+ 1. What is Workers Compensation?

If you get hurt on the job, your employer is required by law to pay for workers’ compensation benefits. You could get hurt by:

One event at work. Examples: hurting your back in a fall, getting burned by a chemical that splashes on your skin, getting hurt in a car accident while making deliveries.

or:

Repeated exposures at work. Examples: hurting your hand, back, or other part of the body from doing the same motion over and over, losing your hearing because of constant loud noise.

Workers’ compensation covers some, but not all, stress-related (psychological) injuries caused by your job.

+ 2. WHAT SHOULD I DO IF I AM INJURED AT WORK?

If you are injured at work or otherwise believe you have suffered an injury because of your work you should report it to your employer. You employer should provide you with a “claim form”. If your employer has given you a claim form you should fill it out and return it to your employer. Be sure to make a copy for yourself.

Note: Your employer must give or mail you’re a Workers’ Compensation Claim Form (DWC-1) within one working day after you report your injury or illness (or your employer learns about it.) You use this form to formally request workers’ compensation benefits. If your employer does not give you a claim form you can download one HERE.

You should complete and return the claim form as soon as possible. This will avoid providing the employer the opportunity to dispute or otherwise refuse to acknowledge your injury.

+ 3. What happens after I file my claim form with my employer?

Your employer should complete the bottom portion and give the complete form to a claims administrator. This person handles workers’ compensation claims for your employer. Most claims administrators work for insurance companies or other organizations that handle claims for employers. These companies are known as Third Party Administrators.

The claims examiner must decide within a reasonable time whether to accept or deny your claim. If your claim is “Accepted” it means the claims administrator agrees your injury is covered by workers’ compensation. If your claim is accepted you will receive paid medical care for your injury. You may also be entitled to payments to make up for lost wages. (Temporary Disability)

If your claim is “Denied” it means the claims administrator believes your injury is not covered by workers’ compensation. If the claims administrator sends you a letter denying the claim, you have a right to challenge the decision. Do NOT delay because there are deadlines for filing the necessary paperwork.

+ 4. Am I entitled to my salary or Temporary Disability while I am off work?

If your injury prevents you from doing your usual job while recovering, you may be eligible for temporary disability (TD) benefits. TD benefits are payments you receive if you lose wages because:

1. Your treating doctor says you are unable to do your usual job for more than three days, or you are hospitalized overnight; and
2. Your employer does not offer you other work that pays your usual wages while you recover.
3. You will not receive a full salary. Temporary Disability benefits are usually 2/3 of your average weekly wages.
4. You do not get paid for the first 3 days off work unless your disability lasts 14 days or more.

+ 5. When do my Temporary Disability benefits begin?

If your injury is covered by workers’ compensation, your first TD payment is due within 14 days after your employer learns that: • You have a job injury or illness; and • Your treating doctor says your injury prevents you from doing your job. You should receive this payment from the claims administrator. The claims administrator must also send you a letter explaining how the payment amount was calculated. • After the first payment, TD benefits must be paid every two weeks, for as long as you are eligible. The maximum benefit period of Temporary Disability payments is 104 weeks per injury.

+ 6. How much is my case worth?

This of course depends on the individual as well as the nature and extent of the injuries. There are a number of variables associated with the valuation of a workers compensation case included the type of work performed, the age of the worker, the worker’s earnings, as well as the extent of any disability as determined by a doctor.

+ 7. How long does it take for my case to resolve?

This can depend on several factors such as the nature and extent of injuries including treatment duration. Cases typically can take anywhere from several months to over a year to resolve. The resolution of a case can be delayed by the need for continued medical treatment, the investigation of the claim by the employer, as well as the potential for a medical examination to be performed by a specially qualified doctor.

+ 8. How is my case going to be resolved?

There are two primary ways a case is resolved. The most common resolution is by way of settlement. This usually involves a lump sum payment by an insurance company. In certain cases it is more advantageous for an injured worker to settle the Permanent Disability benefit while leaving open future medical treatmetn. It can also be resolved through trial if the parties are unable to agree on a settlement. In certain situations an insurance company may wish to not offer any settlement at all and take the matter to trial.

+ 9. Who pays for the doctors?

When you are sent to a doctor either by your employer, the insurance company, or your attorney the employer or insurance company is responsible for those costs. An employer may not seek to have an injured worker pay for their own work injury costs.

+ 10. CAN I CHOOSE MY OWN DOCTOR?

It depends on whether you tell your employer in writing—before you are injured—the name and address of your personal physician or a medical group. This is called “predesignating.” If you predesignate, you may see your personal physician or the medical group right after you are injured. As a general rule, the employer/insurance company has the right to medical control for the first 30 days after notice of injury.

+ 11. Am I entitled to emergency care?

An injured worker is entitled to emergency medical care at the employer’s expense. If you are injured on the job, your medical expenses, including emergency care, should be covered by workers’ compensation insurance carried by your employer.

+ 12. How much do I have to pay my attorney?

Your attorney is typically compensated at 15% of your settlement or award. You pay no out of pocket fees. We only get paid if you get paid. We are paid directly from the insurance company. Additionally your payments come directly from the insurance company.

+ 13. Can I file a Workers Compensation Claim even if I am not in the United States legally?

Yes. California law provides that even a worker not legally in the United States may obtain Workers Compensation Benefits. When bringing a Workers Compensation Claim it is important that your true name is used. Problems can arise if a worker is “sharing” a name and/or social security number with other people. For more information click here.

+ 14. How do I get paid if my case settles?

You will be sent a check directly to you from the insurance company.

+ 15. What if my employer does not have Workers Compensation Insurance?

In this event a worker may choose to sue an employer directly in civil court. This presents a problem in that it can be extremely difficult to obtain payment. Frequently such employers “disappear” or are insolvent. Additionally it may be possible to obtain benefits from the Uninsured Employers Benefit Trust Fund.

+ 16. Can I continue to work while my case is pending?

Many people are faced with the economic reality of not having any income after filing their claim, either because they were terminated or they have been denied state disability insurance benefits. Nothing prevents an injured worker from seeking other employment. You should however check with your doctor. If you start working for another employer while your claim is pending it can impact your claim. An insurance company can conclude that since you are well enough to work that your case may have no merit.

+ 17. How will an employer or insurance company know if I am working someplace else?

Insurance companies frequently make use of private investigators to follow workers who bring injury claims. An investigator will follow a workers compensation claimant throughout the day to learn more about their daily activities and to see if they are “faking” their injuries.

+ 18. WHAT IF I CAN’T RETURN TO MY OLD JOB BECAUSE OF MY INJURIES?

Most workers recover from their job injuries. But some continue to have problems. If your treating doctor says you will never recover completely or will always be limited in the work you can do, you may have a permanent disability. This means that you may be eligible for Permanent Disability (PD) benefits.

You don’t have to lose your job to be eligible for PD benefits. On the other hand, if you lose income because of a permanent disability, PD benefits may not cover all the income lost.

You may also be eligible for a Supplemental Job Displacement Benefit Voucher. A supplemental job displacement benefit is a voucher of up to $6,000.00 that promises to help pay for educational retraining or skill enhancement, or both, at eligible schools. You can use the voucher to pay for tuition, fees, books, tools, or other expenses required by the school for retraining or skill enhancement, and for licensing or professional certification fees, related examination fees, and examination preparation course fees.

Up to $600 of the voucher money may be used to pay for services of a licensed placement agency, a vocational or return-to-work counselor (a person who helps injured workers develop their goals and plans for returning to work), and resumé preparation.

Up to $1,000 may be used to purchase computer equipment.

Up to $500 of the voucher money may be used upon request for miscellaneous expenses without receipts or other documentation.

You may also be eligible for future medical benefits. Additionally you may also be eligible for a one time $5,000.00 return to work supplement.

+ 19. BESIDES WORKERS’ COMPENSATION BENEFITS, CAN I GET ANY OTHER FINANCIAL ASSISTANCE?

Other types of assistance may be available:

State Disability Insurance (SDI) or, in some cases, unemployment insurnace (UI) benefits paid by the Employment Development Department (EDD) when workers’ compensation payments are delayed or denied. (You should file a claim for SDI or UI benefits if you are not working because of your injury, in case there is a problem with your workers’ compensation claim. (Make sure to tell the EDD about your workers’ compensation claim.)

Social Security disability benefits paid by the US Social Security Administration (SSA) for total disability. (These benefits may be reduced by workers’ compensation payments that you receive.)

Benefits offered by employers and unions, such as sick leave, group health insurance, long term disability insurance (LTD), such as AFLAC®, and salary continuation plans.

A claim or lawsuit if your injury was caused by someone OTHER THAN YOUR EMPLOYER. We can provide referrals for third party claims such as car accidents and non-employer premises liability.

+ 20. CAN MY EMPLOYER FIRE ME BECAUSE OF MY INJURY OR BECAUSE I FILED A CLAIM FOR WORKERS’ COMPENSATION BENEFITS?

It is illegal for you employer to punish or fire you for having a job related injury, or for filing a workers’ compensation claim when you believe your injury was caused by your job. It is also illegal for your employer to punish or fire co-workers who testify in your case. California Labor Code Section 132a prohibits this kind of discrimination.

Also, the Federal and Family Medical Leave Act (FMLA) and the California Family Rights Act (CFRA) say that an employer with 50 or more employees usually must let you take unpaid leave for up to 12 weeks, without losing your job, if you need time off for a serious medical condition.

If you do not fully recover from you injury, the Federal Americans With Disabilities ACT (ADA) and the California Fair Employment and Housing Act (FEHA) make it illegal for your employer to discriminate against you for taking action to protect your rights.

If you feel you havebeen the subject of job discrimination you can file a complaint with the [California Civil Rights Department]

+ 21. Are my Workers Compensation Benefits taxable?

Generally Workers Compensations Awards, Settlements, and benefits are not taxable. For further information please see IRS Publication 525 at page 19.