California Workers’ Compensation FAQs
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California Workers’ Compensation FAQs
California’s Division of Occupational Safety and Health (DOSH), also known as Cal/OSHA, works hard to protect people in California from suffering work-related injuries. They conduct inspections, set safety standards, provide educational resources, and offer many additional services throughout the state. Despite their best efforts, work-related injuries still occur, and it is important for you to understand how the workers’ compensation system works.
If you’ve suffered a work-related injury in California, the first thing you need to do is understand the California workers’ compensation requirements. It is important to follow the required steps within the timeline given to make sure you receive the benefits you are entitled to and to avoid any mistakes that could jeopardize your claim. Your employer is legally required to cover your workers’ compensation benefits but it is up to you to bring your claim and make sure that it is handled appropriately.
The specific requirements and compensation you are entitled to will vary depending on the facts of your unique situation. To help you better understand your rights and the requirements to claim workers’ compensation in California, we address many frequently asked questions below.
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What Is California Workers’ Compensation?
California’s workers’ compensation system was established as part of California’s Labor Code to help balance the rights of employees and employers when a workplace injury happens. These workers’ compensation laws exist to help you get the medical treatment you need after a work-related injury or illness, partially recover your lost wages, and help you return to work when possible. The California Division of Labor Standards Enforcement (DLSE) makes sure that California employers follow these laws and carry the required workers’ compensation insurance.
How Do I Get Workers’ Compensation if I’ve Been Injured?
Report Your Injury or Illness
If you’ve been injured on the job, you should notify your employer as soon as you can. Any delay in reporting can potentially be used to dispute your claim and argue that the injury did not occur as a result of your work-related injury. If you wait more than 30 days, it will make filing a claim substantially more difficult if not impossible. If your injury is severe, you should prioritize your health above all and receive emergency medical treatment and notify your employer once your condition is stabilized.
Receive Appropriate Medical Care
In addition to letting your employer know about the injury, be sure to receive any necessary medical treatment. It is important to have a medical evaluation following your injury and to let the provider know that it was a job-related injury as establishing this information will be important evidence in filing your claim and recovering medical expenses.
Whether you take an ambulance to the emergency room, make an appointment with your primary care provider, or see your employer’s physician, it is important to let them know the extent of your injuries and follow any prescribed care and treatment plans. Depending on your contract with your employer, you may be required to see a doctor in their network for an evaluation following an injury. If you have concerns about this or feel that you have not received a fair medical assessment, you should reach out to a California workers’ compensation attorney to understand your options.
It is important to be honest with the doctor treating you. We understand you may be worried if you have a preexisting condition that was made worse by your work-related injury. You might think that they will use this against you to deny your claim and not cover your expenses. However, withholding information that may already be in your medical records is potentially far more damaging to your claim.
You should disclose your condition but clearly explain how the workplace incident has created a new injury. If you have a pre-existing condition and are concerned about how to have this conversation with the doctor without damaging your claim, an experienced workers’ compensation attorney can help guide you through the process.
File Your Claim
If your injury was not severe enough to require an emergency room visit, then you should notify your employer and file a workers’ compensation claim with them. They are legally obligated to provide you with the medical care that you need resulting from the injury. The state of California requires you to fill out a form DWC 1 from your employer to officially start the process and then a claims administrator will examine your case.
If at any point during this process your employer disputes your version of the incident or that it was a work-related injury, these are potential red flags. If you experience any sort of retaliation or adverse behavior stemming from you reporting a work-related injury, we recommend speaking with an attorney as this behavior is unacceptable and often illegal.
How Long Do I Have to File a Claim?
The statute of limitations for a workers’ compensation claim in California is one year. This means that from the date of your injury, you must bring your claim within one year or else you may lose your right to recovery. Delaying can also create additional challenges in identifying any witnesses or other evidence helpful in establishing your claim. While you do not have to prove fault in a California workers’ compensation claim, your employer may dispute that it was a work-related injury or the extent of your injuries so the sooner you act the better.
What Expenses Does Workers’ Compensation Cover?
Your employer’s workers’ compensation insurance has to provide you with the medical care necessary to recover from your work-related injury or illness. You may be required to receive an evaluation and treatment by a doctor within your employer’s Medical Provider Network (MPN). An MPN is a group of medical providers that your employer or their insurance company has chosen to treat their employees after an injury. You are within your rights to request a different doctor within the MPN after your initial doctor’s visit if you are not happy with the care you received or feel that you received a fair evaluation.
California workers’ compensation law has guidelines specifying the medical care and treatment available to you for a work-related injury or illness. Therefore, it is important that you let the doctor you are seeing know it is for a work injury as you are only guaranteed to be able to recover for medical treatment that follows these guidelines.
Partial Lost Wages
If your injury makes you unable to perform your usual work, you will be entitled to temporary disability benefits to help cover a portion of your lost wages. You will typically be able to recover two-thirds of your pre-tax wages per week for temporary disability.
If you are unable to fully recover even with appropriate medical treatment, you may be entitled to permanent disability benefits. This requires a doctor to perform a disability evaluation which will be used to determine the level of impairment. The workers’ compensation system will use this evaluation and additional factors such as age and occupation to calculate a disability percentage and you will receive benefits accordingly.
If you suffer a serious injury and are unable to fully recover and return to your job, you may qualify for benefits to help pay for training to help you find new employment. In order to qualify for a vocational training voucher in California, you will need to be classified as permanently disabled, unable to return to your job, and your employer cannot have offered you an alternative or modified job to accommodate you. If you feel that your disability classification or alternative job offers are inaccurate or insufficient and that you need vocational training to seek appropriate new employment, our experienced attorneys are available to offer a free case assessment.
In the tragic event of a fatal injury, a worker’s spouse or dependents can receive compensation for the loss.
What Types of Injuries Qualify For Workers' Compensation?
To recover workers’ compensation benefits in California, you will need to be able to show that the injury or illness was work-related.
What Is a Work-Related Injury or Illness?
A work-related injury does not require that your job activities were the only cause of your injury, but just that they were a contributing factor to your injury. Whether your injury qualifies will depend on the specific details of your situation and to what degree your work activities were responsible for the injury or illness. If your employer or the insurance company is saying it was not a work-related injury but you believe that your injury was caused at least in part due to your work activity, we recommend speaking with a lawyer.
If you suffered a workplace accident such as falling and breaking a bone, this would be considered a specific injury. You should report it immediately as the date of the accident will be when the statute of limitations starts running. The sooner you report your injury and file your claim, the better the likely outcome will be.
A cumulative trauma may be an injury that results from repetitive actions required of you at work that ultimately lead to a more severe or chronic condition. For example, if you frequently have to lift boxes overhead and overtime develop rotator cuff tendonitis or shoulder impingement syndrome, this could be considered a cumulative trauma. It is important to report these as soon as you are aware of your symptoms as your employer or the insurance company may argue that you should have been aware of the injury and reported it sooner and now the one-year statute of limitations has run.
For an illness resulting from your workplace, it may develop gradually and you should make certain to report it as soon as you are aware of any potential symptoms.
How Much Can I Collect For Lost Wages Under Workers’ Compensation in California?
You can typically recover two-thirds of your pre-tax salary up to a cap set by California law if you are unable to work because of your injury.
What Are the Maximum Benefits I Can Collect?
The maximum workers’ compensation benefit amount in California is pegged to the average weekly wage across the state which is determined annually. In the case of temporary total disability and permanent total disability, for example, the maximum benefit rate for a California workers’ compensation claim was capped at $1,299.43 per week as of November 2020. This amount is subject to change each year when they recalculate the weekly wage average.
What Is the Minimum Benefit I Can Collect?
The minimum workers’ compensation benefit as of November 2020 was $194.91 per week.
Do I Need a Lawyer to Claim California Workers' Compensation?
You are not legally required to hire an attorney to represent you in a California workers’ compensation claim. Depending on the severity of your injuries, the complexity of the case, and if your employer, the claim administrator, or the insurance company are disputing anything, you may want to consider retaining one.
We offer free consultations to anyone who has suffered a work-related injury in California so it costs you nothing to have one of our skilled attorneys review your situation. We promise to be respectful of your time as we understand how disruptive a workplace injury can be to your life. We may even be able to send a representative out to you to further discuss your situation if you are unable to come into our office. We will use our 30+ years of experience practicing workers’ compensation law and dealing with the insurance companies to assess the details of your case and help you understand the strengths and weaknesses of it and if a lawyer may be necessary.
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