Workplace safety has improved over the years, but unfortunately, on-the-job injuries continue to occur nationwide. The United States Bureau of Labor Statistics reported that 2.6 million American workers got hurt or fell ill while on the job resulting in a nonfatal accident in 2021.
Workplace injuries have become an expensive epidemic. These accidents cost American companies 6.2 billion dollars. Employees who suffer an injury while working are entitled to workers’ Compensation benefits. Most states require companies to carry workers’ compensation insurance for employee injuries.
Once an accident happens, you only want to get your life back to normal. You wonder how long it will take to resolve my claim. The aggressive accident attorneys at Arash Law, founded by famous attorney Arash Khorsandi, Esq., have helped injured workers in California for decades. Contact our office at (888) 488-1391 or chat with us to schedule a no-obligation case evaluation.
How Do Workers’ Compensation Claims Work?
There are several stages to a workers’ compensation claim. The claims process begins once a worker informs their employer about their injury. Once the employer knows of the injury, they must file a formal claim with their insurance company.
The time an employee has to begin a claim varies by state. Generally, an employee must inform an employer of their injury within 72 hours (and in some states, within two years), or they risk losing their workers’ compensation benefits.
The employer must assist their employee by helping them get medical care. The employer also begins investigating the cause of the accident and documents their findings.
The insurance company will investigate the injury. The claim for benefits is either approved or denied. The employee can appeal a denial and hire an injury attorney experienced in workplace accidents to represent them during an administrative hearing.
Why Do Insurance Companies Deny Workers’ Compensation Claims?
Insurance companies will deny an employee’s claim for workers’ compensation benefits to keep costs low. An employer’s workers’ compensation insurance carrier wants to protect its bottom line like any other insurance company. Workers’ compensation insurance carriers may use the following tactics to avoid paying claims:
- The insurer may argue that your injuries happened because you deviated from your assigned work duties. For example, they may claim you were engaged in horseplay with other workers or fighting.
- The insurance company can try to blame your injuries on an accident during your commute to work. This argument is common for workers in the transportation industry.
- A common argument against paying a claim is the employee’s injuries are self-inflicted.
- A classic argument made by insurance companies is that the injuries happened because the employee violated company rules or was under the influence of drugs or alcohol.
If you suffered a workplace injury, you might face the hurdles described above as you try to receive the compensation you need to recover fully. An experienced California workers’ compensation attorney can help you face the insurance company and resolve your injury claim successfully.
What If the Insurance Company Approves My Claim?
The insurance company agrees to pay your medical bills if they approve your claim. The company will pay expenses that result from your accident. You also may receive part of your regular wages. You will receive a portion, about two-thirds of your salary, every week until you return to work. If this happens, it resolves your workers’ compensation claim.
Your wage benefits will end once you can go back to work. Getting you back to work is your employer’s priority. They may participate in the Return-to-Work program. The Return-to-Work program lets workers return to work and perform a lighter, less physically demanding duty that won’t exacerbate their injury.
Why Do Employers Like the Return-to-Work Program?
Employers advocate using the Return-to-Work program. Employers may express concern for their employees, so they cite the following evidence in support of the program:
Financial Security
The Return-to-Work program can help employees maintain financial stability while a workers’ compensation case is pending. Workers’ compensation insurance only covers two-thirds of the employee’s typical salary. Losing a significant portion of the employee’s wages can lead them to significant financial insecurity.
Maintaining Skills
The time an employee spends away from work may affect their proficiency. If enough time passes, the employee may lose this skill completely. Returning to work, even on a provisional basis, is good for the employee and can help them avoid frustration and retraining.
Improved Morale
Returning to work can improve morale. Working keeps the mind occupied and helps the employee avoid falling into a depressive state. Having a routine is generally good for a person’s mental health.
The Return-to-Work Program also benefits employers. Employers do not want open lawsuits, and participating in the Return-to-Work program may help them resolve workers’ compensation claims sooner. Examples of how the program can help the employer include the following:
Employee Retention
Having employees quickly return to work retains employees. Statistics show that employees who spend more than six months away from work after an injury are 50 percent more likely to never return to work.
Avoid Hiring New Employees
Hiring and training new employees can be expensive for businesses. Because companies want to avoid this cost, they will try to hold on to current employees. Getting employees back to work quickly after an accident helps companies avoid the expense of hiring temporary replacements.
Lower Workers’ compensation Premiums
The longer an insurance company must pay for an injured worker’s income, the higher the employer’s premium costs. For example, suppose a driver causes a car accident while on the clock, and their insurance company must pay the injured party’s medical costs and other expenses. In that case, the at-fault driver’s insurance premiums increase. Employers want to avoid this expense.
How Is a Settlement Reached?
How complicated a workers’ compensation gets depends on the severity of your injuries. If you can return to work without medical expenses, your case can close quickly. However, the more severe your injuries, the more time it takes to resolve your cases.
Cases involving more severe injuries may take longer to resolve. The first step to resolution is a conversation about damages between the insurance company and your workplace injury attorney. A final settlement amount can include compensation for the following losses:
- Payment for current and future medical bills, costs of future treatment, including surgeries, and the cost of medical treatment
- Payment for the cost of lost income
- Recurrent payments if the injury leaves the employee permanently disabled
How Do Employees Receive Payment?
After finalizing a settlement or winning a judgment, the employee will receive a payout. The final settlement amount is either a lump sum or a structured settlement.
A lump sum payment is a one-time payment issued to the recipient. The lump sum payment must cover all outstanding medical bills, lost income, and other financial losses related to the accident.
An employee may request payment in a structured settlement. A structured settlement is an agreed-upon payment arrangement that resolves a workers’ compensation claim. Under the terms of a structured settlement, the injured employee agrees to periodic scheduled payments instead of a one-time lump sum. An injury attorney can assist their client with creating a structured settlement.
What’s in a Final Workers’ Compensation Settlement?
Working with an experienced workers’ compensation attorney like our very own Tina Eshghieh, Esq. can help you resolve your claim and receive full financial recovery after an on-the-job accident. You only get one bite at the apple in a suit, so your claim must cover all your injuries.
Examples of what you must consider while trying to resolve your claim include:
- The state’s limitations on recovery under workers’ compensation laws
- Outstanding medical bills
- The need for future medical treatment
- Disability status
- Current and future lost income
- Attorney’s fees
Is a Workers’ Compensation Claim Required?
Generally, a judge must approve the settlement agreement. Therefore, a final hearing is the last step before the resolution of your claim. The judge considers the fairness of the agreement before final approval.
Workers’ compensation hearings serve a critical role in the overall claim. The judge’s decision resolves the employee’s workers’ compensation claim.
If the parties have settled, the judge reviews the terms for fairness. The judge may decide to deviate from the settlement and create another agreement drastically that the court finds fair.
If the judge approves the claim, the employee and their injury attorney can let the judge decide the final terms of the settlement. If the insurance company denies the employee’s original claim, a hearing on the merits creates a right to appeal for the employee.
Workers’ compensation trials carry a risk for both parties. For an injured worker, the court may decide the value of their claim is much lower, and for the insurance company, the court may decide the claim’s value is much higher than anticipated.
Call Arash Law Today
The legal team at Arash Law, managed by Arash Khorsandi, Esq., wants to help injured workers across California get the compensation they need to recover financially after a workplace injury. Contact us today at (888) 488-1391 or through our online chat feature to schedule a free, no-obligation case evaluation.
The post How Is My Claim Finally Resolved in California Workers’ Compensation for Employees? appeared first on Arash Law.
