American Ombudsman Enterprises

Work Injury Tips

Seek Medical Attention

Always seek appropriate medical attention for your injuries, whether they are incurred on the job or away from work. Aside from the obvious importance of timely treatment, your medical records play an important role in the claims process.

Report your injury

You must report your injury to your employer at the first opportunity. This establishes the time of your work-related injury and the conditions under which that injury occurred. This simple step will set in motion the claims process and help guarantee your rights under California law.

Complete a Claim Form

Your employer should provide you with a claim form when you report your injury. Complete the claim form and submit the form to your employer at your first opportunity. This act will set your claim 'clock' in motion. If you have any questions regarding the form, contact the Ombudsman.

From the time your employer receives the claim form from you, the workers' compensation insurance company has 90 days to accept or reject your claim of injury. In most cases the claim of injury is accepted with little question and benefits are furnished.

If you neglect to report your injury or complete a claim form, or are slow to complete these steps, then your benefits are likely to be delayed.

Settling Your Claim

As stated above, in most cases the claim of injury is accepted with little question and benefits are furnished by your insurance carrier.

However, if the facts of the injury are in question, the insurance carrier will likely delay making a decision on acceptance of the claim. The law allows the insurance company to take up to ninety (90) days to accept or reject the claim of injury.

In this situation, medical treatment and evaluations become the central focus of the claims process. This makes effective communication between you and the authorized medical providers critical. Be sure that you and your doctors are on the same page.

Your Benefits

Two types of benefits that you can receive are, Temporary Disability Benefits and Permanent Disability Benefits.

Temporary Disability Benefits

When you lose time from work due to a work injury, you will likely be described as being temporarily disabled. Temporary disability (TD) occurs during the period of time in which you are recovering from the effects of the work-related injury and you are not able to work.

It is a healing period and you are expected to improve with proper medical attention. During this healing period you will receive Temporary Disability Indemnity payments. The amount you receive is determined by law, giving consideration to your weekly earnings during the year immediately preceding your injury.

According to California Law the TD payment is 2/3 of your average weekly wage or a maximum set by Statute, whichever is the lesser amount.

Permanent Disability Benefits

When the healing of your injury has reached its maximum, the period of your temporary disability is complete. At that time, your treating physician will provide a written report that states your condition is permanent and stationary (P&S).

Your physician will state the date your condition became P&S and from that date forward, if you are determined to have a permanent disability of some type, you will be entitled to permanent disability (PD) payments.

The insurance company will stop sending you TD payments and begin sending you PD payments. Usually these PD payments will be referred to as PD advances until you and the insurance company have formally agreed upon the percentages of disability.

PD payments are less than TD payments. For instance in California, if you were injured on January 1, 1997 and were receiving $490.00 per week in TD payments, you would likely receive between $140.00 and $170.00 per week in PD payments. As you can see, this is quite a bit less than the TD payments you were receiving, and a lot less than your pre-injury wages. These PD payment amounts are established by law.

In many cases the financial hardship will contribute to marital and family problems. Anticipate you may have to deal with these potential problems.

Your Ombudsman

Remember, when you participate in our ADR programs, the Ombudsman is available to help you during the life of your claim.

Do not hesitate to contact the Ombudsman assigned to your case. In most cases, the Ombudsman will make contact with you as soon as he/she receives notice of your injury from the insurance company. The Ombudsman can provide vital information concerning the process to get back to work.

Home Work Injury Tips