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Workers Comp
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FREQUENTLY ASKED QUESTIONS

 

Should I consult an Attorney?
If you have sustained an industrial injury, it is recommended that you should consult with an attorney immediately. Consulting an attorney in workers’ compensation is "free." A reputable workers’ compensation attorney should advise you whether or not you require representation on your case. Further, should you wish representation, the matters are handled on a contingency fee basis. A fifteen percent attorney fee is generally awarded on most cases.

Will the Claims Administrator take care of me?
Insurance Companies and claims administrators are in the business of making money. They are not in the business of taking care of you, the injured worker. Insurance companies’ and claims administrators’ goal is to limit the amount of exposure or expense that the insurance company or employer has with respect to your individual claim. Fortunately, the Labor Code and Regulations spell out to the insurance companies and claims administrators the benefits that they are mandated to provide. Furthermore, the State has the Workers’ Compensation Appeals Board (W.C.A.B.) which has the ability to find that your claim of injury is work-related and order the insurance company or claims administrator to provide benefits. If you rely upon the carrier or claims administrator for all of your information and advice, eventually you will experience situations upon which you feel or suspect that there is an attempt to shortchange your benefits. Your feelings and/or suspicions may be valid.

Can I only use the county doctor for treatment?
Within certain parameters during the first 30 days from notification of the claim, you can request a change of doctors. After 30 days, if you have not been released from your physician with no need for further medical care, you can choose a physician of your own choice. If the county does not provide you with immediate medical assistance, you should self-procure medical treatment and submit the bills to your employer. If your employer belongs to a Health Care Organization (HCO), the rules may be different. TO AVOID THESE PROBLEMS PREDESIGNATE A PHYSICIAN. THE FORMS ARE AVAILABLE ON THE DEPARTMENT INTRANET FORMS PAGE.

Who's Covered?
Virtually all working Californians are "employees" for purposes of workers' compensation. Exemptions are few. People in business for themselves and some unpaid volunteers may not be covered

What's Covered?
Any injury caused by the job is covered -- everything from first-aid type injuries to serious accidents. Job-related illnesses are covered too. (For example, common colds and flu aren't covered, but if you catch tuberculosis while working at a TB hospital, that's covered.) 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. You don't have to work a certain amount of time or earn a certain amount 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 it 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 Insure 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 three kinds of workers' compensation benefits:

  • Medical care to cure 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.
  • Cash payments to help replace lost wages. Most injuries only keep you from working temporarily, and you'll receive "temporary disability" payments until the doctor says you're able to return to work. Additional cash payments will be made after you're able to work 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 surviving dependents.
  • Rehabilitation services necessary to return you to work. This is just an extension of medical treatment--for example, physical therapy to strengthen muscles. However, if the injury keeps you from returning to your regular work, your employer will advise you if your regular job can be modified or if another position can be provided to accommodate your permanent disability.

Employee Claim Form:
Within one working day of receiving notice or knowledge of injury or illness which results in lost time beyond the date of injury or illness or which results in medical treatment beyond first aid, the employer must provide, personally or by first class mail, a claim form (DWC-1) and a notice of potential eligibility for benefits to the injured employee, or in the case of death, to his or her dependents.

Do I have the right to reopen for new and further disability?
If your case is resolved by Stipulation or by Findings and Award, you are entitled to petition to reopen your case and seek new and further disability within five years from the date of injury. The petition must be timely filed at the Workers' Compensation Appeals Board. New and further disability may include such items as additional Total Temporary Disability benefits, Permanent Disability Benefits, additional injured body parts, and vocational rehabilitation.

Do I have any protection from discrimination?
Labor Code Section 132a provides that an employer may not discriminate against an injured worker who has filed a claim. Discrimination may take many shapes or forms and it may include such actions as termination of employment, a suspension, demotion, and loss of benefits. You have one year from the date of the discriminatory act to file such a claim.

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 work site or be available from your employer). Many times problems and questions can be resolved with a simple phone call. If you still need help, you may call or write to an Information and Assistance Officer employed by the state. 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. This is a free service provided by the state. The Division of Workers' Compensation has 25 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 San Diego
7575 Metropolitan Rd., Suite 202, San Diego, CA 92102-4402
(619) 767-2082