After a work-related injury, very specific procedures must be followed for an employee to receive workers’ compensation. When an injury is reported late, meaning long after the initial accident, it can cause problems and delays with your claim. However, you still may be entitled to benefits.
In California, injured workers are told to notify their supervisor about an injury or illness as soon as possible and have up to 30 days maximum. If you miss this deadline, your employer’s insurance company may deny your workers’ compensation claim. Keep in mind that when you report an injury within the 30 days, the closer you get to the deadline, the more it hurts your claim’s validity. The insurer may argue that your injury or illness did not happen at work or that it simply does not qualify for workers’ compensation.
Reasons why workers often miss an injury reporting deadline include:
In these cases, it still may be possible for a worker to obtain workers’ compensation benefits since late reporting can be excused under some circumstances. To do this successfully, it is in your best interest to hire a San Diego personal injury lawyer to help you through the process.
If you reported your work injury late and your workers’ compensation claim has been denied or rejected, you can take steps to possibly reverse the decision. First, you must appeal the denial by requesting a hearing in front of your local Workers’ Compensation Appeals Board judge. To do that, you must file an Application for Adjudication of Claim and then a form called a Declaration of Readiness to Proceed (DOR).
At the hearing, the judge will hear both sides of the case and decide whether the insurance company must accept your workers’ comp claim. If the judge cannot settle the dispute or needs more information before moving forward, they will set up a “discovery plan” to review additional evidence related to the case. Alternatively, they can send the case to trial.
If the judge does uphold the insurance company’s denial, you can appeal this decision to the seven-member Workers’ Comp Appeals Board (WCAB) in San Francisco. You have 20 days from the date you received the decision or award to file a Petition for Reconsideration with the local district office of the WCAB. The appeals board then has 60 days to determine whether to accept or deny your petition for review.
Unless you have additional evidence, the appeals board will likely not schedule a further hearing and will decide whether to affirm, reject, or amend the original decision or award. If you are unhappy with the WCAB’s decision, you can petition a “writ of review” with the state appellate court within 45 days. The appellate court is limited in its options and can only consider whether the decision or award was reasonable. Lastly, if you disagree with the appellate court’s decision, you can appeal your case to the California Supreme Court. However, workers’ comp appeals are rarely heard in the state Supreme Court.