Victorville
Workers' Compensation Claims
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According to the US Bureau of U.S.labor Statistics, 2.8 million non-fatal workplace injuries occurred during 2019, and 5,333 American workers died as a result of sustaining occupational injuries. The workers’ compensation system administered in California provides injured workers with much-needed financial support to successfully recover from their injuries while ensuring loved ones remain financially secure during this challenging time. Although it offers valuable assistance to thousands of families every year, the workers’ compensation system is extremely complicated, and filing a claim can be frustrating, confusing, and overwhelming.


Successfully navigating this system requires extensive legal knowledge and litigation expertise, meaning the only way to guarantee an optimal outcome is to hire an experienced Victorville workers’ compensation attorney. To learn more about workers’ compensation claims and determine whether you are eligible, consult the information below, then contact Kampf, Schiavone & Associates today for a free consultation.

How Workers’ Compensation Claims Differ From Personal Injury Claims

If you have sustained a workplace injury, you are likely wondering whether you should file a claim through the workers’ compensation system or file a personal injury claim. These options differ in several ways, such as:

• • Effect of Fault
    
    The effect of fault on the claim serves as the most significant difference impacting your decision on which claim to pursue. Filing a personal injury claim results in a payout from the employer only if the employer is considered responsible and therefore legally liable for these injuries. This necessitates proving that the employer owed a duty to the employee. They violated this duty by acting negligently, and this behavior resulted in the employee suffering the damages for which they are seeking compensation.
    
    
    Fault does not influence a workers’ compensation claim, meaning the injured employee will receive benefits regardless of the ability to demonstrate the employer’s negligence. Because a workers’ compensation claim does not require the employee to prove fault, the employee typically receives benefits independent of whether the accident occurred because of the employer’s actions. This allows an injured employee to be considered personally negligent during the incident and thus partially responsible for the injuries sustained without reducing the amount of the compensation package.

• • Type of Damages Available
    
    When filing a personal injury claim, the damages incurred due to the injury depend on the harm that the injured employee suffered as a result of this injury. Damages can include medical expenses for past treatment, estimated expenses for continuing care, pain, and suffering, lost wages, and loss of future earning capacity. A claimant in a personal injury claim may additionally file a claim for punitive damages, the goal of which is to not only cover expenses but to punish the employer and discourage this behavior.
    
    
    The value of the benefits obtained in a workers’ compensation claim depends on calculating a percentage of the employee’s salary to sufficiently replace wages lost during recovery from the injury. Typically, a workers’ compensation package provides wage replacement benefits amounting to around two-thirds of the income they would have earned if they had not received the injury. This fund allocates medical expenses, rehabilitation service, and job retraining but does not cover pain and suffering. An injured employee cannot file a claim for punitive damages.

• • Ability to Sue
    
    In exchange for receiving workers’ compensation insurance, injured employees forfeit the right to file other claims against their employer, such as personal injury claims. However, they may still pursue litigation against third parties that also contributed to the injury. Such a prohibition does not exist in personal injury claims as long as the employer is proven responsible for the accident, whether proximately or directly. In some cases, such as when an employer’s intentionally negligent behavior caused the injury, an employee may be able to file personal injury claims even if they are eligible for workers’ compensation benefits.

• • Financial Responsibility
    
    When an injured employee wins a workers’ compensation case, the insurance company of the employer holds financial responsibility for providing benefits. A successful personal injury case typically includes a defendant covered by multiple insurance policies, such as business or automotive. Some cases result in the defendant directly paying for the damages, instead of or in addition to an insurance company.

• Claims Process
  
  The process of pursuing a claim in a workers’ compensation case involves different defendants than those included in a personal injury case. In a personal injury claim, the plaintiff’s attorney must contact the defendant’s insurance company and engage in negotiations to reach a fair settlement. If the claim is denied, or the parties are unable to negotiate a reasonable settlement that everyone considers acceptable, the claim must enter the court system and the plaintiff’s lawyer will litigate the case.
  
  
  An injured worker seeking benefits in the workers’ compensation system files a claim with the workers’ compensation insurance company that covers their employer. This requires adhering to certain guidelines, such as reporting injuries to a supervisor within a certain amount of time or consenting to an examination by an employer-hired physician. A denied workers’ compensation claim proceeds to be determined by an administrative law judge.

Process of Pursuing a Workers’ Compensation Claim in California

When a worker suffers an occupational injury and wishes to pursue compensation for associated damages, the process of pursuing the claim follows these steps:

1. 1. Initial Stage
      
      The initial stage of the workers’ compensation claim process begins on the date the employee sustained the injury. The injured worker must immediately notify a supervisor of the injury and seek prompt medical attention. Often, the extent or severity of an injury may not become obvious until a healthcare professional conducts a thorough examination and diagnoses the issue. In cases of cumulative injuries, such as repetitive motion or back injuries, this stage is understood as beginning when the employee misses work due to their injury or pursues medical treatment.
      
      
      Any delay in reporting the injury or initiating the claims process can result in severely undermining your claim. After reporting to your employer, you will receive a list of physicians approved by the employer’s workers’ compensation plan to schedule a comprehensive medical evaluation. This physician will diagnose your injury or condition, create a report detailing the specifics of the diagnosis, and designate a disability rating that will be used for calculating damages.

      To be eligible for workers’ compensation benefits, injured employees must report their condition to their employer within 30 days, accompanied by medical documentation of the diagnosis and the treatment plan suggested by the approved physician or other healthcare professional.

1. 1. Filing the Claim
      
      After the employer has been notified of the claim, they are obligated to provide the injured employee with a workers’ compensation claim form, also referred to as a DWC-1 file. This document explains workers’ rights and eligibility for receiving benefits. The injured employee fills out the employee-related sections of the form, detailing each specific part of the body that sustained injury or harm. This stage of filing the claim benefits most from experienced legal representation, as even the slightest error can significantly damage your chances of receiving fair compensation.
      
      
      As part of the claim, the injured employee must provide evidence of the injury, illustrate the chain of events leading up to the accident, and support the assertion that the specific injury they sustained occurred as the direct result of performing job duties within the scope of their job. They must present medical documentation that thoroughly specifies the nature and extent of the injuries, as well as connecting them to the victim’s occupation and/or specific duties. This convincing evidence profoundly strengthens the validity of the claim and increases the likelihood of obtaining maximum benefits.
      
      
      Following the completion of the employee section, the worker will transfer this form back to the employer, whether passing it along in person or through certified mail. The employer will then fill out their section, submit the completed form to the insurance company, and provide the employee with a copy of the document in its entirety.

1. Insurance Company’s Response
   
   After the claim is filed, the insurance company will authorize payment to cover medical care and begin an investigation to determine the claim’s validity. Until the time a decision has been made, the insurance company is considered responsible for paying up to $10,000 toward medical care. If the company does not deny the claim within the 90-day period following the filing of the claim, the employee may consider their claim approved. Temporary disability benefits begin two weeks after the company learns about the injury. If these payments do not occur, the insurance company will be subject to late penalties that equal ten percent of the compensation package. If your claim is denied, your Victorville workers’ compensation attorney will advance your case to court.

Contact Us Today to Pursue a Workers’ Compensation Claim

If you sustained an injury during a work-related accident and believe you may be eligible to receive workers’ compensation benefits, contact Kampf, Schiavone & Associates today. Throughout the past 30 years, our team has helped thousands of California residents complete the workers’ compensation claims process, and we offer top-notch legal representation to deliver you the best outcome in your case. Call (866) 583-8796 or submit the contact form on our website to schedule a free consultation with our experts to discuss how we can assist you.