A little bit of legal background – California Workers Compensation differs from others in that it has more informal, relaxed pleadings and rules of evidence. There’s also no early resolution of cases, mechanisms for motions, summary judgement or dismissals unless all parties stipulate. So, the average length of a litigated claim is 18 months, and the Insurance Carrier is given 90 days to accept or deny the claim. And, failure to report a claim on time can lead to it being presumed compensable without the ability to deny.
All injuries which occur on the job, including first aid, must be reported within 5 days and the 5020-form completed shortly after. The employer is required to provide the DWC-1 to the employee within 1 day of learning about an injury or illness. It’s the best practice to pre-fill the form for the Employee yourself in order to prevent the possibility of error. The Claim Adjuster is the party who labels a claim as compensable or not after evaluating all of the facts. It’s his/her responsibility to pay disability benefits when appropriate and implement proactive strategies to get your Employee back to work and the claim resolved. So, in that sense, they should be your ally.
The insurance company is responsible for the first $10,000 of reasonable and necessary medical treatment to relieve the effect of a work injury or until the claim is denied. The Employer controls the medical treatment for the first 30 days. Afterwards, an Employee can change their doctor if they would like, as long as it’s within the Medical Provider Network of their Carrier.