Workers’ Comp FAQ
Workers' compensation is a state-mandated insurance program designed to provide financial and medical benefits to employees who suffer work-related injuries or illnesses.
In California, most employers are required to carry workers' compensation insurance, which covers medical care, disability payments, job displacement benefits, and death benefits in the event of a workplace injury or illness.
Understanding the ins and outs of workers’ compensation in California can be challenging. You may have many questions, which is why my firm, The Law Office of Cezar J. Torrez, is here for you every step.
Who Is Eligible for Workers' Compensation?
Employees who suffer an injury or illness as a result of their employment are generally eligible for benefits. This includes full-time, part-time, and temporary employees. Coverage starts on your first day at work. Independent contractors are generally not covered under California workers' compensation laws.
How Do I File a Workers' Compensation Claim?
Report your injury: Inform your employer about your injury as soon as possible. Failing to report promptly can delay benefits or result in a denial.
Complete a DWC-1 Form: Your employer should provide you with a claim form (DWC-1). Fill out the "employee" section, describe your injury, and return it to your employer.
Seek medical treatment: Obtain treatment from a doctor approved by your employer's workers' compensation insurance plan. If you’re not satisfied, you can later change your treating physician.
Follow up: Keep track of your injury, treatment, and all communications with your employer and the insurance company.
What Benefits Are Available?
California workers’ compensation offers several types of benefits:
Medical care: Covers costs related to your injury, like doctor visits, hospital stays, medication, surgery, and physical therapy.
Temporary disability: Provides wage replacement if your injury prevents you from working temporarily.
Permanent disability: Compensates for long-term or permanent injuries that affect your ability to work.
Job displacement benefits: Offers vouchers for retraining if you cannot return to your previous job.
Death benefits: Provides compensation to dependents in the event of a work-related death.
What If My Claim Is Denied?
If your claim is denied, do not lose hope. You have the right to:
Review the denial letter: Understand why your claim was denied and gather additional evidence if necessary.
File an appeal: Appeal the decision through the Workers’ Compensation Appeals Board (WCAB).
Seek legal counsel: A workers’ compensation lawyer can help you navigate the appeals process and improve your chances of obtaining benefits.
How Long Do I Have to Report My Injury?
In general, you should report your injury to your employer within 30 days. However, you have up to one year to formally file a workers' compensation claim with the state. There are exceptions, such as if your injury is cumulative or if your employer failed to provide appropriate claim forms.
Can I Be Fired for Filing a Workers' Compensation Claim?
No, it is illegal for an employer to retaliate against you for filing a workers' compensation claim. If you believe you have been wrongfully terminated or discriminated against for pursuing your rights, you may have legal recourse.
What Is a Qualified Medical Evaluator (QME)?
A Qualified Medical Evaluator (QME) is a physician who evaluates injured workers to resolve disputes about their medical condition or treatment. If there is a disagreement about the nature or extent of your injury, either you or the insurance company can request an evaluation by a QME.
How Long Will My Benefits Last?
The duration of workers' compensation benefits varies:
Temporary disability: Typically lasts until you reach maximum medical improvement or return to work, up to 104 weeks within five years of the injury.
Permanent disability: Duration depends on the extent of your impairment, age, occupation, and future earning capacity.
Medical benefits: Continues as long as necessary for your injury.
Can I Choose My Own Doctor for Treatment?
Initially, your employer has the right to select the doctor that treats you for your work-related injury. However, after 30 days from the date the injury was reported, you are allowed to switch to a doctor of your own choice within the employer’s medical network. If your employer does not have a medical provider network or a Health Care Organization (HCO), you can choose your own doctor after the first visit.
What Happens If My Employer Does Not Have Workers' Compensation Insurance?
It is illegal for employers in California to not carry workers' compensation insurance. If they fail to have it, injured workers can file a claim with the state's Uninsured Employers Benefits Trust Fund (UEBTF). This will ensure they still receive medical treatment and benefits. As a result, the employer may face criminal charges and substantial fines.
Are Psychiatric Injuries Covered?
Yes, psychiatric injuries are covered under California workers' compensation, but they must meet specific criteria. The injured worker must demonstrate that the psychiatric injury was predominantly caused by the employment.
Furthermore, the worker should have been employed for at least six months unless the injury was a result of a sudden and extraordinary event.
How Are Permanent Disability Ratings Determined?
Permanent disability ratings are determined based on a standardized guide, the American Medical Association’s Guides to the Evaluation of Permanent Impairment, combined with other factors such as age, occupation, and future earning capacity.
After reaching maximum medical improvement (MMI), a doctor evaluates the injury and gives it a percentage rating, which determines the amount and duration of benefits.
What Is an Independent Medical Review (IMR)?
If there is a dispute over the medical treatment being provided, you can apply for an Independent Medical Review (IMR). The IMR process involves an independent review organization assessing the necessity of the recommended medical treatment based on medical standards.
This review can provide a binding decision, ensuring that only appropriate and necessary treatments are delivered.
What Should I Do If I Am Offered a Lump Sum Settlement?
A lump-sum settlement, also known as a Compromise and Release (C&R), closes your workers' compensation case for a one-time payment. Before accepting any lump-sum settlement, it is crucial to consult with a workers' compensation attorney.
They can help you understand the full implications, including whether the offer adequately covers your current and future medical needs, as well as wage loss.
Trusted Legal Guidance
The workers' compensation system can be complex, but understanding your rights and the process makes it easier. If you have any questions or need assistance with your claim, please reach out to my firm, The Law Office of Cezar J. Torrez. Contact me today for a free consultation and let us help you get the benefits you're entitled to under California law.