Getting workers' compensation payments after a worker injury happens on the job, or an illness develops, typically is not a hard thing to do. It only takes a few simple steps to file a claim form.

The rest is working out the details with the employer. Work together to settle the details on medical cost payments and temporary disability benefits that cover some of the income decrease that happens when the worker loses their earned wages during their time out of work.

1. Report the injury or illness to the employer. Payments can not start until the employer knows about a worker's bad condition and files the claim for workers' compensation payments. Getting the report in as soon as possible is important.

2. Get emergency medical attention if needed. An emergency condition has to be handled before any paperwork gets done on the claim. Workers can file for emergency medical cost coverage after they get treatment.

3. File a workers' compensation claim form with employer. The employer has to give their worker a DWC Form 1, or mail it to them, within 1 working day after the report comes in or they find out about the injury.

If the employer does not give a worker a form, they can ask for one from the Division of Workers' Compensation or download a form online, www.dir.ca.gov/dwc/.

The form has a section for employees and a section for employers. Fill out the employee section and sign it. Make sure to describe the injury or illness completely. Write out a description for all body parts injured, or for all symptoms of an illness. Give the filled out form to the employer.

4. Learn a worker's rights. After a worker's condition is stable and the employer started working on the claim, the worker has time to learn all their rights they might have to count on during their period out of work. Download the Workers' Compensation Guidebook for Injured Workers from the Division of Workers' Compensation online.

5. Employer files claim with claim administrator. The employer fills out their section of DWC Form 1 and signs it. Then, they send the completed form to a claims administrator. They have one working day after their worker gives them the filled out and signed form to file it.

An administrator usually works for an insurance company or other organization that handles workers' compensation insurance for the employer. At some workplaces, the administrator works directly for a large company and handles their claims.

The claims handler is sometimes called a claims examiner or a claim adjuster.

6. Get a copy of the complete form. The DWC 1 copy is the most important record. The employer has to give a worker a copy as soon as they file the claim.

Keep track of all the facts. Keep copies of everything. Even envelopes showing the postmark.

There might be many forms and a lot of paperwork before the claim is done and all the payments come in. Copies will help a worker prove the facts of their case to an employer or an administrator. Anyone that reviews an administrator's decision can also make use of the records.

First, keep track of the medical condition and any difficulties working experienced because of the condition, and any lost work. The administrator can make copies of medical records. Make a request.

Notes made during discussions with the employer, a manager, other workers and any other person involved in a claim make useful records.

Income, both before and after the injury or ilness, needs an accurate record. Copies of pay stubs and time sheets from both periods are worth putting in a file. Dates worked and dates not worked are both useful.

Do not leave any expenses up to guesswork. Any expense workers' compensation can cover is worth keeping a record on. For example, travel costs for medical appointments. Do not throw out the receipts.

7. Hear the decision on workers' compensation coverage from the claim administrator. The administrator reviews the claim and the facts of the injury or illness and makes a decision on coverage by the employer's workers' compensation insurance. They have a responsibility to make the decision within a reasonable time.

The decision is either claim accepted or a claim denied. Workers get their workers' compensation payments after the claim is accepted. A denial means the administrator found that the insurance does not cover the injury or illness experienced by the worker that filed the claim.

The administrator sends a letter for a denial. If a denial letter is not sent within 90 days after the worker files a claim, the claim is usually approved.

8. If a denial is not acceptable, challenge the administrator's denial. Talk to an Information & Assistance Officer at the Division of Workers Compensation about filing an appeal with the Workers' Compensation Appeals Board. Make sure to follow all the deadlines.

Soruce:

California Commission on Health and Safety and Workers' Compensation, Workers' Compensation in California: A Guidebook for Injured Workers (Third Edition, November 2006).