Who Pays for Workers’ Compensation Benefits?

When you have suffered a work-related injury or illness, then your employer is required by law to pay your benefits under the California Worker’s Compensation system. Depending on how your company has set up its Worker’s Compensation insurance policy, you may receive Worker’s Compensation benefits from your state government, a private insurance company, or a third party that your employer hired to administer their Worker’s Compensation claims. 

When you have questions about your Worker’s Compensation claim or have been denied, then you should seek out a Worker’s Compensation attorney, advises the California-based Grossman Law Offices. Insurance companies and employers try to save themselves money by denying claims, even if they are valid. When you deserve your Worker’s Compensation benefits, then you need a lawyer fighting for you. You have the right to appeal your claim if denied. An attorney cares about you getting what you need so that you can move forward in your life after your workplace accident or illness.

State-Run Insurance Programs

Employers in California may choose to obtain Worker’s Compensation insurance through the California Division of Worker’s Compensation (DWC). Even if a state does offer a state fund, many states offer companies a choice to purchase a policy through private insurance or their state fund or even choose self-insurance, as is allowed in California. In California, the Division of Workers’ Compensation is under the Department of Industrial Relations.

An Insurance Company

Employers can also purchase Worker’s Compensation insurance from a private insurance company. Many insurance companies provide Worker’s Compensation insurance to businesses of all sizes. If your company has a policy through a private insurance company, then that company will pay your benefits.

A Third Party Administrator

If your employer is self-insured, then that means that they hired a third-party administrator who distributes Worker’s Compensation claims on behalf of your self-insured employer. If your employer is self-insured, then you should strongly consider hiring an attorney since they tend to have the most resources to fight Worker’s Compensation claims.

What is Worker’s Compensation?

Worker’s compensation is a form of insurance that provides medical benefits and wage replacement for workers who are injured or become ill as a direct result of their job duties and negligence on the part of their employer. Common injuries covered under Worker’s Compensation are carpal tunnel syndrome, strains and sprains, hearing and vision loss, burns, and injuries in the back, neck, or shoulder caused by repetitive movements and overexertion.

What benefits can I receive?

There are different types of worker’s compensation payments: medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits, and death benefits. What type of benefits you receive and how much will depend on the specific circumstances surrounding your case. 

Medical care includes treatments related to helping you recover from an injury or illness caused by your work. This includes doctor’s visits, diagnostic tests, prescription medications, assistive medical devices, and travel costs to treat your injury with a specialist who is not in your area. Disability benefits provide payment for lost wages while you recover or if your injury causes a permanent loss of a physical or mental function that was necessary for you to perform your job. The supplemental job displacement benefit can help you pay for retraining in another field if your injury prevents you from returning to work. Death benefits are available to the spouse, children, or other dependents of a worker who died from a job-related accident or illness.

How are Worker’s Compensation settlements paid out?

You can receive a lump sum of the value of your future medical treatments, called a Compromise and Release, or you can receive payments for a future medical treatment over several weeks, months, or years, called a Stipulation and Award. With Compromise and Release, you cannot reopen the claim if your condition gets worse and you do not keep working for the same employer. Since the payment is given in a lump sum, the victim is responsible for the medical care for their injury.

There are pros and cons to these two methods that Worker’s Compensation settlements are paid out. You should review your choices with a competent and experienced attorney who can help you understand the consequences of each option. An attorney can also ensure that your questions are answered before making your decision.

What should I do if my employer or the insurance company denies my claim?

Insurance companies try to avoid paying compensation to injured employees at all costs. As of July 2022, 2,818 Worker’s Compensation claims were denied in California. You have the right to appeal your denial, and with the help of an experienced Worker’s Compensation attorney, you can hopefully get the money that you deserve. There are many reasons why a Worker’s Compensation claim could be denied:

  • You did not produce proof that you were injured while working
  • You did not report your workplace injury to your employer within 30 days or file your Worker’s Compensation claim within one year of the incident
  • You had a pre-existing injury or medical condition
  • The injury was your fault
  • You were not carrying out your legitimate work duties during official hours at your job when the accident and injury occurred. For example, you got into a car accident while on your way to work.

If your appeal has been denied, the best plan is to hire a Worker’s Compensation attorney to help you file your appeal, help you meet deadlines, collect evidence for the strongest case possible and explain the legal complexities you will face. In fact, you don’t have to wait until your appeal is denied to reach out to an attorney. If you have been injured and need the benefits you deserve, an attorney will fight for you to get what you deserve. Insurance companies are not looking out for you, but an attorney is, so call one today.

Featured image by Pexels

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