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How to Report a Work Injury to Your Employer

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  1. How to Report a Work Injury to Your Employer

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    California’s workers’ compensation system provides no-fault benefits to injured workers. An employee that suffers an injury while on the job can receive compensation for his or her losses without needing to prove anyone’s fault or negligence. The same employee must, however, take a few other steps before receiving a check. One of the main responsibilities an injured worker has is to report the injury to his or her employer. Failing to report an injury on time could lead to workers’ compensation claim denial.

    Stay Where You Are – Ask for Help

    After a workplace accident, stay where you are and request assistance from a co-worker. If you have serious injuries, moving the wrong way could make them worse. Ask a co-worker to call 911 to request an ambulance, if necessary. Have someone take photographs of the location of the accident while it is still set up the way it was when you got hurt. Have someone notify your supervisor or boss of the incident for you, if possible.

    Go to the Hospital

    Put your physical safety first. Even if you have not yet reported the injury to your employer, go to the hospital for treatment of serious injuries. Explain to your doctor what happened and where you notice symptoms. Follow the physician’s treatment plan exactly. Keep copies of your hospital reports, x-rays, and medical bills. Once you receive a diagnosis, take it to your employer if you have not already reported your injuries.

    Notify Your Employer

    If your injuries are not life-threatening, tell your employer about them before seeking medical care. Your employer may need to refer you to a doctor that is part of the insurance company’s medical provider network. Emergency care is an exception. If you need emergency medical attention, do not worry about going to a hospital in your employer’s network. Otherwise, ask your employer for the name of a doctor in the network when you report your injuries.

    Notify your employer within 30 days of the date of the workplace accident. This is a strict deadline you must obey if you wish to recover through the workers’ compensation system in California. If you wait longer than 30 days to tell your employer about your work-related injury or illness, you could lose all right to collect benefits. Notify your employer in writing to document the process.

    Submit Form 1

    Once you have received medical treatment, fill out the Division of Workers’ Compensation Form 1 and submit it to your employer. This form asks for details about your accident and injury, including your full name, address, the date of the injury, and a description of where you suffered the injury. Your employer will fill out the second half of the form, then submit it to the Division of Workers’ Comp. You should receive a copy of your filled-out Form 1 to keep for your records. Your employer should submit the form within one working day of receiving it from you.

    File the Application for Adjudication of Claim

    You may also want to file an application for adjudication of claim. You will only have one year from the date of your injury to file this claim before losing your right to file forever. You will need this form if your employer or its insurance company does not offer fair compensation for your injuries. Filing the claim form opens a case with the Workers’ Comp Appeals Board. Even if a dispute has not yet arisen, you may want to file this form if you are closing in on your one-year deadline, to be safe. File if you think you will need the Board to resolve a dispute in the future to avoid missing the time limit. If you need assistance bringing your workers’ compensation claim, contact a Riverside workers’ compensation attorney.

  2. Medical Fraud and Workers’ Compensation

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    California has a widespread problem with medical fraud in the state’s workers’ compensation system. Health care providers are racking up tens of thousands of dollars in unnecessary tests, procedures, and treatments – exploiting the system to make millions on the backs of workers who suffer injuries on the job. The holes in California’s workers’ compensation system make siphoning money from that system almost too easy.

    Exploring California’s Workers’ Compensation System

    State rules for workers’ compensation are loose in California, leading to plenty of opportunity for fraud. Anyone can pretend to be a medical provider by simply sending a letter to the state, without the need for any proof. Real providers can run meaningless tests and bill the system, knowing they won’t get caught because injured workers don’t see the bill. The weaknesses in the system make it impossible for the state to validate medical provider claims.

    There is a great division of power within California’s workers’ compensation system. The system spreads one job across multiple departments, leading to gaps in communication and dropped responsibilities. The state’s Department of Industrial Relations is in charge of administering workers’ compensation benefits, while medical boards oversee physicians. Hundreds of insurers and self-insured employers decide which medical bills to pay.

    Many states’ fraud strategies stop paying medical providers if a Medicaid agency determines there is reason to suspect fraud. Unfortunately, California has no such law. Medical providers are free to continue performing questionable surgeries, doling out complicated treatment advice, and otherwise exploiting the system at the expense of injured workers – most of which only speak Spanish. There is nothing to prevent this type of fraud from continuing, even if agencies suspect the worst.

    Federal laws have taken steps toward preventing “sham” medical facilities from cropping up. Now, Medicare uses data to check on medical offices and verify their authenticity. Medical officials visit providers when they open, three to five years after they open, and if they receive any complaints. This system dissuades fraudsters from opening false clinics, stealing patient data, and falsifying medical invoices. Once again, however, California has no data reviews or in-person checks that occur on a regular basis.

    The Risk to Injured Workers

    Workers’ compensation fraud hurts more than just the system. Criminal medical providers are getting rich at the expense of injured workers, who undergo unnecessary tests and even surgeries so the provider can make money. Many targeted workers don’t realize they are victims since they never see their medical bills. They trust the opinions of doctors when they say a patient needs surgery – unaware that nurses who get paid for their involvement may tamper with MRI results to encourage this diagnosis.

    Medical fraud also effects employers who pay for workers’ compensation insurance. If an employer is public, it’s the taxpayers who foot the bills for fake charges. In the fraud scheme involving California’s workers’ compensation system, nobody wins except the masterminds. These schemes are far from victim-less crimes. If you’ve been at the tail end of a medical fraud scheme involving workers’ compensation an attorney can help.

    Your Riverside Workers’ Compensation Attorneys

    Workers’ compensation fraud isn’t a new crime, but it’s one that’s currently breaking records in our state. Until lawmakers revise California’s workers’ compensation system to include anti-fraud strategies, injured workers and their employers are still suffering the costs. If you’ve been affected by a medical fraud scheme, get in touch with our workers’ compensation attorneys. We can help you sue fraudulent health care providers for your pain, suffering, and mental anguish.

    If you’re an employer whose business paid the price for a medical provider’s fraud, our attorneys can help you obtain financial compensation for your losses and damages. Nobody should suffer from the criminal activity of others. Contact our Riverside office for a free consultation today.