From Notification to a Settlement: What’s The Timeline of a California Worker’s Compensation Case
An injury at work can be painful, scary, and disrupt your life in the short and long term, but California law provides important protections through the state’s workers’ compensation system. While benefits are available, the process of filing a claim and securing a fair settlement can take some time. Many injured workers are unsure of what to expect when pursuing a claim. The following timeline gives you the confidence of key steps to make sure you are aware of in a California workers’ compensation case so you become more familiar with the process, possible challenges, and the typical timeline.
Step 1: Reporting the Injury to Your Employer on Time
The first step in any workers’ comp case is going to be notifying your boss or the entity you work for about the injury. California law stipulates workplace injuries need to be reported within 30 days of an incident. Failing to report on time can produce a claim denial.
After you correctly report the injury, your employer should supply you with the Workers’ Compensation Claim Form (DWC-1). Your boss has to provide the form within a business day. Completing the form and returning it quickly allows your claim to move ahead without unwanted delays.
Step 2: Filing the Workers’ Compensation Claims (Right After Reporting)
After receiving the accurate and completed document, your employer has to get it to the workers’ compensation insurance provider. The submission marks the official start of the claims process.
In California, the insurance company has up to 90 days to investigate the claim and conclude if they will motion to approve or deny benefits. During this period, workers are actually entitled to up to $10,000 in medical treatment already––even if your claim is still in the review process.
The speed at which this stage moves depends mainly on how efficiently the paperwork gets processed. Delays can mount due to insurance providers asking for additional medical records or documents. Sometimes, insurers also want to conduct extensive investigations.
Step 3: Receiving Medical treatment and Temporary Disability Benefits (Ongoing)
Once a claim is accepted, injured workers start eligibility and receipt of medical care for injuries. Some workers might qualify for temporary disability (TD) benefits if they cannot work during the recovery phase.
Temporary disability benefits typically equal two-thirds of a worker’s average weekly wages, subject to state-imposed limitations. These payments continue until:
A doctor determines the worker has recovered enough to return to their work duties.
A doctor declares the worker has reached maximum medical improvement (MMI)
The worker reaches the limit for TD benefits, which is 104 weeks for most.
The length of this phase varies depending on the severity of the injury. Minor injuries may heal within weeks, but others can extend and require longer-term therapy. Long term-therapy could be months or longer in length.
Step 4: Reaching Maximum Medical Improvement (MMI) and Permanent Disability Evaluation
At a certain point, a treating physician may determine that you have reached the max for medical improvement. Thus, your condition is unlikely to make meaningful further improvement with treatment.
Once you reach MMI, the doctor issues a Permanent and Stationary (P&S) Report, which lays out the following:
- Remaining disabilities (if any)
- Future medical care requirements
- Work restrictions
- Permanent disability (PD) rating (if applicable)
The PD rating plays an imperative role in determining whether or not you may qualify for permanent disability benefits. If you disagree with the rating, you could request an evaluation. You would ask for an evaluation by either a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME), which your attorney could set up for you.
Disputes that surround MMI and disability ratings can add weeks (sometimes months) to your timeline, especially if multiple evaluations are deemed necessary.
Step 5: Settlement Negotiations and Resolution
Once medical evaluations wrap up, discussions about a settlement begin. California workers’ compensation cases typically resolve in one of two ways:
- Compromise and Release (C&R)––A lump sum payment covering all past and future benefits. Once accepted, your case would essentially come to a close, and you would assume any future medical responsibilities. C&R can have an impact on other benefits you are receiving or eligible for, so you want to discuss these options carefully with your attorney.
- Stipulated Findings and Award––These are periodic disability payments with continued access to medical care covered by the employer’s insurance.
Both options ultimately require the approval of an official workers’ compensation judge to ensure fairness. Should an agreement not be reached, the case might go to trial.
Step 6: What Happens If There’s a Dispute?
Insurance Companies do not always agree with a worker’s claim. If disputes arise over medical evaluations, disability ratings, or settlement amounts, hearings may be scheduled before the Workers’ Compensation Appeals Board (WCAB).
Cases that go to trial can prolong the process by several months and sometimes even a year. A judge reviews evidence, hears testimony, and issues a decision. If either party disagrees with the ruling, they may file an appeal, further delaying the resolution.
How Long Does a Workers’ Compensation Case Ultimately Take?
The time it takes to settle a workers’ comp case in California really depends on lots of factors, from the complexity of your injuries, the insurance company’s response times, and legal disputes that may arise. Less involved cases with minor to moderate injuries can settle anywhere between 6 and 9 months. Cases that include moderate leaning towards severe injuries or disputed claims can take 12 to even 18 months to resolve. Cases with a trial could push to a 2-year timeline when all is set and done from injury date to trial completion.
Holds or slowdowns do arise, especially when insurance companies request added medical evaluations or challenge disability ratings. Remember, insurers may challenge you because they want to spend less money and protect their interests. Working with a knowledgeable California workers’ comp attorney can help your case greatly by avoiding missed deadlines and insufficient documentation, and they can stay active to keep the process moving efficiently.
Why is Legal Representation so Critical for Workers’ Compensation Cases?
The laws around workers’ compensation were designed to protect employees, but insurance companies want to minimize those payouts to protect their bottom line or outright deny claims. Having an attorney who specializes in Workers’ Compensation Law with many cases under their belt is going to put confidence and experience behind your case and increase the likelihood of fair compensation. Your lawyer will fight for the proper medical treatment and disability benefits you need. They will immediately take action against unfair denials and challenge low settlement offers. A skilled California workers’ compensation attorney will also represent you in hearings before the WCAB so you can focus on your recovery.
Contact a trusted and experienced California workers’ compensation lawyer for a free and confidential consultation. Attorneys understand insurance company tactics and know how to counter unnecessary delays.
Scot Thomas Moga, a dedicated attorney in San Bernardino & Riverside Counties who represents clients in the many types of personal injury, workers’ compensation and estate planning cases.
