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If you own a business in California, chances are high that you need to have a workers’ compensation policy. But your duties go beyond just taking out this policy; you also need to understand how it’s used, what to do when someone needs to file a claim, and more. To get you going, here are your top seven California worker’s compensation claim questions answered.
This varies depending on the type of injury and how it happened. For example, a repetitive stress injury develops over time, so there’s no specific date at which the injury occurred. With that said, in general, your employee must notify you within 30 days after sustaining the injury. This notice must be in writing. You’ll then need to have the employee complete an official workers’ compensation claim form and return it to you. If they fill out the form before giving you written notice, the claim form can constitute their written notice.
The form is online. All you need to do is download and print it from the DWC website. You can also ask your workers’ compensation claims administrator to provide you with them. For small businesses, this is usually just your insurance carrier. It’s a good idea to have printed forms on hand just in case.
No, you don’t need to worry about finding a doctor to evaluate your employee’s work-related injury. In most cases, neither the employer nor the employee chooses a doctor without restriction. Instead, the insurance company provides guidelines to the employee on which doctors or medical practices to use.
Many insurance companies have an established provider network they use for workers’ compensation claims, and while there might be some wiggle room on choice within this, it’s also possible that a specific doctor will be chosen in advance.
The steps you need to take are pretty simple. They are:
This depends on the findings of the medical doctor. After examining the employee, the doctor will forward their report to the claims administrator. In this report, the doctor will state whether or not the employee can return to work yet. If they state they can, the doctor should also clarify:
Keep in mind that if the doctor’s report states that the employee can’t work, you shouldn’t ask them to, nor should you allow them to work if they request it.
First, ask yourself why you think this. Then, determine what, if any, evidence you have. This can include things like surveillance video, witnesses, and photographs documenting the scene. As soon as possible, inform your workers’ comp claims administrator that you believe fraud has been committed and then provide them with all evidence you have gathered. Then, follow up with them after a few days to see what steps will be taken.
It can be tempting to play investigator yourself, but avoid this. Fraud is a crime, and if it appears there’s a strong case for it, the California Department of Insurance will need to be notified. They’re responsible for the investigation, and if they find fraud has occurred, they’ll work with the local district attorney to prosecute the case.
We know that Workers’ Compensation Insurance brings up a lot of questions for business owners. From our decades of experience with commercial business insurance, we’ve guided customers through many of their questions and concerns. If you have any questions about Workers’ Compensation Insurance, we can help. Contact one of our knowledgeable agents at Leap | Carpenter | Kemps Insurance Agency today.
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Leap | Carpenter | Kemps Insurance Agency provides Commercial Business Insurance, Employee Benefits, Life and Health Insurance, and Personal Insurance to all of California, including Merced, Atwater, Los Banos, Mariposa, Madera, Fresno, Modesto, Turlock, and Stockton.
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