California’s workers’ compensation law is a no-fault system for injuries that are sustained at the workplace, whether they’re specific work injuries, a disabling condition or medical complication or disease arising from your employment. All employers in California are required by law to provide and pay for Workers’ Compensation Insurance for all their employees. So, what should you know about Workers’ comp in California?
If you’ve sustained any form of injury at your California workplace, you have the right to file for a workers’ compensation claim. So long as you’re an eligible employee with an illness or injury, you may be entitled to various benefits like payment of medical or hospital treatment and partial wage replacement to help you recover and get back to financial stability due to your time away from work. However, if you want to get these benefits, you have to file a claim on time.
Here’s what you should know about the process of filing a workers compensation claim:
When to File a Workers’ Compensation Claim
Filing a working compensation claim in California is usually a three step process:
- You have to report the injury
- File the actual workers compensation claim with your employer
- File an Application for Adjudication of Claim with the Workers Compensation Appeals Board (WCAB)
Each of these three steps comes with specific time limits. Understanding how Workers’ comp in California works is critical to ensuring that you take the right steps when filing a claim. You should know that the deadlines for taking any legal action or filing a claim begin on the specific date of the injury. Injuries are pretty straightforward, but if you’re dealing with a more complex issue like an occupational illness such as lung complications due to exposure to toxic substances, the time for reporting and filing a worker’s comp claim can be determined when:
- You first consulted a doctor due to the illness or injury, or when you missed work
- You knew or should have known that the injury or illness was work-related after medical consultations
Reporting the Work-Related Injury
Right after being injured at your workplace, it’s vital that you get immediate medical treatment. Unless it’s an emergency, where you would have to go to any medical facility, your employer or its insurance company usually has a medical provider network that employees can access for their medical care needs. It’s recommended that you get treatment from a doctor in that network. Also, inform the treating doctor that the injury, complication is illness is work-related.
Any work-related injury should be reported to your employer as soon as possible. You could easily lose your legal right to workers’ compensation benefits in California, if you don’t notify your employer by writing within 30 days after your date of injury. There may be a few exceptions, such as when your employer knew about your injury. Any delays, however, could result in you losing potential benefits. So, the sooner you report your injuries to your employer via a written notice, the better.
Filing a Workers’ Compensation Claim
Once you’ve reported your work-related injury or illness, you should expect your employer to provide you with a workers compensation claim form, also known as Form DWC-1 within one working day, alongside information about your legal rights as an employee and the potential eligibility for Workers’ comp benefits in California, steps you have to take to get those benefits and other important details about the workers compensation process.
If you don’t get the Form DWC-1 from your employer, you can easily download it from the forms page of the California Workers’ Compensation website. Make sure to follow the instructions provided on the form when filling out the employee’s section. List each part of your body that was injured and once you’re done, hand over the form to your employer in person or send it by certified or first-class mail, with the U.S. Postal Service. Your employer should also fill out their section on the form, submit the completed form to its insurer and give you a copy.
What to Expect After Submitting the Claim Form
After submitting the claim form, your employer’s insurer is required to authorize payment for your medical treatment while they carry out investigations to determine if your claim is valid. Until the investigation into your claim is complete, and a decision is made, the insurance company is responsible for paying up to $10,000 in medical bills to take care of your treatment. In case your workers’ compensation claim is not denied by your employer within 90 days after submitting the claim form, it will be considered approved.
In case you miss work due to your work-related injury or illness, your employer’s insurance company is required to begin paying you temporary disability benefits within a period of 14 days after it’s notified about your injury, temporary disability or illness. If your employer denies your claim from the word go or doesn’t pay the payments by then, Workers’ comp law in California requires that they pay a late penalty, usually an additional 10% on the late temporary disability benefits that you deserve.
What Benefits are Available
If you’re injured in the workplace in California, you’re entitled to certain benefits, according to California’s Workers’ Compensation law. The benefits you can get fall under these main categories:
- Medical benefits – Include all hospital and medical benefits to help you heal and recover.
- Temporary benefits – If your injury causes you to miss more than three days of work, you’re entitled to receive temporary disability benefits.
- Permanent disability – If your work-related injury or illness results in any form of permanent impairment, you’re eligible for permanent disability benefits.
- Vocational training or rehabilitation – If you were injured before 01/01/2013 and after 01/01/2014, then you’re eligible for a Supplemental Job Replacement Benefit or a benefit voucher than can only be used for a training institution.
- Return to work fund – If you cannot return to work and are already eligible for the Supplemental Job Replacement Benefit, you’re also eligible for a special return to work fund.
- Death benefits – If certain people were dependent on a deceased employee for support or even partial support, they may be entitled to death benefits, so long as the death was as a result of a work-related accident or illness.
- Compensable consequences – If your initial work-related illness or injury cause further problems, you’re entitled to all the benefits of the subsequent complications, just as if they occurred at work.
Application for Adjudication of Claim
Sometimes, the benefits paid by your employer may make you think that all is well, until you realize that your injuries or illness was even more serious and causing further problems. In such cases, disagreements are common. If you have already filed a Workers’ comp claim in California, it will be hard to resolve any compensation claim disputes unless you file an Application for Adjudication of Claim with the WCAB within one year after:
- The date you sustained the work-related injury
- The last day when your employer paid medical benefits
- The day when any of the temporary disability benefits end
What Happens if You Miss the Deadlines?
If you don’t file a workers compensation claim or the application for the adjudication of claim on time, it’s advisable to contact a California workers’ comp attorney. There may be some circumstances when you may be excused for missing a deadline, or the time for filing is extended, but what matters most is to ensure that you follow the provided time limits when it comes to filing a workers compensation claim. An established workers compensation lawyer should explain how the law applies to your specific situation and help protect your rights.
Independent Medical Evaluation
In order to prove your injuries and permanent disability claim in a workers’ compensation case, you have to be evaluated and your injuries described in an objective way. This is usually done by independent medical evaluation experts who rate your permanent disability. Your attorney or the employer’s insurance company may recommend you to an agreed IME workers’ compensation doctor who will explain what the IME process involves and also write a full IME report.