The Application For Adjudication Of Claim, hereafter "Application" is the state form that an injured worker/claimant or their representative must file with the nearest local office of the California Worker's Compensation Appeals Board (WCAB). The filing of the Applicant grants jurisdiction of the WCAB over the injured worker's/claimant's claim. Once the Application is filed at the board the injured worker/claimant is often now called "the Applicant" by the work comp professionals.
One or more Applications are usually filed by the applicant's attorney after they are retained by the applicant to represent their interests against the claims administrator/insurer/employer before the WCAB. However, there are some instances in which the claims administrator will file the Application in behalf of the injured worker with or without their consent or a service provider (aka Lien Claimant) may also file an Application if they have provided services related to an injured worker's compensation injury and they have not been paid in full or in part and they are seeking the WCAB's assistance in resolving the dispute.
To initiate proceedings before the WCAB for the collection of worker's compensation benefits the Applicant Employee or Lien Claimant must file the Application For Adjudication Of Claim with the WCAB within one year of the date of injury or within one year from the expiration of the period covered by payment of any worker's compensation benefits***, or within the last date in which benefits were provided (Labor Code Section 5405). This section of the Labor Code is often referred to as the Statute Of Limitations Defense section.
The Application can be used by the investigator to inform and direct their investigation into the Applicant and their claims. The Application may be used with other documents obtained or other non-document evidence obtained in the course of the investigator's investigation to corroborate the Applicant's claims or perhaps bring to light inconsistencies in the Applicant's claim. The Application informs its reader about the employee demographics, their claims that includes the nature of injury(ies) they are claiming (cumulative versus specific), their claimed date(s) of injury(ies), their claimed employer at time of injury, the body parts or systems they are claiming injury or illness to, the claims administrator and/or insurance company(ies) claimed to have worker's coverage for one or more of the claimed injuries, and the Applicant's claimed earnings at the time of injury.
In addition, the Application informs its reader as to what disability the Applicant is claiming (see section or paragraph 4) and whether or not they were paid worker's compensation disability benefits for those disability periods. Section or paragraph 6 inquire if State Disability or Unemployment Insurance Benefits have been paid to the Applicant. Paragraph or section 7 inquires if medical treatment was provided to the Applicant and whether or not the employer or insurance carrier had provided the medical treatment. If the employer or insurance carrier was not providing treatment, the Applicant may have been receiving medical treatment from their personal health insurance or State Medical Program (Medi-Cal) if hey are uninsured. This informs the adjuster/examiner that they can possibly expect a Lien to be filed by EDD (Employment Development Department) in section 6 or by Medi-Cal Program or the Applicant's personal health insurance company as reflected in section 7 medical section. Answers to section 6 and 7 will also provide the investigator of possible additional leads of information to pursue such as obtaining copies of benefit applications and medical information and records submitted to these respective programs that reflects what the Applicant has claimed to those program administrators and the respective medical providers they used in order to obtain those benefits from those programs. The Application will tell you if the employee has filed any other Applications at the WCAB in section 8. Finally, section 9 tells the adjuster or investigator what issues are disputed between the Applicant and the Claims Administrator/Employer.
Overall, the Application For Adjudication Of Claim is another resource available to the investigator for information that will inform and direct the investigator's investigation into the claim(s) of the injured worker/Applicant that will go towards the evidence needed by the adjuster so that they can make the proper decision regarding the Applicant's eligibility and extent of benefit due if eligible.
2. Permanent Disability Benefits
3. Medical Treatment Benefits
4. Supplemental Job Displacement Benefits
5. Death Benefits
One or more Applications are usually filed by the applicant's attorney after they are retained by the applicant to represent their interests against the claims administrator/insurer/employer before the WCAB. However, there are some instances in which the claims administrator will file the Application in behalf of the injured worker with or without their consent or a service provider (aka Lien Claimant) may also file an Application if they have provided services related to an injured worker's compensation injury and they have not been paid in full or in part and they are seeking the WCAB's assistance in resolving the dispute.
To initiate proceedings before the WCAB for the collection of worker's compensation benefits the Applicant Employee or Lien Claimant must file the Application For Adjudication Of Claim with the WCAB within one year of the date of injury or within one year from the expiration of the period covered by payment of any worker's compensation benefits***, or within the last date in which benefits were provided (Labor Code Section 5405). This section of the Labor Code is often referred to as the Statute Of Limitations Defense section.
The Application can be used by the investigator to inform and direct their investigation into the Applicant and their claims. The Application may be used with other documents obtained or other non-document evidence obtained in the course of the investigator's investigation to corroborate the Applicant's claims or perhaps bring to light inconsistencies in the Applicant's claim. The Application informs its reader about the employee demographics, their claims that includes the nature of injury(ies) they are claiming (cumulative versus specific), their claimed date(s) of injury(ies), their claimed employer at time of injury, the body parts or systems they are claiming injury or illness to, the claims administrator and/or insurance company(ies) claimed to have worker's coverage for one or more of the claimed injuries, and the Applicant's claimed earnings at the time of injury.
In addition, the Application informs its reader as to what disability the Applicant is claiming (see section or paragraph 4) and whether or not they were paid worker's compensation disability benefits for those disability periods. Section or paragraph 6 inquire if State Disability or Unemployment Insurance Benefits have been paid to the Applicant. Paragraph or section 7 inquires if medical treatment was provided to the Applicant and whether or not the employer or insurance carrier had provided the medical treatment. If the employer or insurance carrier was not providing treatment, the Applicant may have been receiving medical treatment from their personal health insurance or State Medical Program (Medi-Cal) if hey are uninsured. This informs the adjuster/examiner that they can possibly expect a Lien to be filed by EDD (Employment Development Department) in section 6 or by Medi-Cal Program or the Applicant's personal health insurance company as reflected in section 7 medical section. Answers to section 6 and 7 will also provide the investigator of possible additional leads of information to pursue such as obtaining copies of benefit applications and medical information and records submitted to these respective programs that reflects what the Applicant has claimed to those program administrators and the respective medical providers they used in order to obtain those benefits from those programs. The Application will tell you if the employee has filed any other Applications at the WCAB in section 8. Finally, section 9 tells the adjuster or investigator what issues are disputed between the Applicant and the Claims Administrator/Employer.
Overall, the Application For Adjudication Of Claim is another resource available to the investigator for information that will inform and direct the investigator's investigation into the claim(s) of the injured worker/Applicant that will go towards the evidence needed by the adjuster so that they can make the proper decision regarding the Applicant's eligibility and extent of benefit due if eligible.
*** The Five (5) Benefits of California Worker's Compensation Benefits are
1. Temporary Disability Benefits2. Permanent Disability Benefits
3. Medical Treatment Benefits
4. Supplemental Job Displacement Benefits
5. Death Benefits
