If you’re injured at work in California, navigating the workers’ compensation process can feel overwhelming. Understanding the key steps and options available to you can make a big difference in how your case is handled. Here’s a breakdown of the essential steps involved in settling a workers’ compensation claim in California, from filing a claim to receiving a settlement.
- Filing a claim (application for adjudication of claim)
The workers’ compensation process begins when an injured worker files an official claim with the California Workers’ Compensation Appeals Board (WCAB). This step is crucial because it opens your case and starts the legal process. It ensures that your injury is officially recognized, and it also allows for the possibility of receiving compensation for lost wages, medical care and other benefits. An experienced worker’s comp attorney like Tim Bartell can start this process and guide you through the rest of the steps to receive the compensation you deserve.
- Choosing a Primary Treating Physician (PTP)
After your claim is filed, you’ll need to designate a primary treating physician (PTP). This doctor will oversee your treatment and guide your recovery. The PTP is responsible for:
- Regular consultations.
- Prescribing medications.
- Ordering diagnostic tests (e.g., MRIs or X-rays).
- Referring you to specialists if necessary.
Your PTP plays a key role in your case as he or she will track your progress and determine when you’ve reached a point known as maximum medical improvement (MMI) or permanent and stationary (P&S) status. This occurs when your condition has stabilized, meaning further recovery is not expected.
- Reaching maximum medical improvement (MMI) / permanent and stationary (P&S) status
MMI/P&S status indicates that your injury has healed as much as possible, whether you’ve undergone months of physical therapy or surgery. At this point, the PTP will evaluate whether you have any lasting disabilities. However, disagreements often arise during this phase, especially if the injured worker feels the PTP’s recommendations are inaccurate or incomplete.
- Obtaining a qualified medical examiner (QME) Opinion
If you disagree with your PTP’s evaluation, you can request a qualified medical examiner (QME) to provide a second opinion. A QME is a neutral, state-appointed doctor who can offer an objective review of your condition. However, hiring an attorney, such as Tim Bartell, can help ensure that you receive a more favorable and thorough QME evaluation. The QME report will either:
- Direct further treatment.
- Issue a permanent disability rating.
If there are any disputes or inaccuracies in the QME’s report, your attorney may take the QME’s deposition to clarify or challenge the findings. Additional QME panels might be needed if there are injuries outside the original QME’s specialty.
- Two ways to settle a workers’ comp case
Once your condition is fully evaluated and rated, you can proceed to settlement. There are two primary ways to settle a workers’ comp case:
- Stipulated award: This settlement option involves bi-weekly payments based on the permanent disability rating assigned by the QME. Additionally, you may receive lifelong medical care if the condition is deemed work-related. This option keeps your medical benefits open, allowing you to continue treatment through the workers’ compensation system.
- Compromise and release (C&R): A lump-sum settlement closes all aspects of your case, including future medical care. This allows you to control your own medical treatment moving forward, but it also means you’ll be responsible for paying for future care out of pocket. A C&R cannot be forced by either party or a judge, so both parties must agree.
- Provisions for government benefits (Medicare, SSDI/SSI)
If you receive government benefits like Medicare or SSDI/SSI, special considerations and protections are needed when settling your workers’ comp case. Your attorney will ensure that any settlement terms comply with these benefits, so you don’t lose eligibility or face penalties.
- Retraining Voucher and return-to-work benefits
Injured workers may also qualify for additional benefits:
- Retraining Voucher: You may be entitled to a $6,000 voucher to cover education or retraining costs.
- Return-to-work fund: If you meet the criteria, you could receive a $5,000 check from the state of California to assist with re-entering the workforce.
- Final settlement approval and payment
Once all settlement details are agreed upon, the final step is having the settlement signed off by a judge. After approval, the insurance carrier typically has 30 days to issue the payment. Whether you receive bi-weekly payments or a lump sum, this marks the final resolution of your workers’ comp case.
Conclusion
The workers’ compensation process in California can be complex and time-consuming, especially if you face challenges with your treatment or disability ratings. Whether you choose to settle through a Stipulated Award or a Compromise and Release, having an attorney like Tim Bartell on your side can help ensure that your rights are protected and that you receive the benefits you’re entitled to. Understanding the steps in this process and what to expect can give you peace of mind as you focus on your recovery.