Workers’ compensation coverage is provided by California employers who are injured while performing their normal job function or who are disabled due to an occupational illness or disease. According to California workers’ compensation laws and the Division of Workers’ Compensation (DWC) who monitors the administration of California workers’ compensation claims, and provides administrative and judicial services to assist California employees, employers are required to have workers’ compensation insurance if they have even one employee (some exceptions may exist).

The goal of workers’ compensation or workman’s compensation is to provide immediate relief to workers who are injured in a work-related accident without the employees having to file a personal injury claim and forcing their employer to pay lost wage compensation or for their medical expenses. Employees are limited, under California workers compensation law, in the amount of compensation they can recover from their employer but the trade-off is the employer must pay for necessary and reasonable medical care and in some cases for lost wages without the employee proving the employer was negligent.

California employers who fail to carry workers’ compensation coverage may be charged with a criminal offense. According to Section 3700.5 of the California Code “it is a misdemeanor punishable by either a fine of up to $10,000 or imprisonment in the county jail for up to one year, or both”. The state can also issue penalties up to $100,000 against illegally uninsured employers.

Work Injuries Covered Under California Workers’ Compensation

In most cases, workers’ compensation will only cover work injuries which arise “out of and in the course of employment”. If you are injured while performing an activity directly related to your job, you should be eligible for worker’s compensation. California employees who are on are injured on a business trip must be engaged in activities required for their job. Workers also may not be covered if they are voluntarily participating in an employee sponsored recreational event, if their injuries are self-inflicted, if they were engaged in horseplay with a co-worker or if they were intoxicated and injured on the job.

Common illnesses and work injuries that are generally covered if they occur while engaged in normal business activities or functions can include:

• Back injuries
• Concussions
• Abrasions
• Burns
• Amputations of legs, arms, fingers or toes
• Cancer from a certain chemical or toxin
• Heart attack
• Stroke
• Carpel Tunnel Syndrome
• Post traumatic stress disorder

California Worker’s Compensation Benefits

There is a three calendar day waiting period before injured employees will receive wage benefits. The three days do not have to be consecutive. If the employee is hospitalized, the injury resulted from a criminal act of violence or if the work injury extends more than 14 calendar days and is unable to return to work the waiting period is waived. The waiting period may also be waived for California employees who meet certain requirements as stated under the California Labor Code Section 4800 and 4800.5.

California workers injured on the job may be entitled to lost wage compensation and paid medical expenses.

• Medical Benefits

California workers’ compensation laws entitled injured employees to payment or compensation for all necessary and reasonable medical care. Common paid medical benefits can include costs for visiting the hospital, surgeries, medications, dental treatment, and medical supplies. Pain and suffering is not compensated by the employer. California workers’ compensation laws allow the employer to make the initial selection for the employee’s doctor. The employee will, after a specified time (generally 30 days), be able to choose their own physician unless the employer or the insurance company has previously established a medical provider network. If the California employer has a medical provider network the employee must see a physician from a specified selection of physicians for the duration of the workers’ compensation claim.

• Temporary Disability

Temporary disability benefits may also be paid to California workers who are injured on the job. Temporary disability is generally calculated as 2/3 of the employee’s gross wages at the time of their work injury. There are maximums and minimum amounts that are paid as outlined under California workers’ compensation law. Workers who are working two jobs at the time of injury may also be compensated for the lost income from the second job.
Temporary disability is paid when the treating physician decides that the employee is unable to work more than 3 days or they have been required to stay in the hospital overnight. Temporary disability will end when the doctor determines the employee has reached their maximum health (given their injury) or they are deemed able to return to work.

• Permanent Disability

Many work-related injuries will result in permanent disabilities or the inability to work at all. To determine permanent disability compensation the treating physician will determine the degree of the employee’s impairment. The impairment is rated according to a pre-determined schedule and the functional loss (as it applies to work related tasks). The workers’ compensation claims administrator will assign a permanent disability rating by reviewing the physician’s report. The assigned rating may be challenged and a review may be requested from another state disability rater, a workers’ compensation judge, or the director of The State Division of Worker’s Compensation. Workers compensation permanent disability payments are calculated using this rating, and the employee’s wages prior to the injury to determine the total amount of permanent disability compensation for the worker’s disability.

• Vocational Rehabilitation

Injured California workers who suffer an injury at work may also be eligible to receive vocational rehabilitation training. This service is provided through the Division of Workers’ Compensation, Vocational Rehabilitation Unit and local community colleges. Injured employees who are injured for 90 days may be eligible for these services. These services are optional.

• Death benefits

If a California worker dies from their work-related injury their dependents may be entitled to compensation through death benefits. Death benefits may include lost wages compensation and paid burial expenses up to a maximum outlined in California state law.

Do I Need a California Worker’s Compensation Attorney?

Unfortunately, workers in California are injured on the job everyday. Some claims are handled smoothly and easily while others may not. If you have been severed injured or have suffered permanent disability and are unable to work again, it may be a good idea to discuss your California workers compensation case with a workers compensation attorney. Workers compensation lawyers have the experience to fight the insurance companies and ensure that they do not limit or deny workers’ compensation benefits to injured employees.

Workers’ compensation in California is of interest to you if you live and work in California, and you or ill or have been injured as a result of your job. You may currently be having problems and difficulties with your employer in being compensated for that injury or illness.

You need to remember what workers’ compensation is. Workers’ compensation is a kind of business insurance. This business insurance provides benefits in the form of income, rehabilitation and medical coverage to employees and/or their family who suffer injury, illness or death in the course of, or as a result of, their job. This does not depend on whether you were at fault as an employee.

These benefits may be given to your surviving spouse and/or children if you die as a result of injury at your place of employment. These benefits are yours or your dependents or survivors as a matter of “right”. Your employer cannot resort to any legal defense. You and/or your dependents or survivors, in turn, cannot sue your employer for your injuries or death.

Workers’ compensation laws were established to mitigate the need for workers to prove that their injuries were the “fault” of their employer and to reduce the need for litigation. The first workers’ compensation laws were passed in Maryland in 1902. The first federal law was passed in 1906. By 1949, all of the states had passed some kind of workers’ compensation laws.

Originally, these laws were known as “workman’s compensation.” California uses the term, “worker’s compensation” or “workers’ comp.”

The Occupational Safety and Health Administration (OSHA) oversees workplace health and safety at the national level. State laws vary and complement the regulations of OSHA.

There is no national agency, however, that requires all employers to provide workers’ compensation benefits. The laws regarding workers’ compensation are determined by each state.

Workers’ compensation in California is governed by the Department of Industrial Relations. The Division of Workers’ Compensation has the specific responsibility of administering workers’ compensation in California.

California passed its first workers’ compensation law under the Compensation Act in 1911. Under this law participation was voluntary for employers. In 1913, the Workers’ Compensation Insurance and Safety Act was passed that required employers to participate. Since that time this Act has been revised and reformed many times.

Workers’ compensation in California is seen as a trade-off between employers and employees. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries or illnesses no matter who is at fault. In return for these benefits, employees are prevented from suing employers because of those injuries.

If you live and work in California it is important for you to know and remember that all employers are required by law to have workers’ compensation insurance, even if they have only one employee. Workers’ compensation is mandatory meaning all employers are required to participate. Your employer has to pay for workers’ compensation benefits if you are hurt or become ill because of your work.

Workers’ compensation in California provides six basic benefits. These workers’ compensation benefits are:

§  Medical care

§  Temporary disability benefits

§  Permanent disability benefits

§  Supplemental job displacement benefits or vocational rehabilitation

§  Death benefits.

The vast majority of workers’ compensation claims are resolved without any need for legal recourse. However, sometimes there can be a disagreement that arises between you and your employer. This disagreement can relate to issues such as was your injury or illness the result of your job, or how much in benefits you are entitled to receive because of the injury or illness.

When there is a dispute between you and your employer, the Division of Workers’ Compensation can help resolve it through its Information and Assistance Unit or by going before a judge at one of the division’s 24 local offices.

It is important to know the rights that you have when you are injured at your workplace in California. Under workers’ compensation laws in California you have the right to receive medical treatment. State law requires that your medical treatment has to be, “scientifically based, nationally recognized and peer-reviewed. Guidelines published by the American College of Occupational and Environmental Medicine (ACOEM) are correct in most cases.

You also have the right to disability payments. These may be temporary or permanent depending on the type and nature of your injury or illness that is work related. Permanent disability is any lasting disability that reduces your earning capacity after maximum medical improvement is attained.

You also have the right to return to work after you have recovered from your illness or injury. Returning to work as soon as possible after an illness or injury is important for both you and your employer. Workers who return to their jobs as soon as it is medically possible have the best outcomes. Recovery from injuries and illness is faster and wage loss is less.

You also have the right to the resolution of a disagreement over your claim. The steps for this resolution have already been mentioned above.

Workers’ compensation in California may be a serious matter for you. You or a friend or loved one may have been injured or become ill as a result of your work. To make matters worse, you or your friend or loved one is in an unresolved dispute with the employer over the injury or illness.

What can you do? What options do you have? Who can you turn to for help?

You or your friend or loved one may need the help of a legal professional. You may need the help of an attorney who knows and specializes in employment law in California. You may need the representation of a workers’ compensation attorney.