California workers are entitled to prompt, effective medical treatment for any injuries or illnesses they suffer while on the job, regardless of who is at fault. The state workers’ compensation law also requires employers to pay essential benefits to injured employees who cannot immediately return to work.
To ensure injured employees have access to workers’ compensation, all employers are required under state law to carry workers’ compensation insurance. This mandate applies to any business that has employees, even if they only have a single employee.
The workers’ comp process can be confusing and frustrating, especially when you’re dealing with injuries or denied claims. That’s where California Work Injury Law Center (CWILC) comes in. CWILC helps injured workers understand their rights, get the benefits they’re entitled to and resolve disputes with employers or insurance companies. Whether it’s getting access to proper medical care, getting the most compensation or appealing denied claims, CWILC is here to protect California workers and walk them through the whole process.
What is Workers’ Compensation?
The U.S. workers’ compensation system is the country’s oldest social insurance program and has been adopted in most states, including California. Workers’ compensation insurance provides benefits to employees who suffer on-the-job injuries or certain work-related illnesses. These benefits usually take the form of payments for the employee’s medical care and compensation for lost income.
California’s workers’ compensation law provides for no-fault insurance policies that cover injuries related to employment. Unlike some states, California’s workers’ compensation law does not require that an employer be negligent or at fault to collect.
How to Apply for Workers Compensation in California
If you work in California and have been injured on the job, you will start the workers’ compensation process by filing a Workers’ Compensation Claim Form within one day of learning of your injury. Every employer must provide an injured worker with a copy of the form, so you should contact a workers’ compensation attorney if your employer refuses to do so.
After receiving the form, your employer will add additional information and submit the completed form to its workers’ compensation insurance provider. Your employer should also provide you with a copy of the form. The insurance company usually has 14 days to mail out a letter informing you of the status of your claim. If you file a form and your employer has not denied the claim within 90 days, the injury is presumed to be covered by workers’ compensation.
By law, your employer is required to authorize any appropriate medical treatment for your injuries within one day of your filing a claim. While your request for workers’ compensation is being considered, you can receive up to $10,000 in medical treatment. If your employer fails to pay your claim promptly, you may be entitled to increased payments.
If your claim is rejected, you have the right to appeal the decision to the Workers’ Compensation Appeals Board and ask that it review the determination. Should you choose to file an appeal, it is generally a good idea to hire a lawyer, such as CWILC, to represent you to protect your rights because your employer and its insurer will have lawyers arguing their side of the claim.
What Does Workers’ Compensation Cover?
Workers’ compensation in California provides comprehensive support for employees injured on the job. Here’s what’s covered:
1. Medical Care
- Initial Treatment: Your employer must pay for your immediate medical care, even if your injury doesn’t cause you to miss work.
- Ongoing Treatment: Coverage extends to necessary follow-up care, including specialist visits, medications, and even transportation costs to and from medical appointments.
2. Temporary Disability Benefits
If your injury prevents you from working temporarily, you’re entitled to temporary disability (TD) benefits.
- What’s Covered: Partial wage replacement for the time you cannot work, calculated as two-thirds of your average weekly earnings (subject to state limits).
- How Long: Benefits typically last until your doctor says you can return to work or you reach maximum medical improvement.
3. Permanent Disability Benefits
If your injury results in a lasting impairment, you may qualify for permanent disability (PD) benefits.
- What’s Covered: Compensation based on the severity of your disability and its impact on your ability to work.
- Additional Support: Even if you return to work, you may still receive PD benefits.
4. Wage Replacement and Job Retraining
If you cannot return to your previous job due to your injury, workers’ comp can cover retraining or education to help you transition to a new career.
5. Death Benefits
In cases where a workplace injury leads to death, dependents and spouses are entitled to financial compensation, including funeral expenses and ongoing support.
Workers’ Compensation Settlements in California
Under California law a worker who has suffered an on-the-job injury can settle their claim with the insurance company. That is done by either agreeing to let the insurance company pay for all future medical care related to the injury, or taking a lump-sum payment equal to the cash value of any anticipated treatment. The settlements are referred to as either a:
Stipulation and Award Agreement: You will enter into a relationship with the insurer to provide you with care for your injuries over the rest of your life. The agreement usually stipulates which injuries and body parts are covered, so you will not be covered for any medical issues unrelated to the workplace injury.
Compromise and Release Agreement: This means you will settle the case for one or more cash payments. While a compromise and release puts cash into your pocket, neither the insurer nor your employer will pay for any future medical care for your injuries.
Common Questions About California Workers’ Compensation
Who is exempt from workers’ compensation insurance?
Since any business with at least one employee must have workers’ compensation insurance in California, nearly all employers carry policies. However, the following are exempt:
- Business owners with no employees (except roofers)
- Some volunteers
- Students participating in amateur sporting events
- Officials for amateur sporting events
- Domestic workers related to their employer
- Deputy sheriffs and clerks
- People who work for food, housing, or other benefits instead of pay
How is workers’ compensation calculated?
In California, workers’ compensation payments for temporary or permanent disability are based on a percentage of your pre-tax wages. Eligible workers typically receive two-thirds of their average weekly earnings, up to a state-mandated maximum. The maximum weekly benefit for injuries in 2024 is $1,619.15 in California. The maximum weekly benefit for TTD will increase to $1,680.29 for injuries that occur on or after January 1, 2025. These payments are generally non-taxable, providing financial support while you recover from your injury.
Who pays workers’ compensation in California?
In California every employer is required to purchase workers’ compensation insurance and, if an employee gets hurt, the insurance company will pay out the benefits to the injured individual. That means the state’s workers’ compensation benefits are financed by the business owners who paid for their policies.
Can my workers’ compensation settlement be garnished for child support?
If you owe child support and are hurt while on the job, you can contact your local district attorney’s office and request a support order modification. It is recommended that you do so right away so you do not accumulate any legal or financial penalties while you have no income.
When you receive a lump-sum workers’ compensation payment, California law permits the district attorney to take a portion of the settlement, including any unpaid child support for the period you were on disability.
