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How Workers' Compensation Work in Beverly Hills, California

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Workers' compensation in Beverly Hills, California works almost the same way in any city and any US state. If you live and work in Beverly Hills, California, this article will give you a brief background on how workers' compensation works for you.

What is workers' compensation?

Workers' compensation is a form of insurance designed to help employers pay for the medical bills (and other forms of compensation) to their employees who got injured at work. Needless to say, workers' compensation applies to work-related injuries and illnesses.

For the part of the employee, workers' compensation is designed to streamline the compensation process. Before the workers' compensation system was created, employees need to go to court to ask for compensation to their employers for their injuries – who often don't give the said compensation under the reason that the injury was the employee's fault (regardless if it's true or not). In other words, prior to workers' compensation, getting compensated for your injuries is difficult and a complicated process. Workers' compensation streamlined this entire process.

How does workers' compensation work in California?

In California, employers are required to obtain a workers' compensation insurance from licensed and authorized insurance companies, or from the State Compensation Insurance Fund (SCIF).

In case your employer has no workers' comp insurance or is inadequately insured, California's Uninsured Employer's Benefit Trust Fund (UEBTF) will pay the compensation so you can still get compensated. Then, the UEBTF will try to get the money back from your illegally uninsured employer. Either way, you will get compensated for your work-related injury – assuming, of course, that your case is approved.

How to be eligible for workers' compensation?

Generally, here are the 4 eligibility requirements so that you can be eligible in workers' compensation:

1) Your employer should be insured for workers' compensation

As mentioned above, in California, employers must have adequate workers' compensation insurance. If they don't have it, the UEBTF will pay for your compensation instead.

2) Your injury should be work-related

Of course, your injury should be work-related.

3) You should have reported your case within the state's deadline

In California, the state deadline for filing workers' comp is one year. However, you must report to your employer within 30 days after the incident (reporting to your employer and filing for workers' comp is different). If you don't report and file a claim within their respective deadlines, your benefits may be reduced or even denied altogether.

4) You should be classified as an employee

If you will observe, the first 3 requirements are either a given or something you can control (like reporting within the deadline). However, you should be classified as an "employee" because not all workers are eligible for workers' compensation.

Workers like volunteers and independent contractors (like freelancers) are often not eligible for workers' compensation. However, if you are classified as an employee – which is simply the "traditional" employee, and most likely you're one of them – then you are eligible for workers' compensation.

What injuries or illnesses are under the scope of workers' compensation?

Almost any injury or illnesses is under the scope of workers' compensation as long as it is work-related. So, whether it's breaking your back because you fell into your office chair, breaking an arm after a machinery accident or got disabled because you fell from the roof you're working on, then it's under the scope of workers' compensation.

However, work-related is not limited to performing a job. Injuries and illnesses because you're running an errand for your employer can also be under the scope of workers' compensation, even though it may not be the main part of your job at all.

How to file for workers' compensation?

Report your injury immediately to your employer, supervisor, HR department or anyone in charge of handling injury cases. Then seek immediate treatment from a medical provider that is authorized to handle workers' comp claims (and a medical provider you and your employer agree about). Most likely, your employer will tell you which medical provider you should go to. In case of emergency, this is not necessary because the ambulance will take you to the nearest medical provider.

Once you got the proper medical treatment, fill out the DWC-1 and give it to your employer. He/she will give it to their insurance company. You must also fill out the Application for Adjudication of Claim, which should be filed within one year, to officially file your workers' compensation claim.

Why is my workers' comp claim denied?

Although you're eligible, it's still possible for your workers' comp claim to be denied by your employer or insurance company. Here are some of the common reasons:

  • Your injury is not work-related
  • You didn't report immediately
  • You didn't seek medical attention right after the incident
  • There are illegal substances present in your body
  • There are discrepancies in your reports and statements

What to do if my claim is denied?

Don't panic. Talk to your employer or insurance company to see the reason behind the denial of your claim. Maybe, it was just a misunderstanding and could be fixed right away. Perhaps, the denial is even a clerical error.

However, if they are firm on their stance, and you also believed that your stance is right, then hiring a workers' compensation attorney could be your next step because appealing for your claim is often a complicated legal process.

Do I need to hire an attorney when filing for workers' comp claim?

Generally, you don't need an attorney when filing for workers' comp because the system itself is streamlined. This is unlike other legal processes – such as suing someone or filing for bankruptcy – where the matters are very complicated, hence having an attorney is highly advisable or even legally required.

However, you can also hire an attorney for the simple reason that you're not confident in filing for workers' comp alone.

If you need an attorney for your workers' comp case, there are workers' compensation attorneys in Beverly Hills, California that's ready to help you in your case. 

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