Workers’ compensation

Who is covered by workers’ compensation in California?

Workers’ compensation covers almost every employee in California from the first day on the job. Your employer must carry workers’ compensation insurance or hold the state’s approval to self-insure. The coverage applies whether you work full time, part time or seasonally. You can open a claim on your own; a workers’ comp lawyer matters most when the insurer delays, denies or disputes part of it.

Coverage does not depend on fault. Labor Code § 3600 asks one question: did the injury arise out of and in the course of your employment? If it did, the insurer owes benefits even if you made a mistake, a coworker made a mistake, or no one did.

• Immigration status does not matter Labor Code § 3351 includes workers “whether lawfully or unlawfully employed.” Your status is not a condition for treatment or benefits.
• Specific injuries A single event: a fall from a ladder, a forklift collision, a cut, a lifting injury on a particular shift.
• Cumulative trauma Damage that builds over months or years of repetitive work, such as back, shoulder, wrist or hearing injuries. These count as work injuries too.
• Independent contractors Generally not covered. But a job title does not decide the question; who actually controls the work does. Many people labeled contractors are employees under California law.

What benefits does workers’ compensation pay?

Workers’ compensation pays for medical care, a portion of lost wages, and compensation for any lasting impairment. It does not pay for pain and suffering. Those damages are only available in a separate lawsuit against someone other than your employer.

• Medical treatment Reasonable and necessary care for the work injury, usually through your employer’s Medical Provider Network (MPN), at no cost to you.
• Temporary disability Payments while a doctor says you cannot work, or while your employer cannot accommodate your restrictions. The rate is generally two-thirds of your average weekly wage, within limits the state sets each year.
• Permanent disability Compensation for impairment that remains once your condition stops improving. A rating converts the doctor’s findings into a percentage, and the percentage sets the payments.
• Supplemental job displacement A voucher for retraining when you have permanent disability and your employer does not offer you suitable work.
• Death benefits Support for dependents and burial expenses when a work injury is fatal.

Temporary disability generally stops once a doctor finds you able to return to work. Otherwise it stops after 104 weeks of payments within five years of the injury, with longer limits for certain serious injuries.

How does a workers’ comp claim move from injury to decision?

A workers’ comp claim moves from notice to your employer, to a filed DWC-1 claim form, to the insurer’s decision. From there it leads either to benefits or to a dispute before the Workers’ Compensation Appeals Board (WCAB). Most claims never see a courtroom, but every claim follows the same basic path.

1. Notice to your employer You tell your employer about the injury, ideally in writing and within 30 days.
2. The DWC-1 claim form Your employer gives you the form within one working day of learning of the injury. You complete your section and return it, and the employer passes it to its insurer. See filing a workers’ comp claim for the details.
3. The insurer investigates The insurer has up to 90 days to accept or deny. While it decides, it must provide limited medical treatment. If it does not deny within 90 days, Labor Code § 5402 presumes that workers’ compensation covers the injury.
4. Treatment and disability payments You treat with a primary treating physician, who reports on your restrictions and your progress. The insurer pays temporary disability while you are off work.
5. Permanent and stationary When your condition stops improving, a doctor rates any lasting impairment. If the parties disagree, a Qualified Medical Evaluator or Agreed Medical Evaluator reports.
6. Resolution The case ends by settlement approved by a workers’ compensation judge, or by a decision after trial at the WCAB.

What deadlines apply after a work injury?

The two main deadlines are 30 days to notify your employer and, generally, one year to file with the Workers’ Compensation Appeals Board. Both come from the California Labor Code, and missing either can cost you benefits.

• 30 days to report (§ 5400) Notice to your employer within 30 days of the injury. Late notice does not always end a claim, but it gives the insurer an argument.
• One year to file (§ 5405) You generally have one year to file an Application for Adjudication of Claim with the WCAB. The year runs from the date of injury, or from the last payment of benefits.
• 90 days for the insurer (§ 5402) The insurer’s window to deny. After that, the law presumes the injury compensable. The insurer can then rebut that presumption only with evidence it could not have found within the 90 days.

For cumulative trauma, the date of injury is when you first suffered disability and knew, or reasonably should have known, that work caused it. That date can be later than you expect, and an attorney can tell you which one applies.

What happens when the insurer disputes the claim?

When the insurer denies a claim or disputes part of it, the dispute goes to the Workers’ Compensation Appeals Board. There, a workers’ compensation judge decides it. A denial letter is the insurer’s position, not a final ruling, and this is the stage where a workers’ comp lawyer usually steps in.

Disputes usually turn on one of three things. First, whether the injury happened at work at all. Second, what treatment you need. Third, how much lasting disability you have. Each has its own process.

• Whether the claim is covered Handled by filing with the WCAB and building the medical and factual record. See denied workers’ comp claims.
• Treatment requests The insurer reviews your doctor’s requests through utilization review (UR). You can challenge a denial through independent medical review (IMR), which the state runs.
• Medical findings Sometimes the parties disagree with the treating doctor. Then a Qualified Medical Evaluator (QME) from a state panel, or an Agreed Medical Evaluator (AME) chosen by both sides, examines you and reports under Labor Code §§ 4060–4062.2. See the QME process.

Can your employer fire you for filing a claim?

No. Labor Code § 132a makes it unlawful for an employer to fire, threaten or discriminate against you for filing a workers’ compensation claim. The same applies if you said you intended to file. That protection covers you from the moment you report the injury.

A successful § 132a petition can lead to increased compensation, reinstatement, and reimbursement of lost wages and work benefits. It is a separate claim with its own deadline, heard by the WCAB. Protection from retaliation does not mean an employer can never end your job; it means the claim cannot be the reason. Our guide to being fired while on workers’ comp in California explains what to do if it happens.

Many people worry about the job as much as the injury. If you are afraid to report because of how your employer may react, raise it with a workers’ comp lawyer before you decide anything.

When is there a claim beyond workers’ comp?

Sometimes someone other than your employer caused the injury. You may then have a personal injury claim against that person or company in addition to workers’ compensation. Workers’ comp is usually the only remedy against your employer, but it does not protect anyone else.

Common examples include a driver who hits you on a delivery route, a defective machine, or a subcontractor who left a hazard on a construction site. The third-party claim can recover pain and suffering and full lost earnings, which workers’ comp does not pay. See third-party claims for how the two cases fit together, including the insurer’s right to reimbursement.

How does a workers’ comp case settle?

A workers’ comp case settles in one of two ways: Stipulations with Request for Award, or Compromise and Release. A workers’ compensation judge must approve either one before it takes effect.

Stipulations pay permanent disability over time and usually keep future medical treatment open. A Compromise and Release pays a lump sum and usually closes future medical care. The right choice depends on your injury, your future treatment needs and your plans for work. The page on workers’ comp settlements compares them side by side.

What does a workers’ comp lawyer cost?

With this firm, the fee for a workers’ comp lawyer is typically around 15% of the award. A workers’ compensation judge approves the fee under Labor Code § 4906, and it is paid from the award itself. You pay nothing up front and receive no separate bill.

The fees and consultations page explains how the firm charges for each of its practice lines. Your first consultation is free and takes about thirty minutes. It is available in person at the office, by phone or by video.