Filing a Workers’ Compensation Claim—What You Need to Know About the First 90 Days

In the Event of a Workplace Injury

Workers' compensation benefits are designed to provide injured workers with the medical treatment necessary to recover from an on-the-job injury or illness and partially replace the wages lost during the recovery period.

Inform your supervisor of your injury as soon as possible. Prompt reporting can help reduce benefit delays. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Your Workers’ Compensation benefits may be lost if you fail to report your injury within 30 days.

Reporting a work-related injury to one’s employer and formally filing a Workers’ Compensation claim can be an intimidating proposition. Many workers don’t fully understand their rights and fear retaliation from their employer should they file such a claim. Others fail to pursue legitimate claims out of a misguided sense that someone filing a Worker’s Compensation claim is trying to get away with something, or is somehow taking advantage of their employer or “the system.”

What the System Covers

The Workers' Compensation system was developed to cover a wide range of work-related injuries and illnesses, including, but not limited to, the following:

• Heart disease
• Hypertension
• Stroke
• Occupational exposure
• Cumulative trauma
• Musculoskeletal issues
• Slip, trip and fall
• Communicable diseases

Workers' Compensation Is a No-Fault System

What you might not realize is that the Workers’ Compensation system exists to protect employers, not penalize them. In most instances in California, workers who are injured on the job are legally prohibited from suing their employers in civil court. This is true even where a worker is injured through gross negligence on the employer’s part. This prohibition exists to protect businesses from incurring prohibitively expensive litigation costs whenever an employee sustains a work-related injury. The tradeoff is that employers are required to carry Workers’ Compensation insurance or to be permissibly self-insured to allow for a system to assist injured workers in receiving benefits, including medical treatment and monies, in an expeditious manner.

Workers' Compensation Timelines Can Affect Your Claim for Benefits

You should advise your employer immediately if you have suffered a work-related injury. The timelines and rules outlined here apply to the first 90 days after a claim is filed. It is important to understand these so that you receive the full range of benefits to which you are entitled.

Once an employee has notified the employer of a work-related injury, the employee should be provided with a Workers’ Compensation Claim Form, known as a DWC-1, to complete. Presenting a completed DWC-1 form to an employer initiates the Workers’ Compensation claim process. Read all of the information carefully, fill out the form and complete and sign the “employee” portion. Describe your injury completely, and include every part of your body affected by the injury. Verbally reporting the injury is not sufficient to trigger an employer’s responsibility to initiate benefits. Be sure to keep a copy of the form for your records as it is one of the most important documents in your case.

Within 14 days of receipt of the Claim Form, the employer must accept, reject or delay a decision regarding the industrial injury claim. If the claim is put on delay, the employer has 90 days to determine whether to accept the claim. During this delay period, the employer is required to furnish up to $10,000 worth of medical care to the injured worker. The employer is not, however, required to pay temporary disability benefits for wage loss during this delay period. Therefore, if the employee is off of work because of the injury, and the employee paid into the State Disability Insurance (SDI) system or has some other disability policy through work, he or she should apply for these benefits.

Know Your Rights Regarding a Medical Provider Network (MPN)

One of the most important issues during the beginning stages of a Workers’ Compensation claim is deciding when and where to begin medical treatment. The employer is legally entitled to choose the medical provider for the first appointment. However, many injured workers are under the mistaken impression that they must continue treating with this initial physician. It is the employer’s duty to notify injured workers of the existence of what is known as a Medical Provider Network (MPN), which is a list of preapproved doctors from which an injured worker can choose. According to state regulations, each MPN must include a mix of doctors specializing in work-related injuries, and doctors with expertise in general areas of medicine. MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses. Usually, the employer will notify the injured worker about the MPN via a letter with a website that lists available physicians. An injured worker can pick a new doctor off the MPN immediately after the first visit with the assigned company doctor.

Not all employers have MPNs. In this case, the employer has medical control for the first 30 days, then an injured worker can designate any doctor who accepts Workers’ Compensation insurance starting 30 days after the employer’s receipt of the Claim Form. Oftentimes injured workers reach out to an experienced Workers’ Compensation attorney during the early stages of an injury claim to seek assistance in identifying a qualified treating physician, as prompt and effective medical treatment can assist an injured worker in making a speedy recovery.