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California Workers' Compensation Requirements Explained
If you’ve been involved in a workplace injury in California, then it is important to understand the requirements for a workers’ compensation claim. There are critical procedural requirements and timelines that you will need to follow to maximize the chances of a successful claim.
You may be wondering if you are eligible or what kind of benefits you can receive, and we will address these questions below. Keep in mind that the circumstances of every case are unique. If you’re uncertain of how to proceed, our specialists at Morgan & Morgan offer free case evaluations where we can address your specific concerns.
What to Do After You Have Been Injured at Work in California
Get Any Emergency Treatment You Need
If you have suffered a serious accident, your health and wellbeing are the top priority and you should receive any necessary emergency medical treatment before worrying about your claim. Once your condition is stabilized, be sure to notify your employer and fill out any necessary paperwork to begin your workers’ compensation claim.
Report Your Injury or Illness
Once your immediate medical needs are addressed, it is important to report your injury or illness to your supervisor as soon as you become aware of it. You are required to notify your employer within 30 days and failing to do so may delay or prevent you from receiving benefits. We recommend notifying them as soon as possible because you will need to fill out paperwork to begin your claims process. Your employer is also required to provide you with up to $10,000 in medical treatment for your work-related injury while your claim is reviewed.
File Your Claim
When you notify your employer of your injury, they should provide you with a form DWC 1 to fill out so that you can begin your workers’ compensation claim. They will then be required to complete this form and forward your claim to the insurance company.
How Do I Know if I Qualify for Workers’ Compensation in California?
Workers’ compensation in California operates on a no-fault basis, which means that your employer has to provide you with benefits no matter whose fault the injury is as long as you meet the following requirements.
- Employment relationship
- Medically substantiated injury or illness
- Injury must occur in the course of employment
- Injury must arise out of employment
If these sound like a bunch of legal jargon, we completely understand, and we will explain each of these in detail below.
Do All Workers Qualify for Workers’ Compensation in California?
Your employment relationship or classification will determine whether you meet the first requirement for California workers’ compensation.
All employers in California are required to carry workers’ compensation insurance. If you are a full time W2 employee, then you will meet this requirement.
If you are working part-time or in a temporary position, you may still be eligible to receive some benefits.
If you are an independent contractor, you typically would not be eligible, but many employers mischaracterize their employees as independent contractors to avoid paying them benefits. If you believe your employment relationship has been improperly characterized to deny you benefits, you should speak to an attorney as you may be entitled to compensation.
Non Legal Residents
In some states, you will not meet the requirements for workers’ compensation if you are not a legal resident of the United States. In California you may be eligible to receive most benefits.
What Type of Injury or Illness Qualifies for Workers’ Compensation in California?
You will typically have to see a doctor within your employer or their insurance company’s Medical Provider Network (MPN) to have your injuries evaluated and a treatment plan setup. It is important that you are honest with them in explaining the severity of your injury and how it occurred as a result of your work-related activities.
This doctor’s evaluation will be necessary in determining the extent of your injuries and making sure that you receive the necessary medical treatment to get better. If you have any concerns over the objectivity or assessment of the initial doctor, you may be able to request seeing a different doctor within their network. If you’re concerned that you are not receiving a fair evaluation or having difficulty communicating effectively with the doctor, a workers’ compensation attorney can help you navigate this difficult situation.
There are two different classifications of injuries in California workers’ compensation law that can impact your claim.
If you develop an illness or suffer an injury as the result of a single accident or exposure, this is considered a specific injury. An example of this would be tripping over something and breaking a bone as a result.
With specific injuries, the statute of limitations begins to run as soon as you are aware of the injury or illness which is often the same day as the accident.
This term is used to describe an injury or illness that is the result of repetitive work-related activities. For example, repeated exposure to a dangerous chemical may not cause any noticeable injury initially but can result in a severe illness over time. Another example for a physical cumulative trauma would be a job where you repeatedly reach for something on a high shelf and over time develop shoulder impingement syndrome resulting in chronic pain.
In the case of a cumulative trauma, be sure to report it to your employer as soon as you notice any symptoms as the statute of limitations will start to run as soon as you are aware or should have been aware of the injury or illness.
Severity of Injuries
Both of these injury classifications require your injury to cause some form of disability or require medical treatment. For example, a small scratch that can be treated with first-aid and doesn’t impact your ability to work will not qualify as an injury for the purposes of a workers’ compensation claim.
Aggravation of Pre-Existing Conditions
If you have a pre-existing condition that has been made worse by the work-related injury, California’s workers’ compensation law considers this a new injury or illness. For example, if you have arthritis in your wrist but then break it while performing your job, you would be able to bring a claim. If you already have arthritis and your work-related activities cause it to flare up, you most likely wouldn’t have a claim as it is a recurrence of an existing condition.
What Is a Work-Related Injury?
If you meet the employment relationship and injury requirements, you will then be required to prove that the injury or illness is work-related. For physical injuries and illnesses, this means that your work activities must have been a contributing factor. It does not require that your job be the only or even the main cause of your injury. For psychiatric injuries, the threshold is higher and you will be required to prove that your work was the primary cause of the injury.
The doctor who evaluates you will give their opinion on if and how your job activities caused your injury. This is why it is important that you communicate clearly with the doctor and include all the relevant details from your account of the incident.
The insurance company may try to say that the activity you were doing when you were injured was not in the course of your employment. If this happens, you will have to present evidence to a workers’ compensation judge to dispute the insurance company’s claim. This can be an intimidating situation and a workers’ compensation attorney may be able to represent you in front of the judge and advocate on your behalf.
What Benefits Can I Receive and What Are the Requirements to Qualify for Them?
After filling out the paperwork and filing your claim with your employer, you are able to receive initial medical treatment covered up to $10,000. You will most likely be required to see a doctor within their network and it is important that the doctor treating you knows it is for a work-related injury as they will have to document everything accordingly and follow established treatment plans for your medical expenses to be covered.
You will be able to receive benefits for your medical treatment until you reach your maximum medical improvement level in the short term. You can also potentially recover for future medical treatment that may be needed.
Disability Payments for Lost Wages
You are entitled to recover payments for work that you have missed as a result of your workplace injury. This will typically cover two-thirds of your pre-tax earnings. Your employer or their insurance company are required to start paying you within two weeks of receiving notice of your injury unless they are disputing your claim.
The doctor’s evaluation will determine what category of disability you are placed into which will impact the amount of your benefits.
This will help cover your lost wages when you are temporarily unable to work or perform the full range of your job duties. If you are still able to perform some functions of your job or work for fewer hours, you can receive temporary partial disability benefits to supplement your lost income.
If you have recovered to the maximum medical improvement level, you can no longer claim temporary disability benefits and a determination will be made as to if you qualify for permanent disability benefits. A doctor will perform a disability evaluation and assign a percentage to your case and you will receive benefits accordingly. You may still be able to return to work and receive permanent disability benefits depending on your condition.
Vocational Retraining Assistance
If you have suffered a permanent disability and have not returned to work within 60 days following the end of your temporary disability period, you may qualify for vocational retraining assistance. If your employer provides you with alternative work within 30 days of your temporary disability ending, you will not qualify for this. In California, you can receive vouchers to help you learn new skills for future employment.
In the unfortunate event of a fatal workplace injury, the employee’s spouse and dependents are eligible to receive benefits.
What Are the Requirements to File an Appeal if My Claim Is Denied?
If your claim is denied, you have the right to file an appeal within 20 days of the decision. You will have to represent yourself or hire a lawyer to represent you in front of the California Workers’ Compensation Appeals Board.
Who Can Help Me Understand California Workers’ Compensation Requirements?
In California, the Division of Workers’ Compensation (DWC) has an Information and Assistance Unit to help all parties involved in a workers’ compensation claim. The DWC works with your employer, the insurance company, and any other parties involved to try to resolve workers’ compensation claims efficiently. They can be a valuable resource but it is important to not confuse them as being exclusively on your side. The only person who will be 100% on your side is a workers’ compensation attorney that you hire to represent you.
At Morgan & Morgan, we have been representing the rights of injured workers for over 30 years. Our California workers’ compensation lawyers have a deep understanding of the relevant law and have experience navigating claims across many different industries and injury types. If you have any additional questions regarding your rights in your workers’ compensation claim, we are available 24/7 and provide free consultations to anyone who has been injured.