Workers' Compensation: The Process

March 2, 2015

Often, many struggle to understand the complex nature that is a California Worker's Compensation claim. Part of the struggle is the many paths and avenues a claim may take before its ultimate conclusion.


After filing an application for adjudication the California Worker's Compensation appeals board, a claim can be accepted, denied, or delayed. Each one of these has their own distinct path to conclusion.


Beginning with delayed claims, a workers compensation insurance carrier has 90 days from the date of notice to make a determination as to whether to accept or deny a claim. This 90 day waiting period is often known as delay. During delay, carrier is liable for the first $10,000 of medical expenses. Thus during this time the carrier will only pay for medical expenses and treatment. Should your treatment exceed the $10,000 during delay carrier has no obligation to pay. At the end of the 90 days the carrier can either accept or deny the claim. During the delay you will not receive any temporary disability benefits. To receive income during this period of delay you will need to apply for state disability income or SDI through the EDD, a department of state of California.


When a claim has been accepted you we entitled to the four main benefits of a work comp claim. Immediately, you will begin receiving medical treatment to cure or relieve symptoms of your injury. Should you be unable to work during this time, the doctor has taken off work, you’d be entitled to receive temporary disability. Eventually, after receiving medical treatment your primary treating physician will find you have reached maximum medical improvement (MMI). At this time, it’s appropriate for you to be seen by med legal evaluation.  Once you’ve been found MMI, you’d also be entitled to permanent disability benefits. Should you be unable to return to work, you may be entitled to a work retraining voucher.


The most complex of these is the denied claim. A claim can be denied for various reasons. Once a claim is been denied, you will receive no benefits until such time as the claim has become accepted. After your claim has been denied, if you haven’t already, you should immediately contact a workers compensation attorney. Once claim has been denied, the only recourse is to have a med legal evaluation from either a QME or an AME. No, there is no other way. Once evaluations happen, there’s a possibility the claim could in fact be moved to an accepted claim. This is why it’s so key to have an attorney involved. They will explain to you the intricacies of moving your claim to accept claim. Once your claim has been deemed accepted, you would be entitled to the benefits above.


The thing to remember in a workers’ compensation claim is each claim must follow its own process. This process may be slower or faster depending on your claim. Generally, represented individuals claims progress at a faster pace. A faster pace, does not mean fast. Workers compensation is a system mired in bureaucracy, and often times the pace is quite gruelingly slow. Worker’s Compensation law center offers competent attorneys help you better understand the process and to help speed up the pace for your claim. We have offices in Redding, Eureka, Susanville, and Crescent city to better serve you. Contact us for a free consultation.




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© 2020 Riley & Associates. Representing Injured Workers with offices in Redding, and Susanville.

The materials on this website do not, nor are they intended to create an attorney-client relationship or constitute legal advice. All California Workers' Compensation claims are different.

For advice regarding your claim, please contact a workers' compensation attorney.