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What Is Workers' Compensation?

Workers' compensation, or "workers' comp," is compensatory money paid to a worker who is injured on the job. The money comes from the employer's insurance company, not from the employer itself. This money will cover the cost of medical treatments and will partially replace wages that are lost because of the injury; but the money will not pay for a worker's pain and suffering.

Every employer is required to retain worker's compensation insurance for its employees. A wide range of workers are covered by workers' comp. Temporary, part-time, independent contractors, and non-legal residents may receive some benefits. You may be entitled to workers' compensation benefits, as well.

Injured on the job? Call (888) 427-8064 for a free case evaluation!

Workers' comp was designed to be the only way for an injured worker to get money for their injury. So generally, an injured worker is not allowed to sue their employer for the injuries. But a worker may be able to sue if a personal injury was caused by someone other than the employer (a "third party"), or if there is a violation of the worker's civil rights. Do not hesitate to consult a Southern California workers' comp lawyer if you have been injured at work and need to fight for fair compensation.

The Steps of a Workers' Compensation Claim

  • Tell the employer about the injury
  • Employer gives the worker a Compensation Claim Form (DWC 1)
  • Worker fills out and returns the DWC 1 to the employer
  • Employer gives the DW1 to a claims administrator
  • Claims administrator accepts or denies the claim
  • Appeal or determination of benefits

Steps 1 – 4

The process starts when an injured worker tells their employer about the injury. After being told about the injury, the employer has 1 day to give the worker the necessary form to file for workers' comp, which is called a Compensation Claim Form (DWC 1). The worker fills out part of the form and then files the form by giving it back to the employer. The employer then fills out the other part of the form and gives it to someone designated to handle works' compensation claims. The employer must return or mail a copy of the completed form to the injured worker within 1 day.

Step 5

The claims administrator is the person who decides to accept or deny a workers' compensation claim. A claim will be accepted if the claims administrator thinks that the injury is covered by workers' comp. This decision must be made within a reasonable time. If a claim is accepted, the injured worker will receive benefits; but if the claim is denied, an injured worker has the right to challenge the denial.

Step 6

An injured worker can appeal a denied claim 2 times by filing with the Workers' Compensation Appeals Board. After a claim is accepted, the claims adjuster uses medical reports to determine which benefits the worker is entitled to. The worker has a right to challenge both the medical reports and the determination of benefits.

Why would an injured worker need a lawyer?

Because workers' comp can be complicated and a lawyer can help.

  • A lawyer can help a worker who feels lost in the process.
  • A lawyer can help enforce a worker's rights
  • A lawyer can help to appeal a denied claim

The steps of filing a workers' comp claim are simple, but complex laws and procedures apply to a claim after acceptance or denial. The injured worker is responsible for keeping up with deadlines, knowing which procedures to follow, and which laws apply to them.

It may be difficult to navigate the laws and procedures of workers' comp without a lawyer. If a worker does not know the law, then they cannot enforce their rights. For example, a worker may be unaware that they are entitled to special benefits.

An Orange County worker's compensation lawyer will already be familiar with workers' comp laws and procedures. Therefore, such a lawyer can easily identify all the benefits that a worker is entitled to. Also, a workers' compensation lawyer can help deal with an insurance company that withholds benefits or treats a worker unfairly.

Denied claims can mean that injured workers who are unable to work because of their injuries have to pay large medical bills. A workers' comp lawyer can help appeal a denial and represent a worker in court.

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