How Is My Work Injury Case Resolved or Settled?

workers' compensation case resolved settled

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How Is My Work Injury Case Resolved or Settled?

How Is My Work Injury Case Resolved or Settled?  Your work injury case is resolved when there is an agreement between you and the claims administrator or a judge issues an order about your workers’ compensation payments and future medical care that will be provided to you. In order to protect your rights, whether or not you are represented by an attorney, settlements must be reviewed by a workers’ compensation administrative law judge, to determine whether they are adequate.  work injury case resolved settled

My Work Injury Case Is Being Resolved or Settled.  What types of settlements are there?

There are two different ways to settle your case:  work injury case resolved settled

  • Stipulations with Request for Award (stips)
    • Payments – You and the claims administrator agree on the amount of temporary or permanent disability payments you will receive. This is usually paid in weekly payments
    • Medical care – The claims administrator usually agrees to pay for medical care if needed.
  • Compromise and Release (C&R)
    • One payment – The claims administrator agrees on an amount to resolve your claim. This is usually paid in a lump sum
    • Medical care – If the lump sum includes the estimated cost of future medical care, the claims administrator will no longer pay your doctor. This becomes your responsibility.

What if my case doesn’t settle?  work injury case resolved settled

If you and the claims administrator are unable to agree on a settlement, your dispute will need to be decided by a workers’ compensation judge.

Want to learn more? Find it in the guidebook

 

 

 

How Is My Work Injury Case Resolved or Settled?   #AskNikkiNow

Los Angeles Workers’ Compensation Lawyers – Free Consultation – consultation@nikkijacobson.com

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work injury case resolved settled

 

 

 

 

Nikki Mehrpoo Jacobson, Certified Specialists in Workers’ Compensation Law
by the State Bar of California Board of Legal Specialization
Professor of Law
Legal Analyst

Work Injury Claim Was Denied

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My Work Injury Claim Was Denied

My Work Injury Claim Was Denied.  Now What?  When a claim is denied, it means the claims administrator believes your injury is not covered by workers’ compensation. If the claims administrator sends you a letter denying your claim, you have a right to challenge the decision. Don’t delay, because there are deadlines for filing the necessary papers. If you need help with your workers’ compensation claim, you can contact the Information and Assistance Unit. You may represent yourself or hire an attorney. If you contest the denial of your claim, your case will be heard by a workers’ compensation administrative law judge (WCJ) at one of the division’s 23 local offices plus satellites.

What if I have a disagreement about my benefits?

At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury or treatment. When there is a disagreement about whether your claim is covered by workers’ compensation, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).

For injuries on or after Jan. 1, 2013, and as of July 1, 2013 for all dates of injury, disagreements about a specific course of medical treatment recommended by the treating physician can only be resolved through a process called independent medical review (IMR).

My Work Injury Claim Was Denied – I want to object to the denial of my claim

If you want to object to the denial of your claim, you will need to file a case at one the division’s 24 offices located around the state. Each DWC office is a trial court where disputes that arise from workers’ compensation claims are decided by a judge without a jury.

How do I file a case?

In order to have your case heard by a judge, you must first file an Application for Adjudication of Claim. The application must be filed at the DWC office in the county where you live or in the county where you were injured. You must serve the application on all other parties, which is generally the claims administrator.

What happens next?

The DWC office where you filed the application will send you a notice confirming that it has been filed. The notice will include your assigned case number, which will begin with the letters “ADJ” followed by a sequence of numbers. Keep the notice and use the assigned case number on all documents and correspondence relating to your case.

How do I get a hearing before a judge?

You must file a Declaration of Readiness to Proceed to request a hearing. Your case will be scheduled for a hearing called a mandatory settlement conference (MSC).

What happens at the hearing?

You and your claims administrator or their attorney will appear before a judge. The judge will discuss the case with both of you and try to assist in reaching a settlement. If your case is not settled at the MSC, you will need to prepare documents that outline the dispute, identify the items each party will present at trial and the names of the witnesses that each party will ask to testify. The judge will then schedule a date for trial.

The trial will be held before another judge. You must attend the trial. The judge will issue a written decision after the trial and send it to you by mail, which usually occurs between 30 and 90 days after the trial. If either you or the claims adjustor disagrees with the judge’s decision, you can file a Petition for Reconsideration.

Want to learn more? Find it in the guidebook

My Work Injury Claim Was Denied:  #AskNikkiNow

Los Angeles Workers’ Compensation Lawyers – Free Consultation – consultation@nikkijacobson.com

Free Work Injury Consultation

 

 

 

 

 

Nikki Mehrpoo Jacobson, Certified Specialists in Workers’ Compensation Law
by the State Bar of California Board of Legal Specialization
Professor of Law
Legal Analyst

Workers’ Compensation Claim Was Accepted

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If my workers’ compensation claim was accepted

If my workers’ compensation claim was accepted …   You should hear whether your claim is accepted or denied from your employer or its claims administrator within 90 days from the date the claim form is given to your employer. If you do not, your injury will be presumed to be covered.

What benefits am I entitled to?

Workers’ compensation insurance provides five basic benefits:

What if I have a disagreement about my benefits?

At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury. When there is a disagreement, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).

Want to learn more? Find it in the guidebook

 

 

Claim was accepted: #AskNikkiNow

Los Angeles Workers’ Compensation Lawyers – Free Consultation – consultation@nikkijacobson.com

Free Work Injury Consultation

 

 

 

 

Claim was accepted: #AskNikkiNow

I was injured at work

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I was injured at work…

I was injured at work. Now What? Workers’ compensation benefits are designed to provide you with the medical treatment you need to recover from your work related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work. Workers’ compensation benefits do not include damages for pain and suffering or punitive damages. Benefits include:  medical care, temporary disability payments, permanent disability payments, Supplemental Job Displacement Vouchers and return to work benefits.

Report the injury or illness to your employer

Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits.  Some injuries are obvious and some are not.  Any physical or psychological injury as a result of your work duties may an industrial injury.  Consult with an attorney who is a workers’ compensation specialist.

Get emergency treatment if needed

If it’s an emergency, call 911 or go to an emergency room right away. Tell the medical staff that your injury or illness is job-related. If you can safely do so, contact your employer for further instructions.

If you don’t need emergency treatment, make sure you get first aid and see a doctor if necessary.

What’s next?

Once you file a claim, your employer is required to provide you with medical care.

Want to learn more? Find it in the guidebook

 

 

I was injured at work: #AskNikkiNow

Los Angeles Workers’ Compensation Lawyers – Free Consultation – consultation@nikkijacobson.com

Free Work Injury Consultation