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What Is Covered Under Workers’ Compensation and When Should an Application for Adjudication of Claim Be Filed?

There are five benefits in the California Workers’ Compensation system. They are available to the injured worker once their claim of a work-related injury has been accepted by the employer or the insurance company.

There is medical care, there are Temporary Disability Benefits during the healing phase of the injury, there are Permanent Disability Benefits expressed as a percentage from zero to one hundred percent, there is medical mileage that covers transportation costs to and from doctor visits, and if a doctor determines that the injured worker cannot return to their usual and customary occupation, there is a supplemental job displacement voucher worth six thousand dollars. In addition to that, the State of California has a Return to Work Fund which an injured worker can apply for and receive a five-thousand-dollar benefit while they are using their voucher to learn a new occupation.

When an injured worker fills out a claim form because of a work-related injury and they are receiving treatment, at that point the claim is not being litigated. If there are any problems with the process or if the injured worker wants assistance through the process and hires an attorney, an Application for Adjudication of Claim is filed with the Workers’ Compensation Appeals Board.

There are statutes of limitations regarding this filing. The basic statute of limitation is one year from the date of injury or one year from the date that the last benefits were provided. There are many numbers of time periods that this can be done. For example, an injured worker will call a workers’ compensation attorney the day after they are injured. This usually happens with a severe work-related injury. The injured worker with a severe injury often experiences fear because they aren’t familiar with how the workers’ compensation system works, they know they won’t be immediately returning to work, and they are aware that they will need assistance through benefits. This is a perfectly acceptable time to seek representation and have an Application for Adjudication filed. Another scenario will have the injured worker starting the process representing themselves (in proper). They will be receiving medical care and Temporary Disability Benefits during the healing phase. Then they start getting so many notices from the insurance company they start to feel overwhelmed. They then decide that they don’t want to handle their case personally anymore and would like an attorney to take over.

In another common scenario, the injured worker is late with seeking representation and it will often result in a sad situation that can be fixed somewhat by an attorney but can’t be restored fully once an error in the process is made. For example, the injured worker has filled out a claim form, they are getting treatment on their own, they may have been off work for a while, and the insurance company was giving them some Temporary Disability Benefits. Then the insurance company sends the injured worker forms to get a Medical Legal Evaluator on their own. They go ahead and request a three-member panel list of Medical Legal Evaluators; they go through the list and select the doctor that has the earliest appointment. So often, those doctors have early appointments because no applicant attorney would ever use them. Now the injured worker is stuck with a medical legal evaluation report that has assigned a very low level of permanent disability because the doctor didn’t listen to what the injured worker was telling them. In the report, the doctor has said that the injured worker is no longer in need of any future medical care. Now the injured worker wants an attorney to fix it. A good workers’ compensation attorney will take this case if they feel that they can do something to help. Quite often, the injured worker is stuck in this unfortunate situation. If you have a significant work injury, (Injuries of the back, neck, knee or shoulder) it is wise to seek representation before the process of getting a medical legal evaluator.

Because of the hassle of the workers’ compensation process, not being treated kindly by their employer, the claims adjuster, their treating physician, some injured workers think they are entitled to Pain and Suffering. Pain and Suffering is not awarded in workers’ compensation cases, nor are future lost wages. Your best bet is to seek counsel that is skilled in maximizing the five areas of compensation at the beginning of this article.

Sacramento Workers’ Compensation Lawyer

Hope this answers some questions you may have about what is covered under workers’ compensation.  For any additional questions please call The Law Office of Alice A. Strömbom at 916-444-7557 for your free consultation.  We’re here for you.


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