All employers in California must purchase workers’ compensation insurance for their employees. Therefore, if you are in legal employment, you have coverage.
No-Fault, No Problem
The coverage you receive as part of the California Workers Compensation law is a no-fault system. In a no-fault system, you do not have to place the fault of the accident on another party to receive benefits and compensation. This is true whether the injury is temporary, disabling, or of a disease type nature.
Workers compensation claims do not require you to be represented by an attorney. However, your employer and its Insurance Company will most definitely be represented by a competent attorney. In the case of a dispute between you and your employer, it is best to seek the help of an attorney.
What to Do After a Work-Related Injury
- Seek medical attention
- Inform your employer in writing
- Fill out your claim form
- Consult an attorney
Californian law sets these time restrictions on workers compensation claims.
- 30 days to give written notice of work-related injury to the employer
- The employer must provide a claim form to the employee within 1 day of receiving notice of injury
- The employee has 1 year to file a claim
After submitting a claim form to your employer, the employer or insurance representative has one day to authorize the appropriate medical treatment. Medical treatment can run up to $10,000 during the time the insurance company takes to assess your claim. After 90 days without a response, the injury is presumed to be covered.
It is possible to appeal a claim and have your case heard by a judge. After notifying the relevant parties that you will be making a claim the following documents should be filed:
After filing the forms you will attend a mandatory settlement conference. If this is unsuccessful, you may also file a Petition for Reconsideration with the judge.
Assuming you have no difficulties filing your claim you can receive the following California Workers Compensation law benefits.
- All medical and hospital benefits are necessary to heal the effects of the injury
- Reimbursement for travel to and from the doctor’s office
Your employer has the right to select the doctor you see for the first 30 days of treatment but you also have the right to change doctors should you feel the need. Whenever an employer works with a Medical Provider Network, you will often receive your medical attention from those providers. Again, it is also within your rights to change medical practitioner should you decide to.
Any injury that results in three or more days off work, or hospitalization, qualifies you for temporary disability benefits. This amounts to two- thirds of your average weekly earnings. There is a maximum limit to the rate which will depend on the type of injury you have.
An accident that results in permanent impairment or disability makes you eligible for permanent disability. The level of your permanent disability is based on your disability, age, and occupation. If the court considers you to be 100% disabled, you will have temporary disability payments for the rest of your life. As the percentage decreases so do the levels of benefit.
Vocational Rehabilitation or Training
If you are required to change employment as a result of your injury It is possible to obtain a “Supplemental Job Displacement Benefit”. This is used for acquiring a new skill-set in another field for employment purposes. The amount you receive will depend on your disability.
10% of the voucher can be used to pay for a counsellor who will help you find appropriate training.
Return to Work Fund
Anyone eligible for the Supplemental Job Displacement Benefit is also eligible for another special State of California fund. The fund provides extra assistance to workers who cannot return to their original job as a result of their injuries.
Dependents may be entitled Death Benefits if the death of their guardian/spouse was related to employment. The death must only have been a result of the work and does not have to have occurred in the workplace.
If an original work-related injury creates additional problems later down the line, you may be entitled to benefits for these following “compensable consequences”. For example, if you injured your leg in an industrial accident and this leg injury causes you to injure you back at a later date, your back injury is a “compensable consequence”.
Additional benefits and penalties
There are several instances in which you can claim penalties or additional benefits from an employer:
- Your employer discriminates against you because you were injured or filed a claim
- They committed serious and willful acts which endangered the safety of their employees
- They failed to have Workers Compensation Insurance.
unreasonable delay of benefit payments will also leave your employer liable to penalties. Such as a penalty of 10% for failure to pay benefits on time
Fees and Costs
You will not pay any money out of pocket, either to the attorney or anyone else. There are no filing fees in a Workers’ Compensation case. The Workers Compensation Judge sets the attorneys fees, which come out of your award. The general fee is 15% of your award.
Workers’ Compensation is a complex field of law, this guide is to help you understand the general contours of it.
For an in-depth explanation of how the law works concerning specific injuries, you should seek the advice of an attorney.
Please visit California.LAW’s list of recommended lawyers to find a compensation lawyer in your area.