Claim Stipulation and Award for California Workers’ Compensation Cases
Under California workers’ compensation law, there are a variety of different types of agreements that you can enter into with your employer’s insurance company for coverage of injuries you sustained while on the job. One type of resolution is known as the claim stipulation and award. Before you discuss payment with your employer, however, your workers’ compensation claim needs to be approved. Below is a brief summary of the anatomy of a workers’ compensation claim in California.
Anatomy of a Workers’ Compensation Claim
While on-the-clock and performing your job tasks, such as lifting heavy boxes, an accident occurs and you are hurt as a result. You notify your supervisor of your injury. Your supervisor writes up a report to document the accident. Because you are in pain, you then immediately seek medical attention. The doctor informs you that you require a series of follow-ups, physical therapy, surgery, and pain medication. The doctor also informs you that you will be unable to return to work for at least six months. Shortly thereafter, you receive a claim form from your employer. The claim form asks for information about the accident such as what happened, where it happened, what you were doing, and what injuries you suffered due to the accident. You sign and date this form and make a copy for your records. You then send a copy back to your supervisor.
When your employer receives your claim form, it will fill out the portion of the form labeled “employer,” then sign and date the form. This completed form is then forwarded to the insurance company. The insurance company is known as the claim administrator. When the insurance company receives the claim form, it will review and investigate, including reading over medical records. While you are in limbo, California law requires that the insurance company continue to cover your emergency medical care up to $10,000. Generally, after a few weeks, the insurance company notifies you whether it will be accepting or denying your claim. If your claim is denied, please see our blog post on filing a claim with the court. If your claim is accepted, you will need to hash out payment terms.
Claim and Stipulation Awards
That’s where claim and stipulation awards come in. Unlike compromise and release awards that were discussed in a previous post, claim and stipulation awards do not give injured employees lump sums of cash. Rather they receive periodic payments. The claim and stipulation award is a product of mediation. The employee and insurance company will mediate on (1) how disabled the accident left the employee (temporarily or permanently), and (2) what medical treatment is necessary in the future. The disability level determines the amount of the award. According to the AMA Guides of Permanent Impairment, certain amounts are assigned to certain types of injuries. In addition, the insurance company continues to cover future medical expenses, though the treatment is overseen by and at the discretion of the claim administrator.
Claim and stipulation awards are generally disfavored by California employees because they limit the amount of money awarded for an injury. The award amount is set by industry standards, which is lower than an award negotiated in a compromise and release agreement. In addition, rather than receiving much-needed money upfront, an employee receives small payments over a period of several years. However, for injuries that are permanent or require extensive medical treatment, a claim and stipulation award is advantageous because it provides for medical care, covered by the insurance company, for the lifetime of the injury. Future medical assistance is not foreclosed like with a compromise and release closure.
Claim Stipulation and Award for California Workers’ Compensation Cases has been brought to you courtesy of Law Offices of Edward A. Smith.
I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. If you or a loved one has sustained an injury at work, please call me at (916) 694-0002 for free, friendly advice. Read more about us on our website, https://www.AutoAccident.com.
Be sure to see what our valued clients have to say about working with our Sacramento law office. Follow these links to read our reviews: Yelp, Avvo, and Google Plus.
The Law Offices of Edward A. Smith is currently a member of the Million Dollar Advocates Forum.
To view our past verdicts and settlements, click here.