión de caso gratuito con KJT Law Group 

If you suffered a work-related injury or occupational illness and have concerns about getting benefits, you have every right to partner with a workers’ compensation attorney. KJT Law Group has decades of experience to back your case, offering comprehensive legal help without charging upfront fees. 

To learn more about navigating the complexities of reclamos de compensación de trabajadores, call our team at (818) 507-8525

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