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Virtually all working Californians are "employees" for purposes of workers' compensation. Exemptions are few. People in business for themselves, some domestic workers, and some unpaid volunteers may not be covered. Maritime workers and federal employees are protected by federal workers' compensation laws.
Exceptions to the California workers’ compensation law applicable to corporate officers, members of Boards of Directors, partnerships, and LLCs are included in Labor Code Sections 3351 and 3352 (http://codes.findlaw.com/ca/labor-code/).
Any injury caused by the job is covered -- everything from first-aid type injuries to serious accidents. Job-related illnesses may be covered too. 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. With the exception of certain psychiatric injuries and residential workers, you don't have to work a certain amount of time or earn a certain amount of money 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 the injury 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. Ensure 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 the following workers' compensation benefits in the event of a compensable industrial injury:
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 (or has reached “maximum medical improvement.”)
Additional cash payments may be made if there is a permanent disability -- for example, the loss of a finger or an eye -- or if you can't return to work at all. If the injury results in death, benefits will be paid to your financial dependents.
Supplemental Job Displacement Benefits (SJDB). SJDB in the form of a non-transferable voucher to use for education-related retraining or skill enhancement at a state-approved school or other resources that can help you find a new job may be due. If your injury causes permanent disability, your physician is supposed to submit the Physician’s Return to Work and Voucher report -- to include relevant work capacities and activity restrictions -- to the claims administrator. Within 60 days of receipt of that completed form, your employer may send you an offer of regular, modified, or alternative work. In this situation, if you do not receive an employment offer from your employer your claims administrator will have 20 days after that to issue a voucher.
For injuries on or after 1/1/13, the maximum voucher is $6,000, but there are limits on the amounts allowed for certain items. If you qualify, you'll receive information on the types of expenses that are covered, the limits, documentation requirements, and deadlines for using the benefit. Receipt of a voucher also entitles you to apply to the California Department of Industrial Relations (DIR) for an additional $5,000 from DIR’s Return-to-Work Supplemental Program (RTWSP). Details, and the online application, are found here: http://www.dir.ca.gov/RTWSP/RTWSP.html.
What are the cash payments?
Temporary disability (TD) benefits are generally two-thirds of your wages subject to minimums and maximums set by the State Legislature. For 2017 injuries, the minimum is $175.87 per week, and the maximum is $1,172.57 per week. For 2018 injuries, the minimum TTD rate will increase to $182.29 per week, and the maximum TTD rate will increase to $1,215.27 per week.
At the beginning of each year, the minimum and maximum weekly rates that will apply for injuries that occur during that year are subject to adjustments based on increases in the State Average Weekly Wage. Thus, the amount of your payment will depend on the rate in effect on your date of injury, as well as your pre-injury earnings. A claims adjuster will send you a letter explaining how much you will receive.
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 five years from the date of injury; 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 for a year or more, you may be eligible for additional benefits from Social Security. Contact your local Social Security office for information.
Permanent disability benefits may be payable after you recover to the fullest extent possible. At that point, 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, you may contact the claims adjuster, an information and assistance officer at the Division of Workers' Compensation, or your attorney if you are represented. They can explain your rights and the process for resolving disputes, which varies depending on a number of factors. Your level of permanent disability will be based on the doctor's report (including the doctor's opinion about how much of your permanent disability was directly caused by your work), as well as factors such as your age, pre-injury occupation, type of injury, and date of injury. The weekly benefit is subject to minimums and maximums set by the state, which vary by date of injury and your level of permanent disability. If you have a permanent disability, the calculation of the benefit will be fully explained in a letter.
Death benefit payments to financial dependents are set by state law according to the number of dependents and the date of injury. Payments are made at the same rate as temporary disability payments, but no payments will be less than $224/week. Workers' compensation also pays a burial allowance of up to $10,000.
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 (generally 15 percent of your award).
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 officers 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
1065 N. PacifiCenter Drive, Suite 170, Anaheim, CA 92806
1800 30th Street, Suite 100, Bakersfield, CA 93301-1929
409 K Street, Room 201, Eureka, CA 95501
2550 Mariposa Mall, Suite 4078, Fresno, CA 93721-2219
300 Oceangate Street, Suite 200, Long Beach, CA 90802-4304
320 W. 4th Street, 9th Floor, Los Angeles, CA 90013-1954
Marina del Rey
4720 Lincoln Blvd., 2nd and 3rd Floors, Marina del Rey, CA 90292-6902
1515 Clay Street, 6th Floor, Oakland, CA 94612-1519
1901 N. Rice Ave., Suite 200, Oxnard, CA 93030-7912
732 Corporate Center Drive, Pomona, CA 91768-2653
250 Hemsted Drive, Second Floor, Suite B, Redding, CA 96002
3737 Main Street, Suite 300, Riverside, CA 92501-3337
160 Promenade Circle, Suite 300, Sacramento, CA 95834-2962
1880 North Main Street, Suite 100, Salinas, CA 93906-2037
464 W. Fourth Street, Suite 239, San Bernardino, CA 92401-1411
7575 Metropolitan Drive, Suite 202, San Diego, CA 92108-4424
455 Golden Gate Avenue, 2nd Floor, San Francisco, CA 94102-7104
100 Paseo de San Antonio, Room 241, San Jose, CA 95113-1402
San Luis Obispo
4740 Allene Way, Suite 100, San Luis Obispo, CA 93401-8736
605 W Santa Ana Blvd., Bldg 28, Room 451, Santa Ana, CA 92701-4070
* Satellite office: 130 East Ortega Street, Santa Barbara, CA 93101
50 "D" Street, Suite 420, Santa Rosa, CA 95404-4771
31 East Channel Street, Room 344, Stockton, CA 95202-2314
6150 Van Nuys Blvd., Room 105, Van Nuys, CA 91401-3370
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).