A guide to compensation claims and benefits for California workers

Did you get a work-related injury or illness? Under California state law, you can file a claim to get the appropriate medical treatment, all paid for by your employer.

An introduction to workers’ compensation

Workers’ compensation is a kind of insurance purchased by employers. Its effects are two-fold. One, it gives financial and medical aid to workers in case of work-related injuries and illnesses. Two, it protects employers from lawsuits that may arise from such incidences.

Who is qualified for workers’ compensation?

Generally, it covers everyone, including contractual employees and apprentices. As long as you are working for an employer, legally or illegally, bound by oral or written contract, you are considered an employee.

Check the California Labor Code to read more about the state’s definition of “employee.”

Benefits under workers’ compensation insurance

With workers’ compensation insurance comes a bevy of benefits. In case of a work-related injury or illness, you can file a claim for any of the following:

Medical care

Do you need medical care to treat your work-related injury or illness? This will pay for all necessary medical treatment, including related services, travel to and from doctor visits, and paraphernalia.

Injuries and illnesses are usually treated by a medical provider network. If your employer has yet to contract a medical provider network 30 days after you reported your injury or illness, you can seek treatment from a physician or medical facility of your choice.

Temporary and permanent disability payments

If your work-related injury or illness results in temporary or permanent disability, your employer is required by law to give you temporary or permanent disability payments. This benefit will cover for the wages you’ve lost during your recovery.

Temporary disability payments are usually two-thirds of your average weekly wage. This benefit is only valid for 104 weeks within a five-year-period after you got your injury or illness.

Meanwhile, the amount you’ll get for permanent disability is based on its severity which can be rated from 0 to 100.

The gravity of your permanent disability also affects the period of time you’ll be receiving the payments. For instance, if you are determined 100% disabled, you’ll get payments for the rest of your life. If the level of your disability is between 70 to 90%, you’ll get a life pension.

Job displacement benefits

If your injury or illness prevents you from returning to your work, you’re entitled to a voucher worth $6,000. This can be used to shoulder education-related retraining and/or skill enhancement costs, which must be taken at a California public school or with a certified provider.

You can also use the $6,000 voucher to pay for certification and examination fees, career-related services, and tools you need for your retraining or skill enhancement.

Death benefit

In case of death due to work-related injury or illness, unpaid or accrued compensation will be given to your dependents or personal representative.

Filing a California workers’ compensation claim

Reporting and submitting the DWC-1

The first thing you need to do is to report your injury or illness to your employer. If you fail to do so within a 30-day period, you might not be able to collect your benefits.

After seeking proper treatment, fill up the Division of Workers’ Compensation (DWC) Form 1. Commonly called DWC-1, you can get this from your employer or download it from the link above. Once fully accomplished, submit it to your employer so they can fill out their part. After that, they will forward the form to the relevant insurance provider.

Waiting for the insurer’s response

Upon receipt of the DWC-1, the insurance provider will investigate your claim, a process that usually takes 90 days.

While the investigation is ongoing, you can receive up to $10,000 from the insurer to foot your medical bills. If, within 90 days, you don’t receive a notification that your claim was denied, consider it approved.

Filing an Adjudication of Claim

In an ideal world, your work-related injury or illness (or your claim for workers’ compensation) won’t have any issues. Unfortunately, that isn’t always the case.

If you run into any disputes regarding your claim or realize your medical condition is more than meets the eye, you’ll need to file an Application for Adjudication of Claim.

It is best if you anticipate such events and file an application beforehand, just in case. You can file this within a year following the date of your injury, the last day you received your medical benefits from your employer, or the last day you received temporary disability payments.

What if you miss any of the deadlines?

If you miss any of the deadlines, don’t hesitate to contact a lawyer specializing in workers’ compensation in California.

Hogue & Belong’s attorneys at law are uniquely positioned to help you settle issues about your workers’ compensation claims in California.

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