How The Process Works


The Workers' Compensation Appeals Board holds hearings in front of Administrative Law Judges to determine the nature and extent of benefits an injured worker is entitled to. The workers' compensation process can be long and involved and is often difficult for the injured worker to endure since usually the injured worker is receiving relatively small amounts of money from the insurance company (if at all) while benefits are being determined. Some of the typical events in the workers' compensation process include the following:


  1. The work injury must be reported to the employer
    The employee typically will fill out a "notice of claim" which is required to be provided by the employer to the injured employee after notice of an injury. By accepting the notice of claim from the injured worker, the employer does not "admit" the injury, but simply puts the employer on notice that an injury is being claims.


  2. Under California law the employer has up to 90 days to investigate and either accept or deny the claim.
    The employer should not be able to automatically take advantage of this 90-day investigation period in every case; if an employer is well aware of an admitted industrial injury, penalties can apply if benefits are delayed or denied. However, in a disputed claim, the employer can take up to 90 days to investigate the injured worker's claim and during that time the employer may be allowed to take the injured worker's statement or have the injured worker examined by a physician, or obtain the injured worker's medical records.


  3. If the claim is accepted, the injured worker will select his or her treating physician and be provided with temporary disability benefits until the medical condition reaches permanent and stationary status (limited to 104 weeks). At that point the injured worker will be evaluated for any permanent consequences from the injury.

  4. If the permanent disability is disputed, the injured worker may be evaluated by a Qualified or Agreed Upon Medical Examiner and the employer may also have the injured worker evaluated by a Qualified Medical Examiner. The Law Offices of Joseph C Waxman will also attempt to negotiate a physician known as “an agreed medical examiner.” That is a physician known to be fair to injured workers to evaluate the case, by agreement with the Worker’s Compensation insurance company

  5. If the dispute can still not be resolved, then a workers' compensation judge may determine the issue after a hearing. Workers' compensation judges sit as administrative law judges and juries do not hear workers' compensation cases.

  6. If the employer or insurance company denies the injured worker's claim, then the injured worker can proceed to obtain medical evidence by obtaining reports from his or her treating physician and/or a Qualified Medical Examiner. The insurance company may do the same and disputes again are determined by a workers' compensation judge after a hearing.

  7. Administrative hearings include the presentation of testimony by the injured worker,as well as supporting witnesses, as well as hearing from employer or employer witnesses.

    Medical evidence is usually submitted by the submission of medical reports on behalf of the injured worker or on behalf of the insurance company. In a disputed case, the law office of Joseph C Waxman Waxmanwill help the injured worker obtain medical evidence either from the treating physician, an agreed medical examiner, or a Qualified Medical Examiner to help present the injured worker's claim in the strongest light.


  8. After a decision is rendered by a workers' compensation judge, either side may appeal to the Workers' Compensation Appeals Board, which is a state-appointed court made up of seven appointees (appointed by the Governor) established/or the purpose of reviewing the decisions of workers' compensation judges.

    After this process, in some instances the cases may be appealed further either to the Court of Appeal or the California Supreme Court.


  9. Attorney fees are set by law.
    A workers' compensation judge will set an attorney fee typically relying in the range of15% of the injured worker's recovery. Attorney fees are contingent and payable only upon the injured worker receiving an award from a judge or settlement.

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