Guide to California Workers’ Compensation

July 18, 2022 | Article by Chain | Cohn | Clark staff

Guide to California Workers’ Compensation

The State of California protects its workers through several laws and regulations. Suppose an individual is injured at work or due to work-related activity. In that case, they might be eligible to receive compensation from their employer.

To qualify for California workers’ compensation in CA, you must meet the following criteria:

  • Be a worker or employee in the State of California
  • Sustain an injury or illness from your job site, duties, or other activity related to work  
  • Not have caused your injury/illness through some form of negligence. For example, If you start a fight at work and get injured, you will likely not have a case for workers’ comp. Or if you are drunk at work and fall from an elevated height with a railing, it will be difficult to qualify for worker’s comp.

 If you are unsure whether or not you have a solid case for workers’ compensation coverage, reach out to a California workers’ compensation attorney for legal assistance.

California Workers’ Compensation Benefits

Various benefits become available if an employee meets the California workers’ compensation requirements. The amount awarded in a personal injury case will be determined by the circumstances of the accident, the size of the defendant, the severity of the injuries, and so on.

We’ve reviewed some of the more common types of compensation available through California workers’ compensation insurance.

Medical Benefits

Under California workers’ compensation coverage, the insurance company will cover all reasonably necessary medical and hospital costs for your injury. The insurance company will even reimburse you for travel back and forth from the doctor’s office at roughly $0.50 per mile. 

The employer (or the insurance company) should have a Medical Provider Network (MPN) designated to handle treatment in the event of a workplace accident. If you are injured at work, you will likely be required to receive all necessary care from that specific network—though you may change doctors within the network if you wish.

Let’s say your employer has a network but does not properly notify you. You will be allowed to choose a doctor outside the network, but you must confirm that the employer never informed you of the MPN. Read all letters from your claims administrator and employer carefully. 

The employer may choose your doctor for the first 30 days of treatment if an MPN has not yet been established, though you have the right to switch doctors in certain circumstances.

All the treatment you receive will be subject to Utilization Review. Utilization Review is a process that employs a doctor who never sees you go over all your doctor’s recommendations to determine if they are credible and adequate. The recommendations must also meet specified guidelines, and this process helps them do so. 

If you sustain a work injury in California that requires medical care, you will be eligible for benefits. Even if your employer needs time to determine whether you were injured at work, they still must pay up to $10,000 in that waiting period. Suppose they decide that you were not injured at work. Your employer will not be responsible for paying your medical benefits unless the court determines your injury was their fault. 

Temporary Disability

Temporary disability benefits for workers’ compensation are paid out to any employee who misses more than three days of work–or goes to the hospital–due to their injury or condition. You will be paid depending on your average weekly wages (AWW). Temporary disability benefits for workers’ compensation will equal ⅔ of your AWW. For those receiving benefits, an annual maximum and minimum wage (AWW) is established each year. The highest recognized value is $2,309.56, and the lowest is $346.42 as of January 1, 2022. The maximum and minimum amounts are approximately $1,550 and $230, respectively. These benefits will usually be paid bi-weekly. 

You must supply medical proof that you cannot work to receive these benefits. Even if you can prove that you cannot work after two years (104 weeks) have passed, your benefits will still stop. This limit applies to all temporary disability cases.

Permanent Disability

If your disability impairs you indefinitely, you will be eligible for permanent disability workers’ compensation benefits. The amount you will receive is determined by a formula that quantifies your disability as a percentage. Then, that percentage either increases or decreases depending on other variables like your age, profession, and the time of injury. One unique characteristic of permanent disability is that you can still potentially return to your job receiving benefits. 

The maximum permanent disability weekly rate is $290, and the minimum rate is $160. Lifelong injuries after 2004 will also increase proportionately to increases in statewide wages. Permanent disability benefits are paid bi-weekly until the total dollar amount is paid.

If you are upgraded from temporary to permanent benefits, your new funds will be paid when the old ones end. If the court rules in your favor and finds that your disability is not yet permanent, you will be given a packed bay. Your benefits will end after two years if the court does not decide that your disease is permanently debilitating.

Vocational Rehabilitation or Training

Also known as the Supplemental Job Displacement Benefit, vocational retraining costs are available to workers injured after January 1, 2013, who can’t return to their last job because of the requirements. If the previous employer does not accommodate them or offer some form of modified employment, the employee will get a $6,000 voucher for education or training at state-approved schools. This money can also be used for your job search and/or a computer. 

Your benefit will depend on your level of disability, up to a maximum of $10,000, if you were injured before January 1, 2013, but after January 1, 2004. !0% of this voucher can also be used to employ the services of a counselor. 

These vouchers cannot be traded in for cash. They are offered if your employer hasn’t offered you a new job within 60 days of them learning you reached Maximum Medical Improvement for your injuries. Maximum Medical Improvement means your condition will not improve with additional time or treatment. 

Return to Work Fund

Individuals eligible for vocational rehabilitation or training also qualify for a special California state fund that helps injured workers. Currently, this benefit provides another $6,000 per injury sustained. This money is not from your employer or their insurance. You can only apply for this fund online. The District Offices of the Workers’ Compensation Appeals Board have special computers for you to sign up. You will need your Supplemental Job Displacement Benefit voucher to obtain these benefits. 

Even a minor disability could keep you from going back to work. If this is the case, be sure to apply for both a voucher and Work Fund benefits. 

Death Benefits

If an employee who is the provider for their loved ones dies because of something work-related, those who rely on the support may be eligible to receive death benefits. Even if the death does not occur at the workplace, loved ones can recover damages if the death was in some way caused by work-related activity or injury. 

Compensable Consequences

You may also be able to recover benefits for additional conditions resulting from work-related injuries. These “compensable consequences” can include the following examples:

  • You get into an accident on your way to the doctor for another work injury
  • A sore back that develops from the constant limping you must do to ease the stress on your work-related foot injury
  • Medical malpractice injuries from treatment for your work injury
  • Your work-related knee injury causes you to fall and break your shoulder

These additional issues will be treated similarly to the initial injury. 

Workers’ Compensation is Required in California

Under California Labor Code Section 3700, all employers are responsible for providing workers’ compensation benefits to their employees. Workers’ comp coverage in California covers all workers, even part-time employees. This is the state’s way of protecting its residents in the workplace. 

If an employer cancels their workers’ compensation policy to end business or switch the providing company, they will be given a proportionately assessed refund. 

What If You Don’t Purchase CA Workers’ Comp?

An employer who does not carry workers’ compensation insurance violates the California Labor Code. This indicates that the Division of Labor Standards Enforcement may issue fines or a stop order to halt their business operations at any time. The business cannot begin running again until workers’ compensation insurance has been purchased. 

Failure to comply with California workmens’ compensation laws is also considered a criminal offense. The employer guilty of said crime could be subject to one or both of the following punishments:

  • A fine twice as much as the workers’ compensation premium that would’ve covered the uninsured period
  • Up to one year of imprisonment in a county jail

In a workplace accident where the employer has no workers’ compensation insurance, the employer must also pay all bills related to an employee’s injury or illness. The employee can file a civil claim against the employer and a workers’ compensation claim. 

Posting Requirements for Employers in CA

One existing California workers’ compensation law requires employers to have a poster at their work site detailing the company’s workers’ compensation coverage policy; and where employees can receive medical care for work injuries. If an employer does not place this poster in an adequate location, they may be fined up to $7,000 per violation as it is a misdemeanor. 

Employers must also give new employees a pamphlet explaining their rights and responsibilities.

California Workers’ Compensation Statute of Limitations 

In California, the time you have to file a workers’ compensation claim is one year from when an employee discovers or should have discovered their injury. If there are no specific injuries, the time window will begin on the date of the workplace accident. If injuries develop over time, the case will be viewed as a cumulative trauma accident. 

In cumulative trauma claims, the statute of limitations will begin running when the victim recognizes that their injury is likely linked to the work accident. The important thing to remember is that the statute of limitations is only extended if the victim had no reasonable way of knowing that their injury was caused by or linked to a workplace accident. If somebody is sore after falling at work but doesn’t visit the doctor for it until a year passes because they think it’s just residual soreness, the defending insurance company could argue that the statute has expired under CA Labor Code Section 5412

After a workplace accident, you should get checked immediately to see if there is anything that may cause an issue, even if you are not in pain. 

When to Report Workers’ Compensation Claims

It should be noted that the statute of limitations for a workers’ compensation claim is not the same as the deadline for reporting a work accident. As an employee, you should report the injury or illness to your employer as soon as possible. You may lose your right to workers’ compensation benefits if you do not provide written notice within 30 days.

Once the employer receives your notice, they should file a claim to their insurance within one business day of finding out. 

Where to Report CA Workers’ Comp Claim Problems

The Division of workers’ compensation or the California Department of Insurance will likely handle any issue with a workers’ compensation claim. Between these two organizations, an individual can receive help for any of the following issues:

  • Broker-agent communications
  • Industry classification disputes
  • Notices of nonrenewal and cancellation
  • Audit disputes
  • Dividend plans
  • Insurance fraud
  • Failure to provide reports on loss history
  • Rating errors in the claim
  • Insurer compliance problems

An experienced California workers’ compensation attorney will also be able to assist you in figuring out the proper next steps if there is an issue with your claim.

California Workers’ Compensation Insurance Cost

Different insurance companies have different prices for workers’ compensation coverage. According to the Workers’ Compensation Insurance Rating Bureau of California’s 2021 pure premium rate filing, the proposed advisory premium rate for 2021 is $1.56 per $100 of payroll. The actual value often ranges based on the job’s risk. Low-risk jobs might only require $0.40 per $100 in payroll, while high-risk jobs could cost over $33 per $100 in payroll.

Prices are determined by the classification of your industry, the payroll, the history of workers’ comp claims, and other factors that indicate how often insurance might be needed. 

California Workers’ Compensation Lawyers

Chain | Cohn | Clark is a Kern County law firm with decades of experience representing citizens (and workers) like yourself. We have extensive knowledge surrounding California workers’ comp laws and are ready to help you get the compensation you deserve.

If your employer is being difficult or trying to avoid the blame for a workers’ compensation accident, fill out our online contact form today to get started holding them accountable. 

You may be eligible to make a personal injury claim for additional benefits if there is a third party whose negligence might have been the root cause of your injury. Talk to a lawyer for more information.