The initial notification of an injury at work is to be taken to the employer to claim workers’ compensation. That said, if a worker is injured at work, he is supposed to inform his employer of the incident at hand. This notification can be carried out either in person or in writing. Once the employer is aware of the injury, he is supposed to inform the workers’ comp carrier. Want to file a workers’ comp claim? We discuss the process in greater detail below:
Making A Workers’ Compensation Claim
Filing for workers’ compensation may seem complicated, but we have broken down the process into 5 simple steps.
Report The Injury To Your Employer
When an employee suffers an injury at the workplace, he is expected to bring the issue to the employer’s knowledge. While every state may have a different deadline for submitting a work-related injury report, most states recommend that the employer shall be notified within 30 days of sustaining injuries or the claim might be rejected.
Submit Official Paperwork
Once the employer is made aware of the injuries, he shall guide the employee on the necessary documentation and paperwork required to file workers’ comp. In most states, a workers’ compensation form is provided by the employer to the injured employee. This form will detail everything related to the incident, including the nature of the injury and how, when, and where the injury occurred.
Employer Forwards The Claim Form
After the form has been filled out by the employee and the necessary paperwork has been carried out, it is upon the employer to send the claim form to the workers’ compensation carrier. Along with that, the employee’s doctor is required to submit a medical report.
The Claim Is Approved Or Denied
Once the claim has been filed, the workers’ compensation carrier or insurer would either approve or deny the claim. In the case of approval of the claim, the insurer will forward the payment details to the employee. The employee and his lawyer may either accept the offer or negotiate for a larger settlement. If the claim is denied by the insurer, the employee is at liberty to apply for a formal appeal through the state board of workers’ compensation.
Employee Returns To Work
The final step in processing a workers’ compensation claim is the safe return of the injured employee with a personalized return-to-work plan. Depending on the injury, the employer may provide the employee with necessary changes in the work environment or in his job role for the smooth functioning of his employment.
Hire A Trusted Legal Team
If you have been injured at work, you may be entitled to workers’ compensation. At Hussain & Gutierrez, we can guide you through the process and help you make your claim. Our legal expertise extends to this area of law and beyond. We are a team of experts dedicated to you.
Extended Workers’ Compensation Guide for California
What is Workers’ Compensation in California?
California’s workers’ compensation system provides financial protection and medical care to employees who are injured or become ill due to work-related activities. It is a no-fault system managed by the California Division of Workers’ Compensation (DWC).
Benefits include:
- Paid medical treatment
- Temporary and permanent disability payments
- Supplemental Job Displacement Benefits (SJDB)
- Death benefits to dependents
Important California Workers’ Comp Forms
| Form | Purpose |
| DWC-1 | The official claim form is submitted to your employer to initiate the case |
| QME Request Form | Used when requesting an independent medical evaluation |
| Application for Adjudication | Starts legal proceedings with the WCAB |
| Compromise & Release (C&R) | One-time lump-sum settlement agreement |
| Stipulations with Request for Award | Settled agreement with ongoing benefits |
Types of Workers’ Comp Benefits
| Benefit Type | Details |
| Medical Care | Covered 100% by employer’s insurer; subject to Utilization Review |
| Temporary Disability (TD) | ~66% of your average weekly wages while recovering |
| Permanent Disability (PD) | Based on the % disability rating using the PDRS |
| SJDB Voucher | $6,000 for vocational retraining if unable to return to work |
| Death Benefits | Given to spouse, children, or dependents if a worker dies from injury |
Medical Treatment Rules in California
- You must get treatment from a doctor in your employer’s Medical Provider Network (MPN).
- Doctors submit treatment requests to Utilization Review (UR).
- If UR denies treatment, you can appeal through Independent Medical Review (IMR).
- Only predesignated personal doctors can be used if declared in writing before the injury.
Why Workers’ Comp Claims Get Denied
- Injury not reported within 30 days
- Not enough medical evidence
- The injury occurred outside the scope of employment
- Missed deadlines for QME or appeal filings
- Pre-existing conditions are blamed
What to Do If Your Claim Is Denied
- File for a Qualified Medical Evaluator (QME) within 10 days of receiving a denial.
- Submit an Application for Adjudication via EAMS (Electronic Adjudication Management System).
- Attend a Mandatory Settlement Conference (MSC).
- Present your case to a Workers’ Compensation Judge (WCJ) if needed.
Legal Protections & Retaliation (Labor Code 132a)
It is illegal for an employer to retaliate against an employee for filing a claim. If they do:
- You may file a 132a petition
- You may be entitled to backpay, reinstatement, and up to $10,000 in penalties
Types of Settlements in California
| Settlement Type | Description |
| Compromise & Release (C&R) | One-time payment; no future benefits |
| Stipulated Award | Agreed disability rating + open medical care |
| Findings & Award | Result of a trial when parties can’t settle |
Understanding Permanent Disability Ratings (PDRS)
- Your disability rating is a % between 0 and 100
- Determined by QME/PTP based on medical condition, age, and job type
- Impacts your permanent disability compensation amount
Industry-Specific Risk Examples
Construction – Falls, machinery injuries
Healthcare – Back injuries, infectious diseases
Transportation – Vehicle crashes, long-haul trauma
Tailoring claim strategy based on industry improves the effectiveness of legal and medical support.
Frequently Asked Questions (FAQs)
What is a Qualified Medical Evaluator (QME)?
A QME is a certified independent doctor who resolves disputes over work injuries in California claims.
Can I sue my employer for a work injury in California?
No, unless there’s gross misconduct. Workers’ comp is the exclusive remedy in most cases.
How long do I have to file a workers’ comp claim in California?
You must notify your employer within 30 days and file your claim with the WCAB within 1 year.
What’s the difference between C&R and Stipulated Awards?
- C&R gives you a lump-sum payment and ends future rights.
- Stipulated Award allows ongoing medical care and partial payments over time.
Can I change doctors in the MPN?
Yes. You can switch to another physician within the MPN or request a panel QME if dissatisfied.
People Also Ask (PAA) – Answered
How much does workers’ comp pay in California?
Temporary Disability (TD) pays about 66% of your gross wages, capped by annual limits.
How is permanent disability calculated?
The Permanent Disability Rating Schedule (PDRS) assigns a rating based on impairment, which is then used in a formula to calculate compensation.
What if the insurer denies medical treatment?
You can file for an Independent Medical Review (IMR) to appeal the denial.
How long does it take to settle a workers’ comp case in California?
Simple cases settle within 6–12 months, while complex ones (especially with appeals) can take 1–2 years or more.
Need Help With Your California Workers’ Compensation Claim?
At Hussain & Gutierrez, we understand how overwhelming the workers’ compensation process can be, especially when you’re trying to recover from an injury and protect your financial future.
Whether your claim has been denied, you’re dealing with delayed medical treatment, or you simply want to maximize your settlement, our experienced legal team is here to fight for you.
We specialize in California workers’ compensation law
We’ll guide you through every step from DWC-1 to settlement
No upfront fees you don’t pay unless we win
Contact us today for a free, no-obligation consultation:
Visit Hussain & Gutierrez Law
Proudly serving injured workers across Los Angeles, San Fernando Valley, and Southern California
Don’t leave your rights to chance; let trusted legal professionals handle your claim so you can focus on healing.
