What Is the Workers’ Compensation Process in California?

More than 100 years have passed since the first workers’ compensation program became law. Much has changed since then, which means you might feel lost among all the formal legal jargon.

Let’s break down the California case process for workers’ compensation by reviewing nine interesting facts. The data from the following list comes from the California Department of Industrial Relations (DIR).

•       California has required employers to carry workers’ compensation insurance since 1913
•       Labor Code Section 3700 requires employers to purchase workers’ compensation insurance
•       Full-time and part-time employees are eligible for coverage
•       California’s workers’ comp program represents the largest insurance system in the world 
•       A no-fault system requires employers to pay regardless of which party was at fault
•       Every employee must receive a workers’ compensation brochure at the time of hire
•       Slips and falls are the most common workplace accident in the Golden State
•       Repetitive stress injuries rank second on the list of most common workplace injuries in California
•       The Division of Workers’ Compensation oversees the largest workers’ comp educational conference in the country

For every step of the California case process for workers’ compensation, the deadlines for taking action begin on the date of your workplace injury. Determining the date of an injury that was caused by an accident is easy to do. There should be an incident report submitted by your manager that includes the date of the workplace accident. However, the deadline for filing a claim for a cumulative trauma injury is not as easy to determine.

A cumulative trauma injury is an injury that does not immediately display symptoms. Two examples of a cumulative trauma injury include an occupational disease and a repetitive stress injury. The deadline for filing a claim for a cumulative trauma injury starts on the first day that you missed work because of the injury. State law also allows you to start the deadline clock for a cumulative trauma injury on the date when your physician diagnosed the symptoms.

Consulting with a California workers’ compensation lawyer can help you decide which of the deadlines you should use for a cumulative trauma injury case.

The first step of the California case process for workers’ compensation involves reporting your workplace injury. Any injury that you suffer on the job should be looked at by a healthcare provider. If you suffer a serious injury at work, you can go to any emergency care center. Less serious injuries require you to visit with a doctor in your company’s healthcare provider network.

You should report your injury or injuries as soon as possible after an accident or when you discover that you suffer from a cumulative trauma injury. California law gives you 30 days to submit a written notice to your employer that describes your injuries, as well as the incident that caused them. However, if your employer knows about the incident that caused your injuries, you might not have to submit a written notice.

A workers’ compensation attorney can guide you through the first step of the California case process for workers’ compensation.

Your employer should provide you with a workers’ compensation claim form (DWC-1) within one working day after you submit a written notice informing your employer about your work-related injuries. With Form DWC-1, you should also receive information that describes your rights and possible qualification for financial assistance. Your employer is not legally obligated to give you Form DWC-1. If you do not receive it within one working day, download it from the California Workers’ Compensation (DWC) website.

Follow the detailed instructions printed on Form DWC-1, and then complete the employee section of the claim form. After completing Form DWC-1, give it to your employer or send it by first-class or certified mail. Your employer completes the remaining section and then submits the claim form to its insurance company. Make sure you get a copy of the completed Form DWC-1.

If you experience a delay in the California case process for workers’ compensation, it might occur after the company’s insurer receives Form DWC-1. Your employer’s insurance company must authorize payment while it investigates your claim. Until the insurance company makes a decision, the insurer is obligated to cover up to $10,000 in medical expenses. This is an especially helpful clause written into the California workers’ compensation program.

If the insurance company does not make a decision within 90 days of receiving your claim, state law considers the claim automatically approved. However, your employer’s insurance company has less time to rule on a claim that involves COVID-19. If work-related injuries forced you off the job, your employer should start paying temporary disability benefits no later than 14 days after learning about your injuries.

You submitted Form DWC-1, along with persuasive medical evidence and witness accounts of how you developed your work-related injuries. Everything appears to be in order, that is until your employer’s insurance company disputes part, most, or all of your workers’ comp claim.

Now, you have to file an appeal to get the compensation you deserve for suffering workplace injuries.

The California case process for workers’ compensation includes an appeal step. To initiate the appeal process, you complete and submit an Application for Adjudication of Claim (Form WCAB-1). You typically have up to one year to submit an Application for Adjudication of Claim, but once again, the sooner you submit your appeal, the faster you should resolve the dispute with your employer’s insurance company.

The one-year deadline starts on the date of your injuries, the last date your employer provided medical benefits, or the day when your temporary disability benefits ended.

Here’s the catch for filing Form WCAB-1. California courts have ruled that an injured employee does not have to file Form WCAB-1 if the employee received an advanced payment to cover medical bills and lost wages. Speak with an experienced California workers’ compensation to learn more about submitting an Application for Adjudication of Claim.

Understanding the California case process for workers’ compensation often involves understanding the difference between an employee and an independent contractor. This distinction is especially important in the Golden State because of the booming high-tech-driven state economy. From Silicon Valley to La Jolla, a large percentage of high-tech workers operate as independent contractors, moving from project-to-project often from the comfort of home.

The California workers’ comp system assumes you are an employee. To demonstrate your employment status, the state reviews several factors. The most influential factor is whether your employer has full control over you when it comes to designating work assignments. Even if you possess a legal agreement that states you are an independent contractor, that does not mean the agreement is correct.

You can still file a claim for workers’ compensation, but you should do it with the help of a workers’ comp lawyer from Morgan & Morgan.

If your employer terminates you before you have the opportunity to file a workers’ compensation claim in California, you can still file a claim if you meet any of the following conditions.

•       Your employer received a written notice that described your injuries before you were fired or laid off
•       You suffered the injuries after your employer fired or laid you off but before your last day at work
•       Medical records confirm you suffered your injury before the layoff or termination
•       You suffer from a cumulative trauma injury that developed symptoms over time

Psychiatric issues follow a different set of standards. You must demonstrate you suffered from some form of harassment and your employer knew about your psychiatric injuries before layoff or termination. You also have to submit medical documentation that confirms your diagnosis.

Remember the California case process for workers’ compensation does not allow your employer to fire you or lay you off as a form of retaliation for you filing a claim. If you believe your employer retaliated against you, contact Morgan & Morgan to determine the best course of legal action. We have an experienced team of employment lawyers to handle a case of employer retaliation.

Waiting to file a workers’ compensation claim can push you dangerously close to one or more deadlines. By hiring the team of highly-rated workers compensation lawyers at Morgan & Morgan, you never have to worry about filing a late claim or filing a claim that contains inaccurate information. We relieve you of the stress generated by having to deal with your employer’s insurance company. You can expect us to help you gather and organize persuasive medical evidence as well.

This is not about proving fault; it is about you receiving just compensation for suffering from one or more injuries at work. Schedule a free case evaluation today with Morgan & Morgan.