Top Seven Workers' Compensation Claim Questions Answered

Pedro Ponce | Dec 3, 2020 | minute read

Workers' Compensation Claim FormIf 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.

1. How Long Can an Employee Take to Report a Work-Related Injury?

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.

2. Where Do I Get the Worker’s Compensation Form?

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.

3. Do I Select the Doctor my Employee Sees?

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.

4. What Steps Should I Take if Someone Gets Sick or Injured at Work?

The steps you need to take are pretty simple. They are:

  1. If the injury is the result of a crime that occurred at your place of business, inform the employee of their workers’ compensation rights within 24 hours.
  2. Deliver the workers’ compensation form to the employee within one working day after they report their illness or injury to you in writing.
  3. After the employee gives you the completed form, give them a copy of it within one working day.
  4. For employees covered by a medical provider network, ensure the employee receives an MPN notification and that the initial medical evaluation is scheduled.
  5. Within one working day of receiving the completed claim form, compile it and your report and send it to your claims administrator.
  6. Within that same day, authorize as much as $10,000 in appropriate medical treatment.
  7. If it’s possible that the employee will be cleared to return to work with modifications, prepare light-duty transitional work for them.

work related injury

5. Can I Ask an Injured Employee to Work During Their Recovery Period?

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:

  • Any limits placed on the employee’s job tasks until further notice. These should be labeled in the report as “work restrictions.”
  • Whether or not their schedule, assignments, equipment, or other elements of their work conditions need modification during the recovery period.

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.

6. What Should I Do if I Think an Employee’s Workers’ Comp Claim is Fraudulent?

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.

7. Who Investigates Workers’ Comp Fraud?

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.

Leap | Carpenter | Kemps Insurance Agency Can Answer Any Additional Questions You Have

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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About The Author

Pedro Ponce is a Commercial Insurance & Risk Advisor who has been representing his customers for over ten years. He holds a Certified Insurance Counselor designation and is currently working on becoming a Certified Risk Manager.

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