Overview of the Workers’ Compensation Process

Law suits can be a long and confusing process. Workers’ compensation law and claims are no exception. The fact that the process does not typically operate like a typical lawsuit makes it even more convoluted and obscure to the typical person off the street. This can really add to the stress and confusion experienced by the people involved in a workers’ compensation suit. A basic understanding of the process can help reduce stress and help you manage the process more efficiently.

The first thing that will happen must be the initial claim. After a worker sustains a work-related injury, he or she will need to make a detailed and accurate account of the related injury. The employer should also take reasonable steps to make sure the report is truthful and complete. This includes determining if there were witnesses to the event. If there were witnesses, the employer should be meticulous about gathering and maintaining written statements, and providing all of this information to the attorney responsible for defending and managing the workers’ compensation claim on the business’s behalf.

After the insurance company receives the statement, an investigator may  be sent out to examine the circumstances of the injury. The investigation will most likely include an on-site survey of the injury site but also an inquiry into the medical records of the injured worker. The investigation will need to look into the extent of the injury and whether it is long term or short term. These issues will obviously have a large impact on the nature, amount, and duration of the benefits awarded to the injured worker.  Following an investigation, there will likely also be an exchange of documents and information that is referred to as “discovery.”  During discovery, both the employer and the employee must exchange certain requested information, including medical records, employer reports, witness lists, and other pertinent material.

After the investigation, if the claim is still disputed, it may go before the Workers’ Compensation Appeals Board. The WCAB will hear the evidence from both sides. The board can then make a decision about whether the injured worker will receive benefits and for how long. If either the employer or the employee disagrees with the results, it is possible to appeal the finding to a higher court.

If your business is facing a workers’ compensation dispute, you need an experienced attorney on your side.  Contact me today at (714) 252-7078 to discuss your business and your case.

Importance of Clarity in Workers’ Compensation Claims

Workers’ compensation law is a quite complicated and nuanced area of law. Employers should actively seek out clarification on new and existing workers’ compensation regulations and laws, as well as endeavor to have a good understanding on the way the current process works. Failure to have a firm grasp on the workers’ compensation system and the laws associated with it can prove disastrous for both the employer and the injured employee. It is essential that all involved in the workers’ compensation system provide as much clarity as possible in every workers’ compensation claim.

At the beginning of every workers’ compensation case, a worker who has sustained a work related injury must provide a written report. This report details the circumstances surrounding the injury as well as the basic nature of the injury sustained by the worker. It is very important for the worker to be as detailed as possible in this report because the employer and the workers’ compensation insurance provider will both use this report as the “jumping off point” for their respective investigations. The more detailed and accurate this written report, the better starting point the employer and insurance provider will have.

After the initial claim is submitted to the insurance company, the claim will be reviewed and either accepted or denied. If a written claim is not sufficiently detailed or if it is inaccurate, that will greatly increase the chances of it being rejected. Providing the most amount of detail and, more importantly, making sure those details are accurate, will speed up the process. Accuracy will reduce the chance of the insurance company rejecting the claim.

After the claim is eventually accepted and approved by the insurance company, the next issue is the amount and nature of benefits that will be granted to the worker claiming a work-related injury. It is essential that the report to the insurance company is accurate as that will be greatly determinative for the amount and nature of benefits awarded to and received by the injured worker. If the insurance company receives an inaccurate report or case file, it will be impossible for the injured worker to receive the proper amount of benefits.

If you have questions about the contents of a workers’ compensation report, contact us today at (714) 252-7078. We have extensive experience helping clients with this process.

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