Workers’ Compensation Decisions: Deadlines, Protections, And Doctors

When it comes to filing for workers’ compensation after an injury or accident on the job, there are many decisions you will need to make. Some proactively, some implicitly. In this article, we will cover what you need to know to make those decisions in California, including:

• The deadlines for filing your workers’ compensation claim in California.
• Why you do not need to worry about employer retaliation.
• How to choose your doctor, and what to tell them.

How Long Do I Have To File A Workers’ Compensation Claim In California?

Injuries are not always obvious, nor is their extent or the extent of their consequences on your life. Because you might only realize these things later, it is important that you understand your rights when it comes to the timing of the filing of workers’ compensation claims.

If you filed an initial claim right away and have begun treatment, your deadline for filing an application for adjudication of the claim is constantly moving forward by one year. Every time the insurer pays for a doctor’s visit, the pharmacy for medication, or sends you a temporary disability cheque, the statute of limitations (the deadline) moves.

This is because that statute is always one year from the date of the injury OR the date of the latest payment of benefits.

What About Ongoing Injuries Or Symptoms That Only Develop Later?

If your claim was admitted, not denied, and some benefits were paid, you still have the right to pursue the claim further within five years of the date of the injury. For example, if you received some treatment and got “better” and had to return to work and stopped receiving treatment only to have a flare-up later. In such cases, the outside limit to petition for new or further disability is five years from the initial injury date.

The deadline can be even later if the symptoms/disability related to the injury do not manifest for years. For example, suppose a nurse gets pricked with a needle at work and is infected with Hepatitis C, which takes years to develop noticeable and serious consequences. In that case, they had no way of knowing they could have or should have filed a claim until the symptoms emerged.

Similarly, cumulative trauma injuries are a specific type of workers’ compensation claims that occur when repeated motions, stressors, or exposure to dangerous chemicals build up until they eventually cause a debilitating injury. The deadline for filing such claims is one year from the latest incident contributing to the injury AND to the discovery of the injury and its symptoms.

Thus, while the question of deadlines is complex in California workers’ compensation law, the right decision is obvious. If you have any questions about the legitimacy or timing of your claim, do not delay even one day. Talk to an experienced workers’ compensation attorney right away. As the saying goes, if you are in a hole, stop digging.

Am I Protected From Employer Retaliation If I File A Workers’ Compensation Claim?

One reason some workers delay reporting their injuries or claiming compensation is that they are afraid of their employer retaliating against them, maybe even by firing them. Fortunately, this is not legal.

If a judge discovers that an employer has retaliated against you because you filed or pursued a workers’ compensation claim, that counts as illegal discrimination under the Labor Code. They can be penalized, and you could recover even greater damages.

However, not all actions you might see as retaliatory are legally defined as such. It is important to consult with an attorney because employers do not have to entirely ignore the realities of doing business – they may be able to let you go when you can no longer perform your duties or if you have been on disability so long that the work is no longer available.

However, even if you have not been directly retaliated against or discriminated against under the labor code, you may still have legal options under the Americans with Disabilities Act or the Fair Employment and Housing Act.

Another reason to contact an attorney, even before you begin treatment, is to have help choosing your doctor.

Will I Be Able To Choose My Own Doctor For My Work Work-Related Injury?

Initially, when you first report your injury, your employer gets to control your medical treatment and send you to a doctor of their choice. Whether you are then able to choose your own doctor afterward depends on whether the employer has a medical provider network.

A medical provider network is an approved list of doctors over which the employer has incredible control and discretion. They can even economically profile doctors and kick them off the list. It is an incredibly unfair and unjust system.

If the employer or their carrier does not have a medical provider network, however, then you may be able to choose your own doctor once 30 days have passed from the claim form filing.

Can I Keep The Doctor I Already Have If They Are Willing To Tackle A Workers’ Compensation Claim?

If you have a pre-designated doctor who is willing to be your doctor in a workers’ compensation case, as long as they are not just someone you designated in case you someday get hurt, you may be able to use that doctor.

There are additional requirements to take advantage of such pre-design designation, but an employer is required to ask you early on whether you want to pre-designate someone. If you have successfully done so within the rules, then the employer does not get to control who you go to. You would go to that doctor.

Can I Change Doctors If I Do Not Like The One My Employer Sent Me To?

If the employer has a medical provider network but you want to change treating doctors, you can do so after you attend the first appointment with the doctor that the employer sent you to. However, you can only change to another doctor within the medical provider network. Fortunately, you do not have to wait 30 days; you just have to attend the first appointment.

There is a requirement that there be a certain minimum number of doctors available to treat common workers’ compensation injuries within a certain geographic area, depending on where you live, rural versus not rural.

Sometimes, your employer or provider’s list will, therefore, be invalid because they lack a sufficient number or types of doctors. If your primary treating physician within the Medical Provider Network wants to refer you to a specialist, but there are not a sufficient number of specialists to choose from, you may be entitled to go to a doctor who is not on the list. That is one way you may be able to break out of the medical provider network list.

There are also limits on choosing or changing doctors, however. You cannot just decide you want to get treated in another city if there are a sufficient number of doctors available in your current city.

Should I Choose My Own Doctor? My Company Has Suggested Referrals.

Choosing your doctor is a huge decision that can dramatically impact the success of your claim. You should always contact an experienced and specialized workers’ compensation attorney to discuss that choice.

The choice of a treating doctor is a complex decision, and your attorney may have very different criteria to suggest than those you would ordinarily choose based on. For example, whether the doctor is capable of advocating for you in the workers’ compensation system.

You might choose a doctor based on reviews or friends’ recommendations, but neither help you figure out if they are familiar with California’s workers’ compensation system. You need and deserve a doctor who knows how to work requests for authorization so that they will be approved and not challenged. It does you no good to have a doctor you really like if he cannot get the medical care you need authorized.

What Information Should I Share With My Doctor After An Injury?

It is also important to always be honest with your doctor. Share information about how you were hurt, and all the symptoms you are experiencing, no matter how minor they may seem. Your doctor cannot read your mind, and small symptoms could be a sign of worse ones to come or guide them towards recommending important tests.

You should also report any other problems that have arisen, even if they are not part of the original injury. This is because you can include compensable consequences (consequences from overcompensating for an injury) in your claim. You can also include emotional and mental symptoms, such as post-traumatic stress-induced nightmares.

You are not qualified to know what is or is not connected or related to your workplace injury. That is why you need trusted and experienced professionals like doctors and attorneys to help you file a workers’ compensation claim.

For more information on Filing A Worker’s Compensation Claim In California, an initial consultation is your next best step. Get the information and legal answers you are seeking by calling (530) 287-6674 today.