One of your rights as an employee in California is the entitlement to workers’ compensation benefits. You can only recover these benefits when a work-related accident exposes you to an injury or illness. Many clients in Orange County, CA have called us wanting to know more about workers’ compensation. In response, our lawyers at The Workers Compensation Attorney Group complied these questions and included them in this FAQ article.
How Does Workers’ Compensation in California Work?
You are entitled to workers’ compensation benefits if you have an occupational injury or illness. Your employer is supposed to pay these benefits through their workers’ compensation insurance company. You may have sustained the injury from hurting your spine in a fall or getting bruised by a machine. Work-related injuries and illnesses may also be caused by repeated exposure to unsafe working conditions.
The California workers’ compensation regulations mandate you (when injured) to report an injury to your employer. If the symptoms of the injury or sickness developed over time, you should report them once you believe that they are work-related. Sharing this information with your employer can help you avoid delays or problems in recovering the benefits. You may lose your right to compensation if you take more than 30 days to report an occupational injury or sickness.
Which Laws Govern the Workers’ Compensation System in California?
Division 4 of the California Labor Codes broadly highlights the key players, processes and legal requirements involved in workers’ compensation. Also known as the California workers’ compensation statute, this law covers topics such as conditions for compensation and insurance rights and privileges. Other topics covered include adjustment of claims, types of benefits, determination of medical issues and workers’ compensation misrepresentations.
The DWC (Division of Workers’ Compensation) is the primary state agency responsible for administering workers’ compensation claims in California. The DWC also offers judicial and administrative services to injured workers to help resolve disputes when pursuing workers’ compensation benefits. As a subsidiary of the Department of Industrial Relations, the DWC is on a mission to reduce the adverse effects of occupational injuries on workers and their employers.
What are Your Employer’s Responsibilities Under California’s Workers’ Compensation Laws?
Your employer must either register as a self-insured entity or company or obtain workers’ compensation coverage before any illness or injury occurs. The employer should also offer new employees a pamphlet outlining their rights and responsibilities on workers’ compensation. A workers’ compensation poster should also be posted in an open place at the workplace for every worker to see it.
The duties of your employer after a work-related injury or sickness are as follows:
- Offering you a claim form for workers compensation within one after reporting an occupational illness or injury
- Returning a copy of the completed form to you within a day of receiving it
- Forwarding the original claim form together with a report detailing the work-related sickness or injury to California’s claims administrator one day after receiving it
- Providing you transitional or light duty work when appropriate
- Informing you about the eligibility requirements for workers’ compensation if you were the victim in a work-related crime
Which Form Should You Fill Out When Recovering Workers’ Compensation Benefits?
As part of reporting a work-related injury or illness, you need to fill out form DWC 1 (a claim form) and submit it to your employer. You can download the claim form from the forms page of the Division of Workers’ Compensation (DWC) website or obtain it from your employer. Either way, the information filled in this form helps open your case and recover the benefits you need.
What Documents Can Help Your Workers’ Compensation Case?
Workers' compensation cases generally require plaintiffs to prove that they were injured while at the course of their job duties. Documents such as employment records, accident report, medical bills, and medical records can help support your case. You may present the employment records to prove your employment status with the employer. An accident report can help explain your efforts to report the work-related accident as soon as it occurred.
You can present medical bills as proof of the amount of money spent on seeking medical treatment. Medical records, on the other hand, can prove your injury or sickness was attributed to a work-related accident. Your lawyer can rely on them to argue the severity of your injuries, treatments sought and outcomes of the treatments.
Can You Rely on Statements from Expert Witnesses to Support Your Case?
During your workers' compensation hearing, your lawyer may introduce witnesses including expert witnesses to testify in your favor. The testimonies need to be persuasive enough for the insurance adjuster to allow any negotiations on your benefits. The various witnesses you may need include economic experts, co-workers, occupational experts, mental health professionals, and medical experts. You may rely on testimonies from your treating doctor and a physical therapist to count as an expert medical testimony.
A mental health professional may be introduced as an expert witness if the occupational injury resulted in mental illness. Consequently, an occupational expert may explain how your condition limits you from performing various types of work. You may need an economic expert to carry a valuation on your lost wages and a co-worker to share with the court the events that lead to your accident.
Is it Manditory for Employers to Have Workers’ Compensation Coverage?
Since you have a right to recover workers' compensation benefits when hurt at work, your employer should have an insurance policy to facilitate the recovery of these benefits. Employers need to obtain a policy from a state licensed insurance company. You can find out more information about workers' compensation coverage for specific employers from the California workers’ compensation insurance website. Details about self-insured employers in California is available on the website for Self Insurance Plans.
How Can You be Compensated for a Work-related Injury or Illness if Your Employer is Uninsured?
Your employer may be subjected to criminal penalties for failing to obtain workers’ compensation insurance. The entity or individual is supposed to pay all bills incurred from treating, copping or recovering from your illness or injury. You will not recover workers’ compensation benefits because of your employer’s lack of coverage. However, you can sue the company or individual to recover any losses you incurred.
Besides suing your employer, you can pursue a claim for benefits with the California Uninsured Employers' Benefit Trust Fund (UEBTF). The UEBTF is a DWC special unit aimed at paying benefits to employees who got hurt or sick while employed by an uninsured employer. Expect the UEBTF to impose the costs of the damages on your employer. Means such as filing liens against your employer's property enable UEBTF to award you the benefits.
What is the Difference Between an Employee and an Independent Contractor in Workers’ Comp?
Workers’ compensation benefits in California only target employees whose employers have workers’ compensation insurance. Independent contractors cannot recover any benefits when they sustain injuries or illnesses from a work-related accident. Your employer may have misclassified you as an independent contractor to prevent you from recovering any damages.
Unlike an employee, an independent contractor can control how a job is done. Control, in this case, may entail determining the materials used in a project and setting a timeline for handling a project. You may not qualify as an independent contractor rather than an employee is the company paying you does any of the following actions:
- Having the right to hire you or terminate your contract
- Controlling the manner or details of your work
- Paying you an hourly salary or wage
- Making social security or unemployment deductions
- Requiring you to work on specific hours or days
- Supplying tools or materials for a job
What Types of Workers’ Compensation Benefits are You Entitled to Receive?
Workers compensation insurance offers five kinds of benefits. They include medical care, permanent disability benefits, and temporary disability benefits. Others include supplemental job displacement benefits and death benefits. Your employer should pay for the medical care to help your recovery from an occupational illness or injury.
You may be awarded permanent disability benefits if you cannot completely recover. Temporary disability benefits are payments made to compensate you for temporary disability caused by the injury. If your condition persists and you do not get back to work, you may recover supplemental job displacement benefits. Death benefits are paid to the spouse, children or dependents of an individual who succumbed to a job illness or injury.
How Do Temporary Disability Benefits Differ from Permanent Disability Benefits?
You are entitled to temporary disability benefits if a work-related injury or illness prevents you from resuming your work while recovering. TD benefits are usually proportional to two-thirds of the gross wages (before tax) you were receiving. You will be awarded the wages based on the income you used to earn from work. Income streams may include commissions, bonuses, overtime, wages, tips, lodging or food allowances.
Permanent disability benefits help employees who experience medical problems after recovering from occupational injuries. Since PD benefits have limitations, you may not recover lost wages through them if you lost income. A medical examination report will help determine whether your illness or injury caused temporary disability or permanent disability. Factors such as your gross income (before getting injured), date of the injury and your disability rating determine the PD payments.
What Type of Medical Care is Offered for a Work-related Illness or Injury?
The workers’ compensation system used in California allows doctors to be the primary medical care provider for injury victims. The duty of the doctors is to offer you evidence-based medical treatments. For this type of treatment, expect them to administer scientifically proven treatments for curing or relieving occupational injuries and illnesses. Each treatment you receive is administered in a specific frequency, intensity, and duration.
California has a medical treatment utilization schedule (MTUS) in place to foster compliance with evidence-based medical care. The MTUS outlines guidelines for treating chronic pain, administering acupuncture, and post-surgical therapeutic procedures. The DWC has a special committee mandates to evaluate the emerging medical evidence regarding these treatments before adopting it into use.
Are There Any Limits to the Types of Treatment You Can Receive?
The California workers’ compensation system has several limitations to the kinds of treatment injury victims can seek. The treatments are limited to 24 visits to an occupational therapist, 24 visits to a physical therapist and 24 visits to a chiropractor. You may be entitled to more visits to a medical practitioner if the claims administrator authorizes the treatment. The same applies if you recently underwent surgery and you require post-surgical medicine.
You have the right to seek treatment for a work-related sickness or injury on a short-term or long-term basis provided it is medically necessary. Your doctor must give evidence showing that a particular treatment is effective and necessary if it is not included in the MTUS (medical treatment utilization schedule). The claims administrator may also hire a third-party expert to review any additional treatment plan.
Who Decides the Kind of Work to do While Recovering from an Occupational Injury or Illness?
Unless authorized by your treating doctor, you have to wait until you fully recover to go back to work. The treating doctor will write a medical report authorizing you to take on light duty work while recovering. Expect the report to highlight the type of work you are limited to do while recovering. The report will also explain the changes required in your previous work assignments or schedule to cope with your condition.
You should involve your lawyer when discussing the changes required in your job with the employer and treating doctor. With legal assistance, it is possible to convince your employer for reduced working hours or schedule. Your attorney can inform the claims administrator about any disagreements you have with the treating doctor regarding when you can return to work.
What if Your Employer Offers You Work While Recovering?
Your employer may ask you to return to work during the duration of your recovery. You should only accept the job offer it if is included in the list of restrictions drafted by your treating doctor. The offer may require you to take on regular work, modified work or alternative work. Alternative work can be a new job opportunity offered by your existing employer.
The phrase “regular work,” in this context, refers to the job you were handling at least 12 months before getting injured at work. Expect this job to pay the same benefits and wages you recently earned as compared to modified work, which has various restrictions. Your employer may offer you modified work for you to earn while recovering instead of having to pay you supplemental job displacement benefits.
Once authorized to resume work, you can take on alternative or modified work. You will only have a 30-day period to accept the work or have the employer withdraw it. You may no longer receive supplemental job displacement benefits if you refuse to respond or reject alternative or modified work in the 30-day period.
What Happens If the Claims Administrator Denies or Takes Time to Accept Your Claim?
The claims administrator must approve you to begin medical treatment one day after filing the claim form even when your case is pending. Just like any other patient, injured employees need urgent medical attention to prevent their conditions from worsening. You are entitled to receive up to $10,000 while your workers' compensation claim is under investigation. Talk to the claims or your supervisor regarding your emergency if you have not been authorized to seek treatment right away.
What Other Benefits Can You Recover Outside the Workers’ Compensation System?
You have the freedom to recover other benefits outside the workers’ compensation system. The benefits may include payments from third-party entities if someone other than the employer caused your injury. You can also recover benefits such as salary continuation plans, long-term disability benefits, group health insurance and sick leave, which are offered by unions and employers.
Your injury or illness may entitle you to receive benefits paid by the federal or state governments. The benefits include Social Security Disability Insurance (SSDI), unemployment insurance and State Disability Insurance payments. State Disability Insurance offers short-term payments to eligible workers when they need time off work. The Unemployment Insurance program targets eligible workers who lost their work while SSDI compensates individuals who cannot work for up to one year due to a medical condition.
What is the Difference Between FMLA and Workers’ Compensation?
The FMLA, which stands for Family and Medical Leave Act, is a federal law requiring employers to allow their workers to access up to 12-weeks of unpaid leave in a one-year period. You may take the leave due to the birth of your child, the adoption of a new child or sudden illness affecting your immediate family member. You also have the right to seek treatment during the 12-week period for a severe health condition you are facing.
Unlike the FMLA leave (which is mandated at a federal level), workers' compensation is a state level program designed to help workers recover compensation for workplace injuries. You do not have to sustain a workplace injury to be eligible for an FMLA program, unlike the workers' compensation program. However, an FMLA program will require you to have worked at least 1,250 hours in the previous 12 months before going on leave.
Are Workers’ Compensation Benefits Taxed in California?
Permanent disability benefits and temporary disability benefits are tax-free in California. Your workers’ compensation benefits can only be taxed if you are a beneficiary of Social Security Disability Insurance. SSDI and workers’ compensation benefits should be less than 80 percent of your gross income before you got injured. If the payments exceed this range, an offset amount will be taken out of your SSDI benefits and taxed.
The supplemental security income earned while recovering from a work-related injury is usually taxed. You will not be required to report any workers’ compensation benefits earned in a tax returns form as income. Your duty to pay income tax will take effect once you return to work and start earning wages.
When Do You Need a Workers’ Compensation Attorney?
You may find it difficult to navigate the workers’ compensation system or make a claim for a work-related injury by yourself. One thing you should be focusing as an injury victim is medical treatment. Consider hiring a workers’ compensation lawyer to help you pursue the case and solve any disputes that arise. Here are various reasons to hire the lawyer:
- Your employer’s insurer denied your claim (because you filed it too late or your injury did not qualify as a work-related one
- You are receiving government benefits such as SSDI benefits (An attorney can help you have a small portion of the SSDI benefits reduced for the workers’ compensation ones to be sustainable)
- There are disputes regarding your permanent disability ratings (your lawyer can convince the insurance company that you deserve a higher rating by working closely with your treating doctor)
- You are experiencing trouble seeking quality treatment (Your attorney can ask the workers’ compensation insurer to approve your medical treatment in time)
- Your ability to work was temporarily or permanently affected (A lawyer can help you seek the highest award possible out of your workers’ compensation claim?
- You have a pre-existing injury or illness (Your attorney can help prove that the pre-existing condition is different from the work-related one)
- Your case needs to proceed to a workers’ compensation hearing, which takes the form of a mini-trial and requires legal representation
Have Your Claim Handled by an Experienced Workers’ Compensation Lawyer Near Me
The general information needed to familiarize yourself with the workers’ compensation program has been included in various parts of this article. You should consider working with an experienced law firm like ours, The Workers’ Compensation Attorney Group, if you have suffered a work-related injury. We pride ourselves for being among the leading workers’ compensation law firms in Orange County, CA. Speak to one of our representatives at 562-485-9694 stating your injury or illness and the type of legal help you are seeking.