California Workers’ Compensation: Eligibility and Filing

Admin December 18, 2018 StrongtieInsurance

If you have been injured or fallen ill for work-related reasons, then you could be entitled to workers compensation. Although it is a legal requirement for all employers in California to provide workers’ compensation benefits, it is not always that straightforward. For some people, even knowing if they are eligible for workers compensation is not easy. Others do not know what they are required to do in the event of an accident. Below is a discussion about California workman comp eligibility and what the claim filing process entails.

California Worker Compensation Eligibility

Of course, not everyone is eligible for workers compensation benefits. Below are the four basic requirements that one must meet to be eligible.

The employer must be Covered

Although all employers in California are required to have workers compensation insurance, there are obviously several exemptions. If your employer is not covered by workers compensation insurance, then you are not eligible.

You must be an employee

Not every worker is an employee. For instance, freelancers, consultants, and independent contractors are not employees, and therefore, they are not entitled to workers compensation insurance.

The injury must be work-related

For you to be eligible for California workman comp, your injury must have occurred due to work-related issues. Thus, if you have sustained an injury away from work, you may not be entitled to workers compensation.

Deadlines must be observed

Even if all the above criteria have been met, all the deadlines set out in the law must be met for one to eligible for the California workman comp benefits. If you miss the deadline for reporting the accident, then you may not be eligible for compensation, or at least, things may become quite complicated for you.

Filing a Claim

Within thirty days after sustaining a work-related injury, an employee is supposed to report the accident to the employer. Within one day after reporting, the employee should receive the worker’s compensation claim form. This form contains information about the rights and the benefits that the victim is entitled to.

After receiving the workers’ compensation form, the employee must fill out the employee’s section. At this stage, the employee is required to carefully follow the instructions and accurately list the injured parts of the body. The filled form should then be hand-delivered to the employer or sent via first-class or certified mail. The employer should then fill out the employer’s portion, submit the form to the relevant insurance company, and provide a copy to the employee.

Once the claim form has been submitted, the insurance company has to authorize the payment of the medical bills as it investigates if the claim is valid or not. Until a determination is made, the insurance company is responsible for about 10,000 dollars in medical bills. If the claim is not denied in 90 days after submission, then it is considered approved.

The Takeaway

Overall, it is clear that although all California businesses with one or several employees are required to have workers compensation insurance, eligibility to the California workman comp is not always guaranteed. There are several conditions that must be met for one to be eligible. Besides, the claim has to be filed correctly and on time. If you have any question about workers compensation in California, get in touch with us today.