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

How To File A Workers’ Compensation Claim?

WORKERS’ COMPENSATION CLAIM FORM (DWC 1)

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File a claim form (DWC-1)

File a claim form (DWC-1) to protect your rights and start the workers’ compensation process. Your employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn’t give you the claim form you can download it from the forms page of the DWC website.

How to fill out a claim form

Complete only the “employee” section of the form and send it to your employer right away. Be sure to sign and date the claim form and keep a copy for your records. Return the claim form to your employer in person or by mail. If you mail the claim form, use certified mail — return receipt requested — so you have a record of the date it was mailed and the date it was received. If you don’t return the completed form to your employer you may risk your right to benefits.

What happens next?

Your employer should fill out the “employer” section and forward the completed claim form to the insurance company. You should receive a copy of the completed claim form from your employer. If you don’t, request a copy and keep it for your records.

Generally, the insurance company has 14 days to mail you a letter telling you the status of your claim. If you don’t receive this letter, call the insurance company to find out the status of your claim.

Want to learn more? Find it in the guidebook

 

#AskNikkiNow

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

Free Work Injury Consultation

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

What is ADR? Alternative Dispute Resolution Workers’ Compensation

What is ADR? Alternative Dispute Resolution Workers' Compensation

What is ADR? Alternative Dispute Resolution Workers' Compensation

 

What is ADR? Alternative Dispute Resolution Workers’ Compensation

What is ADR?  Alternative Dispute Resolution Workers’ Compensation:  Provisions of workers’ compensation reform legislation, implemented through Labor Code Sections 3201.5 and 3201.7, allow employers and unions to form a labor-management alternative workers’ compensation program also known as a carve-out. A key feature of most carve-outs is an alternative dispute resolution process. This section includes both research and guidebooks on carve-outs.

 

 

 

 

ADR? Alternative Dispute Resolution Workers’ Compensation

ADR? Alternative Dispute Resolution Workers’ Compensation

ADR? Alternative Dispute Resolution Workers’ Compensation

 

 

 

Best Los Angeles Workers Comp Lawyer

 

 

What is ADR? Alternative Dispute Resolution Workers’ Compensation

What is ADR?  Alternative Dispute Resolution Workers’ Compensation:  Provisions of workers’ compensation reform legislation, implemented through Labor Code Sections 3201.5 and 3201.7, allow employers and unions to form a labor-management alternative workers’ compensation program also known as a carve-out. A key feature of most carve-outs is an alternative dispute resolution process. This section includes both research and guidebooks on carve-outs.

Denaturalization Under the Trump Administration

Denaturalization

Immigration Consultation Request Form

DenaturalizationNikki Jacobson   Los Angeles Immigration Attorney   Rose, Klein & Marias LLP

Justice Department Secures First Denaturalization As a Result of Operation Janus

On January 5, Judge Stanley R. Chesler of the U.S. District Court for the District of New Jersey entered an order revoking the naturalized U.S. citizenship of Baljinder Singh aka Davinder Singh, and canceling his Certificate of Naturalization, the Justice Department announced.

Following Judge Chesler’s order, Singh’s immigration status reverted from naturalized citizen to lawful permanent resident, rendering him potentially subject to removal proceedings at the Department of Homeland Security’s discretion.

Singh’s denaturalization is the first arising out of a growing body of cases referred to the Department of Justice by United States Citizenship and Immigration Services (USCIS) as part of Operation Janus. The action against Singh was filed contemporaneously with two other Operation Janus cases, as announced by the Justice Department on Sept. 19, 2017.

A Department of Homeland Security initiative, Operation Janus, identified about 315,000 cases where some fingerprint data was missing from the centralized digital fingerprint repository. Among those cases, some may have sought to circumvent criminal record and other background checks in the naturalization process. These cases are the result of an ongoing collaboration between the two departments to investigate and seek denaturalization proceedings against those who obtained citizenship unlawfully.

“The defendant exploited our immigration system and unlawfully secured the ultimate immigration benefit of naturalization, which undermines both the nation’s security and our lawful immigration system,” said Acting Assistant Attorney General Chad Readler of the Justice Department’s Civil Division. “The Justice Department will continue to use every tool to protect the integrity of our nation’s immigration system, including the use of civil denaturalization.”

USCIS dedicated a team to review these Operation Janus cases, and the agency has stated its intention to refer approximately an additional 1,600 for prosecution.

“We appreciate the dedication of our Justice Department partners as we work together to ensure the integrity of our nation’s legal immigration system,” said USCIS Director L. Francis Cissna. “I hope this case, and those to follow, send a loud message that attempting to fraudulently obtain U.S. citizenship will not be tolerated. Our nation’s citizens deserve nothing less.”

Baljinder Singh aka Davinder Singh, 43, a native of India, arrived at San Francisco International Airport on Sept. 25, 1991, without any travel documents or proof of identity. He claimed his name was Davinder Singh. He was placed in exclusion proceedings, but failed to appear for his immigration court hearing and was ordered excluded and deported on Jan. 7, 1992. Four weeks later, on Feb. 6, 1992, he filed an asylum application under the name Baljinder Singh. He claimed to be an Indian who entered the United States without inspection. Singh abandoned that application after he married a U.S. citizen, who filed a visa petition on his behalf. Singh naturalized under the name Baljinder Singh on July 28, 2006. Singh has been residing in Carteret, New Jersey.

This case was investigated by USCIS and the Civil Division’s Office of Immigration Litigation, District Court Section (OIL-DCS). The case was prosecuted by Counsel for National Security Aaron Petty of OIL-DCS’s National Security and Affirmative Litigation Unit, with support from Deputy Chief Patrice Rodman of USCIS’s Office of the Chief Counsel, Northeast Law Division and Immigration Services Officer Caroline D’Angelo of USCIS’s Field Operations Directorate.

 

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Nikki Jacobson
Los Angeles Immigration Attorney
Rose, Klein & Marias LLP