February 26, 2024 | Article by Chain | Cohn | Clark staff

California law requires employers in the state to provide workers with a “safe and healthful” workplace (CLC 6400). However, it’s impossible to eliminate all on-the-job accidents and injuries. So, California law also says that employers must carry workers’ compensation insurance to provide benefits to employees who are injured or killed at work (CLC 3700).

If you’re injured at work and want to receive workers’ compensation benefits, the basic procedure is simple:

  • Report the injury to your employer as soon as possible.
  • Fill out a workers’ compensation form and return it to your employer.
  • Your employer completes the remainder of the form before sending it to their workers’ compensation insurance company.
  • The insurance company processes your claim and awards you the benefits you deserve.

Unfortunately, the claims process is often more complicated than this. Your employer may not agree that your injury occurred at work. The insurance company may delay your claim, deny it, or award benefits that are less than what you need for your medical treatment.

If any of these situations occur, you can negotiate with the claim administrator for your case or file an appeal. You can also get help from a workers’ compensation attorney like the state-certified workers’ compensation specialists at Chain | Cohn | Clark.

In the rest of this FAQ, we’ll take a more detailed look at how to get workers’ compensation benefits.

The Basic Qualifications for Receiving Workers’ Compensation

You must meet two basic qualifications to receive workers’ compensation benefits:

  1. You are an employee. Workers’ compensation applies to all employees in California. It doesn’t cover those who aren’t anyone’s employees—like sole proprietors and independent contractors. The term independent contractor is not always clearly defined. If you’re unsure whether you’re an employee or an independent contractor, talk to a workers’ compensation lawyer.
  2. Your injury occurred at work or as you carried out your work. In general, it doesn’t matter who was at fault when you were injured. However, there are some disqualifying circumstances. For example, you can’t collect workers’ compensation benefits if you were injured in a fight you started, hurt yourself deliberately, or were drunk when you were injured.

You are most likely eligible for workers’ compensation benefits if you meet these basic qualifications.

How to Apply for Workers’ Compensation Benefits

Here’s the California workers’ compensation claims process in detail:

  1. Report the injury to your work supervisor as soon as possible. In many cases, if you don’t give your employer written notification of your injury within 30 days, you may be unable to collect benefits.
  2. Your employer is required to give you a copy of the official claim form (called DWC-1) within one working day of when you report your workplace injury. You can also find the claim form on the California Division of Workers’ Compensation (DWC) website.
  3. Fill out your DWC-1 and give the completed form to your employer. Your employer must fill out the remainder of the form and forward it to their insurance company. You must file your DWC-1 within one year of the date of your injury or the date you realized you were injured. If you are applying for death benefits for a family member killed on the job, the one-year time limit still applies.
  4. Once you’ve filed your DWC-1 with the insurance company, the insurer is required to pay up to $10,000 toward your medical treatment while your claim is being considered. If your employer uses a medical provider network (MPN), be sure to see a doctor who practices within the MPN.
  5. The insurance company will assign your case to a claim administrator who decides whether you should receive benefits. You should hear from the insurance company within 90 days.

What happens next will depend on how the insurance company responds:

  • If your claim is accepted, the insurance company will let you know what benefits they are offering you. If you don’t hear back from the insurance company within 90 days, your claim is considered accepted, and you should receive benefits.
  • If your claim is denied, you can appeal the decision by filing an Application for Adjudication of Claim with the Workers’ Compensation Appeals Board (WCAB).
  • If your claim is accepted but you disagree with the type and amounts of your benefits, you can negotiate with the insurer or file an appeal.

Here are the steps of the appeals process:

  • If you file an appeal with the WCAB, a mandatory settlement conference (MSC) will be scheduled for you. In the MSC, a judge will work with you—and your lawyer, if you have one—and the insurance company to try to reach a settlement.
  • If you don’t reach a settlement in the MSC, your case will go to trial before another judge.
  • If you disagree with the judge’s decision after the trial, you can still file a motion called a Petition for Reconsideration.

If your case is straightforward—perhaps minor injuries that clearly occurred at work—you may be able to navigate the California workers’ compensation claims process on your own. The DWC Information and Assistance Unit is a good resource for answers to questions. But they cannot take any action on your behalf.

An experienced workers’ compensation attorney is typically an invaluable resource. Nearly all workers’ compensation lawyers work on a contingency basis, which means they only get paid if you receive benefits. Then, their payment is a small percentage of your settlement—usually between 10% and 15%.

Workers’ Compensation Benefits

The main benefits available through workers’ compensation insurance include:

  • Medical benefits: Payments for the medical care you need to recover from your injury.
  • Temporary disability benefits: Payments that cover two-thirds of your regular wages while you’re unable to work.
  • Permanent disability benefits: Long-term payments that are granted if your injury is severe enough to affect you indefinitely.
  • Job training: Money toward training for a new job if you can’t return to your previous position.
  • Death benefits: Payments for a family member whose death resulted from a workplace incident.

Bakersfield Workers’ Compensation Attorneys

Workers’ compensation cases are often tricky—involving complicated regulations, loads of paperwork, filing deadlines, and disputes over benefits. The experienced workers’ compensation lawyers at Chain | Cohn | Clark can relieve the burden of finding your way through the system while you recover from an injury.

For a free, no-obligation review of your case, contact us today.