Hi, my name is Pete Schaeffer. I’m a
workers’ compensation attorney in California. I’ve done over 3,000 cases,
and I’m going to tell you how to go about filing your workers’ comp case. If
you get injured on the job, the single most important thing for you to do is
report the injury. If you’re one of those people that goes home and thinks that you’re going to get better tomorrow, forget about it. If it’s more than a
first aid injury, tell your supervisor. I can’t tell you that strong enough. The
biggest reason your cases get denied is because you don’t report the injury. So
make sure you report it. Tell a co-worker at the very least. Hopefully, he’ll
remember that if he’s ever interviewed by human resources or another supervisor.
You know, “Did Joe tell you he got injured?” “Oh yeah, I remember that.”
So, remember, file your claim. How do you file your claim? You gotta ask for a
worker’s comp form. It’s simple. Maybe your employer won’t give it to you.
They don’t want their rates to go up. Maybe you think it’s an act of disloyalty to
file a worker’s comp claim. Trust me, it’s not. Part of your employer’s
responsibility in the state of California is to have you covered by
workers’ comp insurance. Personally, the money doesn’t come out of his pocket. He
buys an insurance policy for if you get hurt doing his work. Remember, you’ve got to be
injured on your job, or in the course of your employment. Driving your car to work
in the morning doesn’t qualify. You better be in the parking lot if you get
hurt. Now, what’s it take to file a claim? Simple. You get the form. You fill out the
top half of the form. The form is very simple. I have one right here. This is a
worker’s comp form. You just fill out the top portion of the form, give it to your
supervisor, and he does the rest. He sends it in to the insurance company, they fill
in their portion, and before you know it, you get a letter in the mail from a
claims adjuster. What’s a claims adjuster? The single most
important person that you’re going to deal with before you lawyer up.
Now do you need a lawyer to file a worker’s comp claim? No,
but if your employer doesn’t give you a claim form and resists your filing a
claim, you better come to a lawyer because he needs to file it for you.
Now, the claims adjuster. They’re the gatekeeper of your case.
They will determine who you’re going to see for medical treatment initially. Now, your
employer may have a medical provider network. What’s a medical provider
network? A group of doctors that the insurance company has approved to give
you medical treatment. Now these doctors have been filtered
through a process. Initially, when they started medical provider networks, all
doctors could join in a particular specialty. Then as time went by, those
doctors that were perceived by the insurance company to be too liberal – gave
away too many diagnostic tests that cost them too much money – they got rid of them.
So the guys that were left, generally are very conservative. They’re not going to
order MRIs willy-nilly. They’re not going to give you surgery because you want it.
Everything gets approved by utilization review. “Utilization review,” don’t forget
those words. It’s almost like the devil’s workshop.
Who are these people? I don’t know. You won’t know. But some nameless, faceless
person is going to determine whether you get treatment.
Now, if treatment is denied like it is 70 percent of the time, there’s an
IMR process: Independent Medical Review. That’s a nightmare all by itself. Get a
lawyer when you get to that point. Frankly, it costs you the same amount of
money to have a lawyer in the beginning of the case, as it does at the end of the
case. So once you get injured, just see a lawyer. If you like the guy you see, let
him be a lawyer. Oh yes, they don’t take any money from you. Not a penny. And if
they don’t make money for you, you don’t owe them a nickel. You’re there risk free.
The only one with skin in the game is your lawyer. So, what do you got to lose?
You don’t like them? Fire them. Get another lawyer. But the
bottom line is, you should get representation. Because
unless you want to play Perry Mason, forget about it. This is a tough system.