What Every Employee Should Know Before Filing for Workers’ Compensation in California
Suffering an injury or illness related to your job can feel overwhelming and distressing. As you focus on your recovery, it’s important to understand the steps you must follow and the requirements you need to meet when filing a Workers’ Compensation claim. This article explains the specifics of filing a Workers’ Compensation claim in California.
What is Workers’ Compensation Insurance?
Workers’ Compensation is a mandatory insurance program for most companies that provides care and compensation to employees who suffer a work-related illness or injury.
Workers’ Compensation is a “no-fault” system, meaning it does not matter who was at fault — even if it was the injured employee — to receive benefits.
In California, Workers’ Compensation claims are adjudicated in their own special court, the Workers’ Compensation Appeals Board (WCAB), which is a state-level administrative law court that only handles Workers’ Compensation claims.
Injured workers in California who wish to file a Workers’ Compensation claim must submit an Application for Adjudication to the Workers’ Compensation Appeals Board, rather than filing a civil claim for employer negligence in Superior Court.
However, there are some limited circumstances where an injured worker may file both types of claims (a Workers’ Compensation claim and a civil law claim for negligence), like when a negligent third party caused the injury, such as a motor vehicle accident where a third party’s negligence was the cause.
Report the Injury
Timeliness is crucial when it comes to Workers’ Compensation claims. You should report your injury to your supervisor and/or Human Resources as soon as possible.
- You have 30 days from the date of injury to report the incident to your employer, and one year from the date of injury to file an Application for Adjudication of claim with the Workers’ Compensation Appeals Board. While there are some exceptions to these deadlines, meeting this deadline is key to securing benefits.
- Failing to report the injury within 30 days, or failing to file the Application for Adjudication with the court to open your claim could result in losing your right to receive Workers’ Compensation benefits.
Typically, the best course of action would be to report the injury to the employer within 30 days of the date of injury, and then hire an attorney, who will then file the Application for Adjudication with the court.
Seek Medical Treatment
It is important to seek medical treatment when you become injured. This means not only initial treatment, but follow-up appointments and following your medical professional’s treatment plan. The employer is required to provide medical treatment within 24 hours once an industrial injury has been reported. However, if the employer fails to provide medical treatment as required, it is still very important to seek medical treatment through any available means. This ensures you receive necessary medical attention and that the provider’s medical records document your industrial injury.
Deadlines
As stated above, you have 30 days from the date of your work-related injury to report it to your employer, and you have one year from the date of your injury to file an Application for Adjudication with the Workers’ Compensation Appeals Board, to open your claim with the court, in the state of California.
Complete DWC-1 form
In the state of California, claimants are required to complete and submit a DWC-1 form. This step is crucial in initiating your claim and getting it filed with the state. After reporting your injury to your employer, they have one business day to give you or mail you this form. You have up to one year to file your claim; however, the longer you wait, the longer it may take to receive your benefits.
Records
Obtaining medical records in relation to your injury is imperative to filing for Workers’ Compensation in California. Without proper documentation, there is no record to corroborate the claim of injury, which could allow the employer to deny the injury ever happened and make it difficult for the court to find an industrial injury occurred. That is why it’s so important to report the claim to the employer in a timely manner and seek medical treatment, whether the medical treatment is provided by the employer or sought privately through health insurance or paid for out of pocket. Be sure to ask your doctor or medical provider for detailed records about your injury and to get a copy of the incident report from your employer.
Understand Your Rights
Review California’s Workers’ Compensation laws and rights by visiting the state of California’s Department of Industrial Relations website. It is important to have knowledge of what you are eligible for and what your rights are when applying for a claim.
If you get injured while working, your employer is responsible for covering your medical expenses, regardless of whether you take time off.
Specific Incident vs Cumulative Trauma
Specific Incident injuries are those that occur due to a particular event while performing job duties, arise out of employment, or are caused by employment. For example, an employee is on a ladder in a warehouse at work and falls off hitting their head. These types of injuries typically happen due to an accident that occurs while the client is carrying out their work responsibilities.
Cumulative Trauma injuries are conditions that develop gradually over time due to repetitive job duties, or repetitive exposure to conditions arising out of or caused by employment. For example, an individual might develop Noise-Induced Hearing Loss (NIHL), along with symptoms such as tinnitus and dizziness, after working for five years on a construction site regularly exposed to equipment like jackhammers, power saws, or air compressors. Another example is a data entry clerk who types on a keyboard for hours on end and eventually develops carpal tunnel or cubital tunnel syndrome in the elbows, wrists, or hands. In some cases, a specific incident may also worsen these injuries.
Filing for Workers’ Compensation for cumulative trauma injuries can be more complex, as these injuries develop gradually, making it difficult to pinpoint a specific date of occurrence. The legal presumption for the date of injury on a cumulative trauma is the last year of exposure, so the year immediately preceding the last day of actual physical work. As soon as you become aware that your injury is work-related, notify your employer. Additionally, seek medical treatment, gather medical records that document the injury as job-related, and begin the process of filing a Workers’ Compensation claim.
Know Your Options
Getting hurt on the job is a stressful experience. You may wonder how to survive financially while your ability to work suffers. There are several other potential benefit options you will want to investigate in addition to Workers’ Compensation.
EDD State Disability Insurance
In California, the Employment Development Department (EDD) offers State Disability Insurance (SDI) benefits that provide short-term wage replacement to people who need to take time off work due to illness or injury, pregnancy, childbirth, surgery, or alcohol or drug rehabilitation. EDD SDI benefits are only available for employees who pay into the EDD system and differ from EDD unemployment benefits. So, if you suffer an injury at work and your employer fails to provide temporary disability payments or initially denies liability, the state will pay SDI benefits for up to one year, as long as a doctor certifies your medical condition.
Long- and Short-Term Disability
If you are unable to perform your essential job duties because of an injury, contact your company’s Human Resources Department to find out if your employer offers long- or short-term disability insurance. This type of insurance is different from other policies your company may provide. Unlike medical insurance, long- or short-term disability insurance is a private benefit that many companies offer to employees who need to take a leave of absence due to illness or injury. Most policies provide 60–80% of an employee’s salary for a period of time, usually between 1-12 months for short- term and 1-3 years for long-term. Although it is important to keep in mind that the stipulations for long- and short- term disability insurance programs vary greatly by case and company.
Social Security Disability Insurance (SSDI)
SSDI is reserved for individuals who will be unable to work due to a disability for at least 12 months or whose condition is likely to result in death. The Social Security Administration regulates SSDI claims and payments and has strict guidelines for receiving benefits. If you have received a diagnosis that will prevent you from working for this amount of time, you can visit the SSA’s website to begin filing a claim. Keep in mind that the waiting period for SSDI application approval can take months, and sometimes years. If you have other options available, be sure to explore and apply for those as well.
If you are eligible for both WC and SSDI benefits, you are allowed to receive benefits from both programs. To learn more about how these programs interact, check out our blog post about filing for both programs simultaneously.
Guidelines
It’s important to note that the total amount you receive from Workers’ Compensation, long- and short-term disability, and SSDI may affect each other. In some cases, agencies may reduce one benefit by taking credit for the payments made by another.
As a general rule, an employee cannot receive more money from these various benefits than they made while working. Some long-term and short-term disability policies may also require you to repay benefits if you later receive Workers’ Compensation or SSDI awards. To protect your rights and maximize your benefits, you should file for Workers’ Compensation and SSDI with the help of an experienced attorney. A skilled attorney can structure your settlement properly, so you receive the full benefits the law grants you.
Hire an Attorney
Navigating the Workers’ Compensation claims process can be incredibly complex and time-consuming, as there are numerous regulations, laws, and deadlines that apply to many different aspects of the claim, from getting medical treatment, to obtaining the special medical legal reports from the doctors in the Workers’ Compensation claim that then becomes the evidence needed at trial for a judge to issue a Finding & Award of Permanent Disability and / or other Workers’ Compensation benefits via settlement or trial.
You should strongly consider hiring an attorney who specializes in Workers’ Compensation law when filing a claim. Despite what they may say, the employer and insurance company do not have injured workers’ best interests at heart and often take advantage of their lack of knowledge to block access to the full benefits the law provides. An experienced attorney will handle the entire claim for you, including handling all the necessary paperwork, setting up medical treatment, advocating on your behalf with the doctors, and guide you through every step of the claims process.
Attorney Fee
Workers’ Compensation attorneys work on a contingency fee basis, meaning the attorney receives a specific percentage of the total benefits they recover for the injured worker. The Workers’ Compensation court must approve attorney fees, and the insurance company pays these fees directly to the attorney, so the injured worker and attorney never exchange money directly. Also, a consultation for potential representation by an attorney in a Workers’ Compensation claim should be free. So, if any attorney charges a fee for a consultation, you should immediately cease communications with that attorney and find another attorney who specializes in Workers’ Compensation that may be able to help.
Workers’ Compensation Checklist
- Report the injury
- Seek medical treatment
- Adhere to strict deadlines
- Complete the DWC-1 form
- Obtain medical records
- Understand your rights
- Explore benefits options
- Consider hiring an attorney
Fierce Advocacy
At Nyman Turkish, we treat every client with care and compassion while fiercely advocating for those we represent. Our team of skilled attorneys, legal assistants, and case managers is committed to providing support and guidance throughout the process.
Workers’ Compensation laws vary by state and can be difficult to navigate. With over 50 years of combined experience, our Workers’ Compensation attorneys have successfully handled a broad range of work-related injury cases and understand the complexities of this area of law.
We offer a free case evaluation to every individual who contacts us. During this review, we take the time to thoroughly assess your situation and determine whether our team may be the right fit to assist you in pursuing the benefits you may be entitled to.
