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Who's Covered?
Virtually all working Californians are "employees" for purposes of workers' compensation. Exemptions are few. People in business for themselves and some unpaid volunteers may not be covered. Maritime workers and federal employees are protected by federal workers' compensation laws.
What's Covered?
Any injury caused by the job is covered -- everything from first-aid type injuries to serious accidents. Job-related illnesses are covered too. (For example, common colds and flu aren't covered, but if you catch tuberculosis while working at a TB hospital, that's covered.) The key is whether the injury or illness is caused by your job.
When am I covered?
Coverage begins the first minute you're on the job and continues while you are working. You don't have to work a certain amount of time or earn a certain amount before you're protected. Coverage is automatic and immediate.
How do I get my benefits?
Report the injury to your employer or supervisor immediately and complete a simple claim form if more than first aid is required. The claim form will ask what, where, when and how it happened. Your employer or supervisor will see that you get medical help right away and file the necessary reports.
Prompt reporting is the key. Benefits are automatic but nothing can happen until your employer knows about the injury Insure your right to benefits by reporting every injury, no matter how slight. Even a cut finger can lead to disability if an infection develops.
What are the benefits?
California law guarantees three kinds of workers' compensation benefits:
Reasonable and necessary medical care to cure and relieve effects of the injury. Not just doctor bills, but also medicines, hospital costs, fees for lab tests, X-rays, crutches, even travel expenses for required medical treatment. State law requires pre-authorization of non-emergency medical care, and there are limits on some types of treatment, so stay in touch with your claims administrator to make sure you get appropriate care and your bills will be paid.
Tax-free payments to help replace lost wages. Most injuries only keep you from working temporarily, and "temporary disability" payments will usually continue until the doctor says you're able to return to work or that your condition is permanent and stationary.
Additional cash payments will be made after you're able to work if there is a permanent disability - for example, the loss of a finger on an eye - or if you can't return to work at all. If the injury results in death, benefits will be paid to your surviving dependents.
Supplemental Job Displacement Benefits in the form of a non-transferable voucher to use for education-related retraining or skill enhancement at a state-approved school. Injured workers are eligible for a voucher if they have a permanent disability, their employer does not offer appropriate modified or alternative work, and they can't return to work for the employer within 60 days after temporary disability ends. The voucher amount ranges from $4,000 to $10,000, depending on the level of permanent disability.
What are the cash payments?
Temporary disability benefits are generally two-thirds of your wages subject to minimums and maximums set by the State Legislature.
For 2005 and 2006 injuries, the minimum TD payment was $126/week and the maximum is $840/week. For injuries occurring in each subsequent year, the minimum and maximum payments are subject to adjustments based on increases in the State Average Weekly Wage, so the amount of your payment will depend on your date of injury. For example, for 2008 injuries, the minimum is $137.45 per week, and the maximum is $916.33 per week. A claims adjuster will send you a letter explaining how much you will receive. Your temporary disability payments will be based on your pre-injury earnings and the rate in effect at the time of injury.
Temporary disability isn't paid for the first three days you're unable to work, unless you're hospitalized as an in-patient or are off work more than 14 days. After that you should receive a check every two weeks until the doctor says you can go back to work. State law allows temporary disability payments for a single injury to continue for no more than 104 compensable weeks within two years from the date of the first payment; or for a few very serious types of injuries such as amputations, severe burns or chronic lung disease, the state allows payments for up to 240 weeks within five years of the date of injury. If the maximum temporary disability period expires before you can return to work, or if temporary disability is delayed or denied, you may be able to get State Disability benefits through the California Employment Development Department (EDD), but you need to apply in advance, so contact EDD at 1-800-480-3287 (http://www.edd.ca.gov/ for forms and information.
If the injury is very serious and you won't be able to work a year or more, you may be eligible for additional benefits from Social Security. Contact your local Social Security office or ask your employer or claims administrator for information.
Permanent disability benefits may be payable after you recover to the fullest extent possible. The doctor who treated you will evaluate the permanent effects of your injury. You and your employer may agree to rely on the treating doctor's report to establish your permanent disability payment. If you don't agree on the treating doctor's report, and you are not represented by an attorney, you must choose an evaluating doctor from a panel of three independent doctors provided by the State. If you are represented by an attorney and you don't agree on the treating doctor's report, the attorney will arrange for a medical evaluation.
Your permanent disability payments will be based on the results of the doctor's evaluation and factors such as how much of your permanent disability was directly caused by your work, your age, pre-injury occupation, type of injury and date of injury. The weekly benefit is two-thirds of your income subject to minimums and maximums set by the state, which vary by date of injury, level of permanent disability, and in some cases, whether or not your employer makes an appropriate job offer so you can return to work.
Death benefit payments to survivors are set by state law according to the number of dependents. Payments are made at the same rate as temporary disability payments, but no payments will be less than $240/week. Workers' compensation also pays a burial allowance.
What if I have a problem or need more information?
Start by contacting your employer or the claims administrator who handles your company's workers' compensation claims (the name and phone number should be posted at your worksite and should also be available from your employer). Many times problems and questions can be resolved with a simple phone call. If you still need assistance, you may call or write for free help from an Information and Assistance Officer employed by the State. Some problems may need to be resolved by the Workers' Compensation Appeals Board, which is a court of law. You can represent yourself or hire an attorney to represent you. If you hire an attorney, you will not pay the attorney directly, but the attorney fees will be paid out of your permanent disability, and are generally 12 to 15 percent of your award. Also, if you hire an attorney, other people involved in your case, including your claims adjuster, may no longer be able to speak directly to you about important matters, but will be required to communicate through your lawyer, and state Information & Assistance offices may no longer be able to provide free assistance or advice to you. In addition, if you choose to stop having an attorney represent you, or you want to change lawyers, your original lawyer can still claim a portion of your benefits. As long as you don't have a lawyer, Information and Assistance Officers can review your situation, answer your questions and intervene on your behalf. The Division of Workers' Compensation has 24 local Information and Assistance Offices around the state. Check the following list for the address and phone number of the office nearest you.
Information and Assistance Offices, California Division of Workers' Compensation
Anaheim
1065 N. PacificCenter Drive, Anaheim, CA 92806
714-414-1801
Bakersfield
1800 30th Street, Room 100, Bakersfield, CA 93301-1929
661-395-2514
Eureka
100 "H" Street, Room 202, Eureka, CA 95501-0481
707-441-5723
Fresno
2550 Mariposa Mall, Room 2035, Fresno, CA 93721-2219
559-445-5355
Goleta
6755 Hollister Avenue, Room 100, Goleta, CA 93117-5551
805-968-4158
Long Beach
300 Oceangate Street, Room 200, Long Beach, CA 90802-4304
562-590-5240
Los Angeles
320 W. 4th Street, 9th Floor, Los Angeles, CA 90013-2329
213-576-7389
Marina del Rey
4720 Lincoln Blvd., 2nd and 3rd Floors, Marina del Rey, CA 90292-6902
310-482-3820
Oakland
1515 Clay Street, 6th Floor, Oakland, CA 94612-1402
510-622-2861
Oxnard
1901 N, Rice Ave., Ste. 200, Oxnard, CA 93036-8293
805-485-3528
Pomona
732 Corporate Center Drive, Pomona, CA 91768-2653
909-623-8568
Redding
2115 Civic Center Drive, Suite 15, Redding, CA 96001-2796
530-225-2047
Riverside
3737 Main Street, Suite 300, Riverside, CA 92501-3337
951-782-4347
Sacramento
160 Promenade Circle, Suite 300, Sacramento, CA 95834
916-928-3158
Salinas
1880 North Main Street, Suites 100, Salinas, CA 93906-2037
831-443-3058
San Bernardino
464 W. Fourth Street, Suite 239, San Bernardino, CA 92401-1411
909-383-4522
San Diego
7575 Metropolitan Drive, Suite 202, San Diego, CA 92102-4424
619-767-2082
San Francisco
455 Golden Gate Avenue, 2nd Floor, San Francisco, CA 94102-7104
415-703-5020
San Jose
100 Paseo de San Antonio, Room 241, San Jose, CA 95113-1402
408-277-1292
Santa Ana
605 W Santa Ana Blvd., Bldg 28, Room 451, Santa Ana, CA 92701
714-558-4597
Santa Rosa
50 "D" Street, Suite 420, Santa Rosa, CA 95404-4771
707-576-2452
Stockton
31 East Channel Street, Room 344, Stockton, CA 95202-2314
209-948-7980
Van Nuys
6150 Van Nuys Blvd., Suite 105, Van Nuys, CA 91401-3370
818-901-5367
Workers' Compensation Fraud Is A Felony
Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be punished by imprisonment in county jail for one year, or in state prison for up to five years, and/or fined up to $150,000 or double the value of the fraud (whichever is greater) and ordered to pay restitution for any medical evaluation or treatment. (IC § 1871.4).