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Getting injured at work does not have to end up being a legally contentious affair.
Like many other states, California runs a no-fault workers’ compensation system, which is put in place to benefit both employees and employers. A no-fault workers’ comp system prevents employees from suing their employers, with the other side of the coin being an employee does not have to prove the employer was responsible for causing an injury or injuries.
All a worker has to do is demonstrate that an injury or injuries that resulted from a work-related incident. Note the term “work-related.” Some employees mistakenly believe California workers’ compensation benefits apply only to workplace incidents. The system set up in California applies to all ‘work-related” activities, which means it covers work-related activities that do not occur in the workplace.
The California Division of Workers’ Compensation (DWC) administers workers’ comp claims, as well as provides judicial support by resolving disputes that are connected to workers’ compensation claims.
If you were injured in a work-related incident, your employer has to follow a series of steps for a claim to process in a smooth manner. Employers are responsible for not violating any workers’ comp laws, as well as protecting the rights of workers.
Let’s see what employers have to do when processing a workers’ compensation claim.
Employers must inform their insurance companies about a work-related injury as soon as possible after the incident that caused the injury or injuries. Your insurance company and its attorneys should ask for a copy of the worker’s personnel file, as well as contact the worker’s supervisor and co-workers to corroborate the injured worker’s version of events. If a lawyer representing the injured worker contacts you, let your insurance company know about it.
After an injured worker recovers from one or more injuries, employers must welcome the employee back into the workplace. Employers should ask for medical documentation that gives an employee the green light to get back to work at a 100 percent functioning level. As an employer, you cannot penalize or terminate a worker from exercising the rights granted to the worker by California workers’ compensation statutes. If you violate the rights granted by California workers’ comp laws, you might face a civil and/or a criminal charge.
The California Workers’ Compensation Board fulfills many roles, with one of the most important roles consisting of curbing abuses of the system. Employers must work with the board to prevent fraudulent claims that can include exaggerated symptoms and lying about where an incident took place that caused one or more injuries. Employers must provide accurate reports to avoid getting penalized for trying to minimize the number of claims filed each year. Deceiving the board by not filing legitimate claims to keep your company’s premiums down is against the law.
In a vast majority of cases in California, a workers’ comp claim moves through a three-step process.
- Report the injury
- File a claim with your employer
- Submit an “application for adjudication of claim” with the Worker’s Compensation Appeals Board (WCAB)
Regardless of the severity of an injury, you should seek immediate medical treatment. If your injury required emergency medical care, you have the right to visit any healthcare facility that delivers emergency treatment. Less serious injuries require you to go through your employer's healthcare provider network.
You should report your injury to your employer as soon as possible. California law requires employees to file a workers’ compensation injury report within 30 days after the incident that caused the injury. If you fail to meet the 30-day deadline, you can lose your right to receive workers’ comp benefits.
Remember that you are responsible for reporting an injury or injuries. Although there might have been witnesses to the incident, it is up to your to inform your employer about the incident.
Within one working day after you reported your work-related injury, your employer should provide you with claim Form DWC-1. You should also receive information concerning your legal rights and the potential for getting benefits. Closely follow the instructions on Form DWC-1 and when you complete the form, give it back to your employer for processing. Your employer has to fill out the employer section of the form.
If your employer’s insurance carrier began paying your medical expenses, you might think that you are headed in the right direction for making a full recovery. This might be true if you suffered minor injuries, as those types of injuries heal relatively quickly. However, disagreements surrounding the paying of workers’ compensation benefits can derail the entire process.
After you file a claim with your employer, the next step involves filing the Application for Adjudication of Claim, which is Form WCAB-1. Workers typically need to file Form WCAB-1 within one year after the date of the work-related injury, the last day when your employer-provided workers’ comp benefits, or the day when your temporary disability benefits ended.
In some cases, courts have ruled an injured worker can receive an extension for filing the application for adjudication of claim. This happens when a worker has received advanced payments for medical expenses because the employer understood the payments covered likely workers’ compensation benefits. Workers that qualify for this extension have five years to file an application for adjudication of claim.
Injured workers in California qualify for financial assistance and non-cash benefits, both of which are considered tax-exempt by state law. The tax-exempt status for financial and non-cash benefits differs from other programs such as unemployment benefits.
Here are the financial benefits paid out by most workers’ compensation policies.
The most common financial benefit paid out by a workers’ comp policy is for all medical expenses. This includes diagnostic tests, treatment sessions, and physical therapy that gets workers back on the job. Other types of medical costs covered by work-related injury insurance are surgeries and prescription drugs. Your policy might provide financial benefits to cover the costs associated with medical assistance devices and transporting you to and from healthcare facilities. Check with the DWC website to determine the current IRS-sanctioned mileage rate for transportation costs.
Temporary disability benefits take care of the wages lost because an employee had to recover from one or more injuries. Payments are calculated for lost wages by taking two-thirds of the average weekly wage. Depending on the date of a work-related injury, the state has established a different maximum amount of payments for temporary disability benefits.
California workers have the right to receive temporary disability benefits for up to 104 weeks over a five-year period. If you suffer from the following injuries or illnesses, California law allows you to receive temporary disability benefits for 240 weeks.
- HIV
- Hepatitis B or C
- Severe burns
- Amputation
- Certain injuries to one or both eyes
- Chronic lung disease
- Pulmonary fibrosis
Permanent disability benefits go to workers that cannot go back to work at their current jobs and cannot be active in the job market by seeking another job. The amount paid out for permanent disability benefits depends on a permanent disability rating for the injury suffered by a worker. A permanent disability varies depending on the type and extent of an injury, the age of the employee, the worker’s occupation, and any restrictions issued by a worker’s physician. Permanent disability payments can run from four months until 14 years.
Severely injured workers might qualify for life pension benefits. To become eligible for this workers’ compensation benefit, you must have a permanent disability rating between 70 percent and 100 percent. Life pension payments represent a small weekly payment made to supplement permanent disability benefits.
Some types of injuries make it difficult, if not impossible to go back to work for the same employer. For example, a warehouse worker who suffered a severe back injury has to learn new vocational skills to secure gainful employment. Vocational retraining costs, which are also referred to as Supplemental Job Displacement Benefits, are available for employees that can no longer work for their current employers. The retraining benefit comes in the form of a voucher worth $6,000 for educational purposes and job-specific skills retraining. You can use the retraining voucher to pay for fees, tuition, and textbooks.
Death benefits, which compensate spouses and/or dependents, help pay for burial expenses for employees killed while participating in a work-related activity. California has established a maximum amount to be paid for death benefits. As of March 2021, death benefits pay out at a temporary disability rate that cannot be less than $224 a week.
Although most employees are aware of workers’ compensation, many of them do not understand the legal obligations employers have to provide insurance coverage for work-related incidents that cause injuries. The following are five of the most common questions asked about California’s work-related injury insurance coverage for employees.
According to California Labor Code Section 3700, businesses with at least one employee must purchase insurance that covers workers that get injured in a work-related incident. A sole proprietor and an independent contractor do not have to purchase work-related injury insurance, although some proprietors purchase insurance to cover themselves. If a proprietor decides to purchase worker’s comp insurance, the proprietor must clearly define the coverage in the policy.
Executive officers and directors of corporations must be covered as well unless a corporation is 100 percent owned by the officers and directors. If the officers and directors of a corporation completely own the corporation, then they have the legal right to opt-out of coverage.
Employers in California are legally obligated to buy workers’ comp insurance from a licensed insurance company or via the State Compensation Insurance Fund. An employer also has the option to self-insure for work-related injuries. A commercial agent can help a business purchase insurance to cover the costs of work-related injuries. The California Department of Insurance (CDI) presents an online rate comparison for the top 50 insurance providers.
The California DWC does not provide insurance for workers’ and it does not have any information about employers and their insurance companies. If you want to find out which insurer provides workers’ compensation insurance for your employer, you need to contact the Workers’ Compensation Insurance Rating Bureau (WCIRB).
Self-insurance for workers’ compensation requires the approval of the state, with minimums established at least $5 million for net worth and $500,000 for net income. Although the minimums exclude most smaller employers, several small employers can join a group to purchase self-insurance by pooling their workers’ compensation liabilities. The employers must do business in the same industry. For example, a group of restaurants pooling resources cannot allow a small grocery store chain to join the group.
The State of California does not regulate premiums for insurance that covers work-related injuries. Although the Workers’ Compensation Insurance Rating Bureau issues reports that suggest rates, each insurance company can establish its own insurance premiums. This means California employers must shop around for the best policy the same way individuals purchase car, life, and health insurance policies.
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If you did not file one or more documents on time, contact a California worker’s compensation attorney for legal assistance. Because the law covering workers’ compensation extensions is complex, an experienced lawyer might be able to get you an extension. The biggest advantage of having an attorney on your side is to avoid possible disputes when it comes to getting the money that you deserve for a work-related injury.
Make sure to ask about the fees a workers’ comp lawyer charges before you agree to hire an attorney. Most workers’ compensation lawyers operate on a contingency fee basis, which means they receive a percentage of the cash benefits awarded for a workers’ compensation claim.
