Every job, whether in California or elsewhere, comes with its own set of risks or hazards. The majority of the time, you may be able to avoid them, but there could come a time when fate catches up to you, and you suffer an on-the-job injury. Workplace accidents can include sudden incidents, such as falls or equipment malfunctions, or long-developing conditions like repetitive stress injuries and occupational illnesses.
Knowing what happens in the event of such an injury before it happens might make the situation at least a little less stressful. Taking the appropriate steps if you suffer an injury at work can help accelerate the claims process and ensure you receive the benefits you need and deserve.
At the Time of the Injury
Depending on the severity of your injuries, you or a co-worker may need to call 911. Emergency medical services should be contacted right away if you are facing a life-threatening condition. You should not wait for your primary care physician or another doctor in the event of an emergency.
If your injury does not require immediate medical attention, you may seek first aid at work or visit an urgent care clinic. California law requires that employers authorize up to $10,000 in medical treatment while your workers’ compensation claim is pending, even before the claim is officially approved. This ensures that injured workers receive immediate care.
Reporting Your Injury to Your Employer
You should report your injury as soon as possible. Any delay could jeopardize your ability to receive workers’ compensation benefits. California law requires employees to notify their employer of a workplace injury within 30 days.
Your employer must then provide you with a DWC-1 claim form on the following business day. Once you complete and submit the form, your employer is required to forward it to their workers’ compensation insurance carrier. From there, the insurer has 90 days to accept or deny your claim. During this period, medical care up to $10,000 must remain authorized.
Employers are also legally obligated to carry workers’ compensation insurance or be self-insured. Agencies such as the California Division of Workers’ Compensation (DWC) and the State Compensation Insurance Fund (SCIF) oversee compliance and the distribution of benefits.
The Primary Treating Physician
During the course of your claim, you will see a primary doctor for your treatment. Who that doctor is depends on several factors:
- If you chose a medical group or physician ahead of time.
- If your employer participates in a Health Care Organization (HCO) or Medical Provider Network (MPN).
- If your employer is not part of an HCO or MPN, and you have not chosen a doctor, your claims adjuster will select the doctor responsible for your care after a work-related injury.
Sometimes disputes arise over treatment recommendations. In such cases, your care may go through Utilization Review (UR), a process in which the insurance company evaluates whether a treatment is medically necessary. If treatment is denied through UR, you may request an Independent Medical Review (IMR). Additionally, the state may assign a Qualified Medical Evaluator (QME) to provide an impartial medical opinion.
Workers’ Compensation Benefits Available
You may receive several categories of benefits after an injury at work. These include:
- Medical Care: Coverage of all reasonable and necessary medical expenses, including doctor visits, surgeries, prescriptions, therapy, and medical equipment.
- Temporary Disability Benefits: Payments to replace a portion of lost wages if you cannot work while recovering. In California, temporary disability generally equals two-thirds of your average weekly wage, subject to state minimum and maximum limits. These benefits can last up to 104 weeks within five years of the date of injury. They are divided into Temporary Total Disability (TTD), if you cannot work at all, and Temporary Partial Disability (TPD), if you can work in a limited capacity.
- Permanent Disability Benefits: If your injury results in a lasting physical or mental impairment, you may qualify for permanent disability benefits. These are determined using the Permanent Disability Rating Schedule (PDRS), which assigns a percentage value to your level of impairment.
- Supplemental Job Displacement Benefits (SJDB): If your employer cannot accommodate your restrictions and you cannot return to your former job, you may receive a voucher worth up to $6,000 for retraining or education to pursue new work.
- Death Benefits: In the event of a fatal work-related injury, surviving dependents may be entitled to weekly death benefits and funeral expense reimbursement.
When Workers’ Compensation Claims Are Denied
Obtaining workers’ compensation benefits is not always as simple as filling out a form. Many workers encounter delays, disputes, or outright denials. Insurance companies may question whether the injury was truly work-related, or they may dispute the severity of the disability.
If your claim is denied, you have the right to file an appeal with the Workers’ Compensation Appeals Board (WCAB). At this stage, injured workers often require the assistance of an attorney. A lawyer can represent you in hearings, ensure your medical evidence is properly presented, and argue against unfair claim denials.
There are also alternative paths to resolving disputes. Some cases may settle through a Stipulated Award, where benefits are agreed upon but medical care remains open. Others may resolve through a Compromise & Release (C&R), in which the worker accepts a lump sum settlement in exchange for closing the claim. Each type of settlement has advantages and risks, which an attorney can explain in detail.
Legal Rights and Protections for Injured Workers
California law also protects workers from retaliation. Under Labor Code Section 132a, it is illegal for an employer to fire, discriminate against, or retaliate against an employee for filing a workers’ compensation claim. Workers may also bring Serious and Willful Misconduct claims against employers who intentionally violate safety regulations and cause injury.
These protections are crucial, as many workers fear reporting an injury due to concerns about job security. Understanding your legal rights can prevent further hardship.
How Hussain & Gutierrez Can Help
Filing a workers’ compensation claim is only the first step. From disputes over medical treatment to wrongful denials, the system can be overwhelming. At Hussain & Gutierrez, our attorneys focus exclusively on helping injured workers in California secure the benefits they deserve.
We understand the complexities of medical reviews, benefit calculations, settlement negotiations, and appeals before the WCAB. Our experience means we can anticipate the tactics insurance companies use to delay or deny benefits, and we know how to fight back.
If you or a loved one has suffered a workplace injury, do not delay. Contact Hussain & Gutierrez today for a consultation and let us protect your rights at every step of the process.
Frequently Asked Questions (FAQs)
How long do I have to report a workplace injury in California?
You must notify your employer within 30 days of the injury. If you fail to report it within this timeframe, you may lose your right to benefits.
Can I choose my own doctor for a workers’ compensation claim?
Yes, if you predesignate your personal physician before your injury. Otherwise, your care may be managed through your employer’s Medical Provider Network (MPN) or Health Care Organization (HCO).
How much will I get paid while on workers’ comp?
In California, temporary disability benefits typically equal two-thirds of your average weekly wage, subject to minimum and maximum amounts set by the state each year.
What happens if my workers’ comp claim is denied?
You have the right to appeal to the Workers’ Compensation Appeals Board (WCAB). Many injured workers benefit from hiring an attorney to challenge the denial and secure benefits.
What types of settlements exist in workers’ comp cases?
Settlements can be reached through a Stipulated Award, where benefits are ongoing but medical care remains open, or a Compromise & Release, where a lump sum is paid to close the case.
Can I be fired for filing a workers’ compensation claim?
No. California law under Labor Code Section 132a prohibits employers from retaliating against workers for exercising their right to file a claim.
What is a Qualified Medical Evaluator (QME)?
A QME is a state-certified doctor who evaluates your medical condition when there is a dispute about your injury or disability level. Their report often plays a key role in resolving claims.
