Workers Compensation in California
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How does workers’ compensation work in California?
We briefly outline California Workmans’ Comp laws and how workers compensation attorneys can help you win your workers’ comp case. Worker’s comp requirements vary by business type.
Generally, employers who have at least one employee are required to fulfill three basic criteria:
– Purchase California workers’ compensation insurance.
– Provide new hires with a pamphlet that explains their workers’ comp rights and responsibilities.
– Display the “notice to employees” in a conspicuous area at the workplace. This poster provides information about workers’ comp coverage and where to seek medical assistance for job-related injuries and illnesses.
Should any employee suffer an injury or illness at work, the employer must then:
– Provide the employee with a workers’ compensation claim form within one working day after the work-related injury or illness is reported.
– Return a copy of the completed form to the employee within one working day of receipt.
– Forward the claim form, along with the report of occupational injury or illness, to the claims administrator within one working day of receipt.
– Authorize up to $10,000 in appropriate medical treatment within one working day of receiving the employee’s claim.
– Provide transitional, light duty work whenever appropriate.
Note: Employers who use a Medical Provider Network (MPN) may have additional requirements to meet.
What is workers’ compensation?
Workers’ compensation benefits are designed to provide you with the medical treatment you need to recover from your work related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work. Workers’ compensation benefits do not include damages for pain and suffering or punitive damages.
If you get hurt on the job, your employer is required by law to pay for workers’ compensation benefits.
You could get hurt by:
– One event at work. Examples: hurting your back in a fall, getting burned by a chemical that splashes on your skin, getting hurt in a car accident while making deliveries.
– or –
– Repeated exposures at work. Examples: hurting your wrist from doing the same motion over and over, losing your hearing because of constant loud noise.
What are the benefits provided through workers compensation?
– Medical care: Paid for by your employer, to help you recover from an injury or illness caused by work.
– Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering.
– Permanent disability benefits: Payments if you don’t recover completely.
– Supplemental job displacement benefits (if your date of injury is in 2004 or later):
Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer.
– Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.
What should I do if I have a job injury?
Report the injury to your employer Tell your supervisor right away. If your injury or illness developed gradually (like tendinitis or hearing loss), report it as soon as you learn or believe it was caused by your job.
Get emergency treatment if needed
If it’s a medical emergency, go to an emergency room right away. Your employer may tell you where to go for treatment. Tell the health care provider who treats you that your injury or illness is job-related.
Fill out a work accident claim form and give it to your employer
Your employer must give or mail you a claim form (DWC 1) within one working day after learning about your injury or illness. Use it to request workers’ compensation benefits.
Where can I find the required DWC-1 claim form if my employer hasn’t provided me with it?
California employers are required to provide the DWC-1 claim form and notice of potential eligibility within one day of an employee reporting a work injury. If your employer does not provide this form to you, it is available from the California Department of Industrial Relations, Division of Workers’ Compensation Website: DWC-1 Claim Form
Do I need to fill out the claim form (DWC 1) my employer gave me?
Yes. Giving the completed form to your employer opens your workers’ compensation case. It starts the process for finding all benefits you may qualify for under state law.
Those benefits include, but are not limited to:
– A presumption that your injury or illness was caused by work if your claim is not accepted or denied within 90 days of giving the completed claim form to your employer
– Up to $10,000 in treatment under medical treatment guidelines while the claims administrator considers your claim
– An increase in your disability payments if they’re late
– A way to resolve any disagreements between you and the claims administrator over whether your injury or illness happened on the job, the medical treatment you receive and whether you will receive permanent disability benefits.
What benefits am I entitled to with a work comp claim?
Workers’ comp insurance provides five basic benefits:
- Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
Any service reasonably necessary to treat an illness or injury may be covered, including doctor visits, hospital stays, physical therapy, lab tests, x-rays, medicines, medical equipment and travel costs. There are, however, limits on chiropractic care, physical therapy and occupational therapy. - Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering
Employees who are unable to work because of their injury or illness may be eligible to receive up to two thirds of their regular pay every two weeks. Minimum and maximum payments are set by the state. - Permanent disability benefits: Payments if you don’t recover completely
An injury that causes a permanent loss of physical or mental function measurable by a doctor may entitle employees to long-term wage replacement. The specific payment amount depends on the employee’s age and occupation and the doctor’s medical reports. As with temporary disability, the state determines the minimum and maximum payments. - Supplemental job displacement benefits (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer
Employees who have a permanent disability and are not offered regular, modified or alternative work by their employer may be eligible for a nontransferable voucher worth up to $6,000. It’s designed to cover the cost of any resources required to find a new job, i.e., licenses, certifications, retraining or skill enhancements at an approved school, etc. - Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.
Payments may be made every two weeks to the spouse, children or other dependents of any employee who dies from a job-related injury or illness. The rate varies based on the number of dependents. California workers’ comp also provides a burial allowance.
Get good medical care after a jobsite accident
Get good medical care to help you recover. You should be treated by a doctor who understands your particular type of injury or illness. Tell the doctor about your symptoms and the events at work that you believe caused them. Also describe your job and your work environment.
What kind of medical care will I receive for my work injury?
Doctors in California’s workers’ compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
How long does it usually take for the insurance company to investigate a claim?
After you file a claim form, the workers compensation insurance company has up to 90 days to accept or deny it. During this time, you can still receive medical treatment. You are entitled to up to $10,000 in medical treatment even if the claim is eventually denied.
The claims administrator hasn’t accepted or denied my claim yet, but I need medical care for my injury now. What can I do?
The claims administrator is required to authorize medical treatment within one working day after you file a claim form with your employer, even while your claim is being investigated. The total cost of the treatment provided while your claim is being investigated is limited to $10,000. If the claims administrator does not authorize treatment right away, speak with your supervisor, someone else in management or the claims administrator about the law requiring immediate medical treatment. Ask for treatment to be authorized now, while waiting for a decision on your claim.
What are temporary disability (TD) benefits are payments?
Temporary disability (TD) benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering.
Are temporary disability (TD) benefits taxable?
No. You don’t pay federal, state or local income tax on TD benefits. Also you don’t pay Social Security, taxes, union dues or retirement fund contributions.
I’m afraid I might be fired because of my injury. Can my employer fire me?
It’s illegal for your employer to punish or fire you for having an injury at work, or for filing a workers’ compensation claim when you believe your injury was caused by your job. If you feel your job is threatened, find an attorney who can help. Note that there are deadlines for taking action to protect your rights.
Does workers’ compensation cover undocumented immigrants?
Yes, California Workers’ Compensation law specifically includes “aliens” in the definition of employees eligible for workers’ comp benefits. Under California law, all of the rights and remedies available to citizens are also available to workers who are undocumented.
Can my employer say it is my fault?
Unless you were drunk or high on the job, you still have a case so long as you were injured while at work.
What is the turnaround time once I obtain the form to file my claim?
Once you receive the form to file your claim, you should complete and file it as soon as possible. Once it has been filed, the insurance company has 90 days to either accept or deny your claim. If the insurance company fails to act within that time frame, your claim is considered to be accepted.
Don’t wait to file your workers’ compensation claim.
Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits.
Can I sue my employer for more money?
Maybe. However, if the accident was caused by the employer’s negligence, you may have a civil case against your employer or a third party. Our firm can help you with these claims, known as third-party liability claims.
What are the benefits of hiring an attorney for my Work Comp case?
While you can handle your workers’ compensation on your own, there are a number of advantages to working with our law firm.
First, having a California workers’ compensation attorney will level the playing field. The insurance company has a team of lawyers to represent its interest. They will have attorneys that will work to find reasons to deny or delay your claim. Our expert lawyers can help you prepare your workers’ compensation claim and help you get the benefits that you deserve.
Second, our workers’ comp lawyers can help you find an appropriate doctor near you. This will help support your case. Within our personal medical professional and care network, there may be better physicians to see who will evaluate your injuries and document them in a way that helps your case.
Third, our attorneys can help make sure that you get the maximum level of benefits that you are entitled to under the law. Without a lawyer, you may be bullied into returning to work sooner or accepting a settlement that leaves you without the benefits that you need. Our experienced California workers’ compensation attorneys will use their experience and knowledge of the law to advocate for you to receive the maximum amount of benefits under the law.
The information contained in this is general in nature and is not intended as a substitute for legal advice. Changes in the law or the specific facts of your case may result in legal interpretations different than those presented here.
Resources:
Workers’ Compensation Claim Form (DWC 1)
Workers’ Compensation Charts for California
Division of Workers’ Compensation Information Services Center
Workers’ Compensation in California: A Guidebook for Injured Workers
Compensación del Trabajador de California: Una Guía para Trabajadores Lesionados
What we do for you
Medical Treatment and Medical Care Services
We will make sure you obtain any necessary treatment. Whether it’s through our lien doctors in our trusted network, or through the insurance carrier.
We will make sure that you don’t pay the medical bills. They do not come out of your settlement. We will make sure that the Insurance takes care of these medical bills!
Disability Payments
If your doctor places work restrictions, we will make sure the insurance and your employer are respecting those restrictions.
If you’re not able to work, we will make sure you’re getting paid while you are seeking medical treating and while your case settles. Note: Not full check, but 2/3 of your check. For example: If you’re making $1,000/week, your disability checks would be $666/week.
Settlement
At some point you will see a doctor who will decide if your injury status has plateaued and will determine the % of disability from your work injury.
The settlement is based on that % and any future medical care you were recommended. Two types of settlement: Stipulation and Award or Compromise and Release.
– Stipulation: Payments. % paid at the amount its worth and your medical care remains open.
– Compromise: Lump Sum. % paid at the amount its worth and your medical is “bought out”
Start Your Workers Comp Case Now with No Cost to You
Our fees are not paid by you, but through your workers’ compensation benefits. That is how the law works in California. No attorney fees until we win your case. Nothing out of pocket. No settlement. No payment.
Can I sue my employer for more money?
Maybe. However, if the accident was caused by the employer’s negligence, you may have a civil case against your employer or a third party. Our firm can help you with these claims, known as third-party liability claims.
Don’t wait to file your workers’ compensation claim
Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits.
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