The Workers’ Compensation Appeals Board holds hearings in front of Workers’ Compensation Judges to determine what benefits an injured worker is entitled to. The process can be long, involved, and difficult for the injured worker to endure since usually the injured worker is receiving relatively small amounts of money from the insurance company (if at all) while benefits are being determined. Here’s how it works.
- The work injury must be reported to the employer.
If you are injured on the job you must fill out a Claim Form which the employer must provide to you within 24 hours of reporting your injury. By accepting the claim form, the employer is not admitting the injury. The claim form merely puts the employer on notice a claim is being made.
- Under California Workers’ Compensation Law the employer has 90 days to accept or deny the claim.
The employer can take up to 90 days to investigate a work injury claim and during that time the employer may be allowed to take the injured worker’s statement or ask the injured worker to see a company doctor, or obtain medical records. For injuries after January 1, 2005 the employer must pay for medical care up to $10,000 during the first 90 days.
- If the claim is accepted, the injured worker can select a treating doctor (from a list of doctors that the employer provides in certain cases) and be provided with temporary disability benefits until the medical condition becomes permanent and stationary. At that point the injured worker will be evaluated to determine the level of permanent disability.
- If the level of permanent disability is disputed on an accepted claim, the injured worker may be evaluated by what is called a Qualified Medical Examiner (QME).
- If the dispute can still not be resolved, then a workers’ compensation judge may determine the issue after a hearing at the Workers’ Compensation Appeals Board.
- If the employer or insurance company denies the claim, then the injured worker must obtain medical evidence by obtaining reports from the treating doctor and/or a QME chosen by the worker from a random panel of three doctors provided by the state. The case may then proceed to trial before a judge.
- At trial the injured worker and witnesses may testify.
Medical evidence is usually submitted by the submission of medical reports on behalf of the injured worker or on behalf of the insurance company. In a disputed case, Attorney Poe will help the injured worker obtain medical evidence either from the treating physician or a QME, or both, to help present the injured worker’s claim in the strongest possible light.
- After the judge issues a decision, either side may appeal to the Workers’ Compensation Appeals Board, which is a state-appointed court made up of seven appointees (appointed by the Governor) established for the purpose of reviewing the decisions of workers’ compensation judges.
After this process, in some instances the cases may be appealed further either to the Court of Appeal or the California Supreme Court.
- Attorney fees are set by law.
A workers’ compensation judge will set an attorney fee at 15% of the injured worker’s recovery. Attorney fees are contingent and payable only upon the injured worker receiving an award from a judge or settlement.