California Laws

• Workers Compensation is mandatory for California employers. Employers can buy insurance from an independent company or from the State Compensation Insurance Fund (SCIF). [For more info on SCIF]

• If your employer is not insured, employee will get compensated from the Uninsured Employers Benefits Trust Fund (UEBTF). UEBTF will then attempt to recover the money from the uninsured employer. [For more info on UEBTF, link to website: ]

• If you have started receiving benefits for medical treatment, you have 5 years from the day of injury to officially file a claim. If you are not receiving benefits, you have one year to file the claim.

• If you are collecting benefits from a relative who died in a work-related injury, you have one year from the day of death to file the claim.

• The insurance company must respond to you within 14 days of receiving your claim. At that point, they will begin making payments, deny your claim, or they will let you know that your claim is under investigation. If under investigation, the insurance company has 90 days to make a decision. While doing so, you are entitled to receive medical treatment of up to $10,000.

• If you are denied compensation, there is an appeals process you may go through. You can file a Declaration of Readiness and turn it into WCAB, which will schedule a hearing for you. The judge will settle the dispute. If dispute cannot be settled at the hearing, a trial will be scheduled.

• In CA, workers compensation attorneys are paid on a contingency basis only. Meaning, they will get a percentage of the benefits you receive. The percentage is usually 12%-15%. The judge must approve of the fee.

 

Standard procedure after a work-related injury

1. If emergency, seek medical attention immediately from any treatment facility available to you.

2. If not emergency, notify employer as soon as possible. Your employer will let you know if you need to be seen by a doctor in their medical provider network (MPN), or by your predesignated personal physician. The insurance company is required to create a Medical Provider Network (MPN). This is a network, or group of doctors who are preauthorized to treat your injury. While you are required to select and treat with one of these pre-approved doctors, you are allowed to switch to a different doctor within the MPN if you are not satisfied with the care you are receiving.

3. While at the doctor, notify him that the injury is work related to ensure the doctor fills out proper paperwork.

4. File a claim by filling out Form DWC-1 and an Application for Adjudication of Claim. In California, you have one year from the date of injury to file the claim. Describe your injury completely. Include every part of your body affected by the injury. Give the form to your employer. This is called “filing” the claim form. Do this right away to avoid possible problems

5. If injury developed over time, report it as soon as possible so as not to lose benefits.

6. Contact IIHC. We will find you the best medical and rehab resources. The doctors at our facilities are certified in completing and correctly filing claims forms. We also offer free attorney referrals. These experienced lawyers can:

• Expediting workers comp claims through the system

• Assess if there is cause to file a case against a third party, such as the manufacturer of the machine you were working on when you got hurt

• Negotiate the best compensation and settlement for your injuries

 

Related Topics:

• California Employees Rights

• California Laws

• Benefits (Compensation)

• Predesignating a Physician

• Filing a Claim

• Resolving Disputes

• Workers’ Compensation Facts

• California Workers Comp FAQs