Making Sure Your Workplace Accidents Don’t Become Problems: Going from a Sustained to an Accepted Workers’ Compensation Injury

After you sustain an injury at work, it is crucial that you promptly take action to take care of yourself and your claim of injury. Once the injury is reported to your employer, their workers’ compensation insurance company has up to 90 days to investigate if the injury genuinely occurred due to your job. This investigation period is called the delay period (delay phase above). Navigating the delay period is important because if the injury is accepted at the end of the delay period, you should receive medical and financial benefits from the insurance company. If the injury is denied however, it will take months or longer before you receive any benefits from the insurer. This article provides some general advice for taking care of yourself, and your case, during the delay period.
 
If You Need Immediate Medical Attention: Seek Medical Attention Immediately

If you need to go to the Emergency Department (ED), go there immediately. The ED is equipped to treat life-threatening injuries and conditions, and you should call an ambulance or take yourself to the ED if you believe your life is at risk. Taking care of your life should be your primary concern, and workers’ compensation can be addressed later.  

Most workplace injuries are fortunately not life-threatening and are treated at urgent care clinics. Urgent care treats medical issues that need immediate attention but are not life-threatening. Urgent cares commonly treat simple fractures, cuts that need stiches, sprains, strains, ect. The benefit of urgent care is that appointments are not needed for the initial visit, and they provide immediate medical treatment. Urgent cares are also usually the first point of contact for injured workers seeking treatment before the injury is formally reported and know how to handle those cases.  Major Northern California urgent care facilities include Concentra, Carbon Health, and Kaiser Permanente On-the-Job.
 
Report Your Injury to Your Employer ASAP

You should report your injury to your employer as soon as possible. Once you do, your employer is generally required to provide you a DWC-1 claim form. The claim form is important because it provides proof that you reported the injury to your employer, including when it occurred, what body parts were affected, how the injury happened, and the date that the injury was formally reported. The claim form will almost always also prompt your employer to send you out for medical treatment if you have not already begun treatment.  

Reporting the injury immediately also helps you avoid the claim of injury being barred by the statute of limitations and starts the clock on the delay period. If for some reason your employer does not give you a claim form, make sure to follow up your verbal reporting with an email or text message to document reporting the injury to them.
 
Ensure That You Are Seeing a Workers’ Compensation Physician

Seeing a workers compensation physician for your injury is generally helpful during the delay period. One of the primary benefits you receive for seeing a workers’ compensation physician is that you are entitled to $10,000 of medical treatment from the insurance company during the delay period. Treatment requested by your workers’ compensation physician and approved by insurance will be paid for by the insurer without you receiving a bill. You are also not charged for treatment provided during the delay period if the case is later denied.

Treating with a workers’ compensation physician also helps ensure their billing complies with California Labor Code sec. 3751(b), which prohibits medical providers from billing you for services after a claim form has been filed and until they are given notice that liability for the injury has been denied.

Verifying that you are seeing a physician through workers compensation is usually done by your physician. At any initial medical appointment, you should be ask if the injury happened at work. Once told the injury is work related, the clinic will direct your medical care to workers compensation if they cannot provide that treatment. However, if there is ever any doubt about treating through workers’ compensation, you can check your physician’s reports to see if your insurance claim number or employer’s name is on them. If the workers’ compensation claim number or employer name is not on any of your physician’s medical reports, then you should double check with their office to make sure you are actually treating through workers’ compensation.
 
Do Not Be Afraid to Advocate for Yourself

Your employer may not volunteer help with having your injury addressed through workers’ compensation. If your injury qualifies as a “first aid” injury, your employer does not need to provide a claim form and begin the workers’ compensation process. A first aid injury is an injury that results in no time lost from work beyond the shift you were injured on and requires one-time medical treatment, if any. For this reason, employers sometimes steer an injury towards being considered a first aid injury to avoid workers compensation. This is often done by offering extra rest breaks or letting an injured worker go home for the day, hoping they can recover without medical treatment.

Due to employers’ incentives for injuries to be first aid claims, you may need to clearly and unequivocable advocate for yourself to receive medical care if you feel your workplace injury needs it and your employer disagrees. Specifically asking for a claim form and where to receive medical treatment is often enough to tell your employer that your injury is not a first aid claim and the workers’ compensation process must begin.
 
In Closing (TL;DR)

If you seek medical treatment for your work place injury as soon as you know you need it, report the injury to your employer promptly, and make sure you treat with a workers’ compensation physician, you give yourself the best chance of having your injury accepted at the end of the delay period. Making it through the delay period is just the first step of the workers compensation process, and we can work with you through the rest of those steps to help you reach the best possible outcome. Contact us if you have any questions.