What is workers' compensation?
Workers' compensation is a state-mandated insurance system that provides benefits to employees who are injured or become ill because of their work. Nearly every California employer with even one employee must carry it.
It is a no-fault system. You generally do not have to prove your employer was careless, and your own mistake usually does not disqualify you. In exchange, workers' compensation is typically the only remedy against your employer for a work injury, which is why it is important to get every benefit the system provides.
What injuries are covered?
California recognizes two broad types of work injuries:
- Specific injuries: a single event, such as a fall, a lifting accident, or a vehicle collision while working.
- Cumulative trauma: an injury caused by repeated activity or exposure over time, such as repetitive-motion injuries to the hands, back, neck, shoulders, or knees.
Occupational illnesses, and in some cases psychiatric injuries, may also be covered. Under California law, immigration status does not bar an injured worker from receiving workers' compensation benefits.
Steps to take after a work injury
- Get medical care. In an emergency, go to the nearest emergency room first.
- Report the injury to your employer in writing. California generally requires notice within 30 days. Report it as soon as possible, even if it seems minor.
- Complete the claim form (DWC-1). Your employer must give you a claim form within one working day after learning of your injury. Fill out the employee section and return it to your employer. Keep a copy.
- Keep records. Save copies of medical records, work restrictions, letters from the insurance company, and notes about who you spoke with and when.
- Talk to an attorney before signing anything, especially before a medical-legal evaluation or a settlement.
While your claim is being investigated: once you file your claim form, your employer generally must authorize up to $10,000 in medical treatment until the claim is accepted or denied. If the claim is not denied within 90 days, it is presumed to be covered.
Benefits available
Medical treatment
Treatment reasonably required to cure or relieve the effects of your injury, generally at no cost to you. Treatment requests are reviewed by the insurer through a process called utilization review, and denials can be challenged through independent medical review.
Temporary disability (TD)
Payments that replace part of your lost wages while you recover and are unable to work. TD is generally two-thirds of your average weekly wage, subject to minimum and maximum amounts set each year. For most injuries, TD is limited to 104 weeks paid within five years of the injury date, with some exceptions for specific serious conditions.
Permanent disability (PD)
If your injury leaves lasting limitations, you may be entitled to permanent disability payments. The amount depends on a medical rating of your impairment, your age, and your occupation. The rating process is technical, and small errors can significantly change the value of your case.
Supplemental job displacement benefit
For eligible injuries, if your employer does not offer you work you can do, you may receive a voucher for retraining or skill enhancement.
Death benefits
If a worker dies from a work injury or illness, dependents may receive death benefits and burial expenses.
Deadlines that matter
- 30 days: the general deadline to report your injury to your employer.
- 90 days: the insurer generally has 90 days from the date you file the claim form to accept or deny it.
- 1 year: generally, you must file a claim with the Workers' Compensation Appeals Board within one year of the injury date. Certain events can extend this deadline, but don't count on it.
Deadlines depend on the facts of each case. If you are unsure whether a deadline has passed, get advice right away.
Medical-legal evaluations (QME and AME)
When there is a dispute about your injury, your treatment, or your level of disability, a medical-legal evaluator often decides the question. If you have an attorney, the parties may agree on an Agreed Medical Evaluator (AME); otherwise a Qualified Medical Evaluator (QME) is chosen from a state-issued panel. These evaluations can determine much of your case's value, and preparation matters.
Protection against retaliation
California Labor Code section 132a prohibits employers from discriminating against employees for filing or intending to file a workers' compensation claim. Retaliation can entitle you to additional compensation.
When should you talk to a lawyer?
You can handle a claim on your own, but the insurance company has adjusters, attorneys, and doctors working on its behalf. Consider speaking with an attorney if:
- Your claim was denied or delayed
- Your treatment request was denied
- You have a QME or AME appointment coming up
- Your TD payments stopped or seem too low
- You were offered a settlement
- You were fired, demoted, or treated differently after reporting your injury
Attorney fees in California workers' compensation cases are a percentage of your recovery and must be approved by a workers' compensation judge. There is nothing to pay up front.
This guide is general information, not legal advice. Laws and benefit amounts change, and every case depends on its own facts. For advice about your situation, contact the office for a free consultation.