What Forms Do I Need for My Workers' Compensation Claim in California?

For California workers who sustain injuries or develop an illness because of their job, state worker compensation laws provide certain benefits to recover financial losses they may have suffered. Eligible employees may receive medical care and income replacement compensation from their employers while unable to work. To receive these benefits, though, one must complete several steps, including:

• Notifying their employer, they got injured on the job
• File a claim form with the employer, and,
• Filing an Application for Adjudication of Claim with California's Workers' Compensation Appeals Board (WCAB)

There are also deadlines to meet for each of these requirements, and missing them could mean losing your workers' compensation eligibility for your injuries. 

Filing the Right CA Workers's Compensation Forms on Time 

The clock starts running from the moment you get hurt at work, found out you had an injury from your job or should have reasonably known you were injured or sick because of your employment. The last condition is challenging since some occupational illnesses and injuries happen over time, like carpal tunnel, for example. 

According to state law, your deadline to report your injury and file a claim begins when:

• First day you missed work or were medically assessed for an injury, and,
• You know or reasonably should know that your job caused your injuries

Reporting a California Work Injury

Your first course of action after being injured at work is to seek medical care right away. It doesn't matter where you go in emergency situations, but you usually are required by California workers' comp laws to visit a medical provider on your company's preferred network. At your doctor's appointment, make sure to tell your physician that the injury or illness they are treating you for is work-related. 

You are also required to report your injuries within 30 days of receiving it or getting diagnosed, or you risk your eligibility for workmans' comp benefits. There is an exception to this rule: if your employer or supervisor knew about your injury already. However, it's probably wise to officially notify your company in writing anyway to avoid disputing this fact. 

Using CA Workers' Comp Form DWC-1 to File Your Claim

Within a day of telling your boss you were hurt at work, they should give you a Form DWC-1 to file a claim. You should also receive additional information about your rights and any other benefits you might qualify for while injured. Of course, if they don't have one available, you can always download it at the California Division of Workers' Compensation website.

This form must be filled out completely and thoroughly, so make sure to follow the instructions carefully when filling out your document section. For many injured employees, this can be difficult to complete because you may not know the full extent of your injuries yet. Because you have 30 days to file your work injury claim, consider speaking with a skilled workmans' comp attorney first to ensure you don't miss any information.

Once you've successfully filled out your part of the form, give it to your employer to fill out the remaining sections. They should then submit it to their insurer and provide you a copy of the completed document as required by law. 

Using Medical Benefits While Awaiting a Workers' Comp Claim Decision in CA

After your filing, you should continue receiving treatment while the insurer investigates the claim. Currently, the insurance company has to pay up to $10,000 in medical costs on your behalf during this time. If, after 90 days, you don't receive a claim denial, it's generally recognized that your claim has been approved. This means visiting a doctor in their specified provider network in their workers' comp insurance policy. 

Additionally, suppose you have already missed work because of your occupational illness or sustained injuries. In that case, the insurer should start temporary disability payments within 14 days of receiving your filed claim and your inability to work. Should they fail to do so, ask you for my details regarding your claim, or deny it outright, a late penalty will be accrued. This is usually an extra 10% on top of your normal temporary disability benefit rate. 

CA Workers' Compensation Form for Disputed Claims

If you've been receiving temporary disability benefits from your employer's workers' comp insurer, you may be thinking that your claim was approved. If you only suffered minor injuries, this could be the case, but be prepared for a dispute to show up at any time. Unfortunately, they aren't that uncommon since insurance companies are all about saving money on payouts, even for minor incidents. 

When an insurer denies your claim, you will need to open a case with the Workers' Compensation Appeals Board. To do this, you need to file an Application for Adjudication of Claim (Form WCAB-1), which you can download on the DWC's website. 

You have one year after one of these milestones in your case to file this document with the Board:

• Date of injury, or,
• Last day you received medical benefits from your employer, or,
• Date your temporary disability benefits stopped 

As mentioned earlier, California courts recognize that injured workers may need longer time to file this form in certain situations. For example, this usually applies to instances where employers and their insurers paid medical costs in advance, knowing these payments were for a potential workman's compensation claim. In these instances, a worker has five years to file this application instead. Otherwise, one only has a year. 

CA Workers' Compensation Forms for Death Benefits

Some workplace injuries and illnesses are so grave that the employee dies, leaving their surviving family members to struggle with the damages caused. If you are in this tragic situation, it's possible to seek death benefits if you were a dependent of the deceased. State law gives you a year from the date of their death to submit an application for adjudication, as well. 

Bear in mind that the determination of your dependency will be based on your relationship and needs at the time they were injured, not when they passed. This makes it especially important to speak with a knowledgeable CA workers' compensation attorney about the specifics of your case. 

Currently, any death benefit payments you receive will be based on the same rate as the temporary disability your loved one received before dying. That amount is typically two-thirds of the average weekly income they earned before getting hurt at work. Additionally, any temporary or permanent disability payments your family member had received stop upon death and have no bearing on the death benefit you might receive.