How Does Workers’ Compensation Work?

Workers’ compensation in California typically covers the costs of work-related injuries such as medical expenses and lost wages. Workers’ compensation was adopted in California in the second decade of the 20th century and is the nation’s oldest social insurance program. Under this program, employees are entitled to receive prompt, effective medical treatment for injuries they suffer on the job, regardless of whose fault the accident was. In return, they are prevented from suing employers over those injuries.

California employers are required by law to carry workers’ compensation insurance, even if they have only one employee. If employees get sick or injured on the job, employers have a responsibility to pay workers’ compensation benefits. Workers’ compensation insurance provides basic benefits including medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits and a return-to-work supplement, as well as death benefits where workers are killed on the job.

How the Process Works

The workers’ compensation process begins with an injured worker reporting the incident and filing a workers’ compensation claim. Workers’ comp will cover all medical bills related to the injury and provide a portion of the worker’s lost income.

Here are the steps involved in the process:

Reporting the injury: If you have been injured in an accident on the job, the first step you need to take is to report the incident and injury to your employer as soon as it happened. Under California, you need to report a work-related accident within 30 days. But, it is not advisable to wait that long. Workers should report the injury as soon as possible.

Filing the claim: Your employer should give you a workers’ compensation claim form known as Form DWC-1 within one working day after you report your injury, along with information about your workers’ compensation rights and potential eligibility for benefits, what you need to do to receive those benefits and other details about the workers’ comp process. Follow the instructions on the form for filling out your potion. Be sure to list each injury. Once you are done, hand the form to your employer. Your employer should fill out their portion and submit the completed form to the insurance company. Don’t forget to get a copy of the completed form.

Insurance company’s investigation: Once you file the claim, the insurance company has 90 days to accept or deny the claim. If they don’t decide within 90 days, the injury becomes accepted. Until the insurance company makes a decision regarding your claim, they must provide you with medical treatment for up to $10,000 even if they end up denying the claim. The insurance company may move to question you under oath or they may get records of your prior medical treatment and employment. They may also require you to be medically evaluated by a doctor.

The Appeal: If your claim is denied, the insurance company will send you a Notice of Denial. If you wish to appeal the denial of the workers’ comp claim, you have one year to do so from the date of the denial letter.

What Benefits Will Workers Get?

Workers’ comp in California provides five basic benefits:

Medical care: This is paid for by your employer to help you recover from an injury or illness suffered on the job. This could include cost of surgical treatment, hospitalization, and even treatments such as chiropractic care and acupuncture. You can select a treatment doctor in the Medical Provider Network and your doctor has to request treatment.

Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your job as you recover.

Permanent disability benefits: Payments if you don’t recover fully from your injuries. This typically applies to catastrophic injuries such as brain injuries, amputations, etc.

Supplemental job displacement benefits: These are vouchers that help pay for retraining or skill enhancement if you don’t completely recover from your injuries and don’t return to work for your employer.

Death benefits: These are payments to the worker’s spouse, children or other dependents if they die from a job-related injury or illness.

If you have been injured on the job, it is important to thoroughly understand the workers’ compensation system, which could be complex and intimidating. Getting a good understanding of the system will help injured workers better understand what they rights are and the compensation to which they are entitled.

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