California Workers' Compensation Claims: Eligibility, Filing and Appeals

This article gives you a clear overview of how the workers' comp laws work in California.

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The California workers’ compensation program, like all other states’ workers’ comp systems, is regulated and operated by the state, not the federal government. This article gives you a clear overview of how the workers' comp laws work in California.

Workers' Comp Basics in California

In a nutshell, California employers must provide workers’ compensation benefits to employees by paying for workers’ compensation insurance from one of the many licensed insurers in the state, or from the State Compensation Insurance Fund (SCIF). All employers must purchase workers’ compensation insurance, regardless of the number of employees. When a worker suffers a work-related accident or becomes ill due to conditions on the job, the insurance company pays for the employee’s medical treatment, lost wages, and possibly compensation for a permanent impairment and job retraining.

If a worker is injured and the employer was not properly insured, California’s Uninsured Employer’s Benefit Trust Fund (UEBTF) will step into the place of the insurance company to pay worker’s compensation insurance benefits. The UEBTF will then attempt to recover the money from the illegally uninsured employer.

Common Work-Related Injuries

The most common workers’ comp injuries in California are from car (or truck) accidents, falls, and lifting or moving objects. Almost all injuries and illnesses arising at work and related to the job are eligible for workers’ compensation benefits. This includes injuries caused by a one-time accident, cumulative injuries (injuries caused by doing the same motion over and over), and illnesses arising out of the job environment or work tasks. For information on injuries that happen off the jobsite and injuries that may have been the employee’s fault, see our article on which particular injuries and workers are covered by workers’ comp.

How to File a California Workers Compensation Claim

You should notify your employer as soon as you are injured or know that a work-related illness has developed. Unless you have a medical emergency, do this before seeking medical treatment, as your employer may refer you to a physician who is part of its medical provider network.

After you have obtained treatment, fill out DWC (Division of Workers’ Compensation) Form 1 and give it to your employer, who will in turn give it to its workers’ compensation insurance company. You will also need to file an Application for Adjudication of Claim within one year of your injury to officially file your worker’s comp claim.

There are several other forms you need to file with the Application for Adjudication of Claim—for more information, see Nolo's article on filing a worker’s comp claim in California (this article also covers how and when the insurance company must reply to your claim).

Collecting Workers' Compensation Benefits in California

California workers’ compensation insurance pays for all medical expenses related to the injury, as long as the medical expenses are authorized. But at least at first, you may have to select a doctor within the medical provider network.

Temporary disability benefits are also available if you are unable to work for a period of time. Temporary disability pays two-thirds of your average weekly wage while you are temporarily disabled, up to a weekly maximum. The weekly maximum was $1,074.64 for 2014. There may be up to a 90-day delay in your first payment while your claim is pending approval.

If your ability to work has been permanently impaired, partially or totally, you will also be eligible for permanent disability benefits. Permanent disability payments are based on the percentage of the impairment you suffered as a result of the work-related injury. Workers' compensation benefits are not taxable.

Workers' Compensation Claim Denials

Your employer’s insurance company might deny your claim if it believes that:

  • there is insufficient evidence of an injury
  • your injury isn’t work-related
  • your injury is due to another job
  • you don’t need medical treatment, or
  • you can return to work.

Appealing a California Workers' Compensation Denial

If you disagree with your employer or insurer about a benefits decision, including the denial of your claim, you can file a Declaration of Readiness to Proceed with the Worker’ Compensation Appeals Board (WCAB). You must also serve this form on your employer’s insurance company and include a proof of service form. The Appeals Board will hold a hearing and make a determination on your claim. For more information, see our article on appealing a denial of your California workers' comp claim.

Following are the WCAB locations in California.

California Workers' Compensation Appeals Board Locations

Anaheim office:
1065 N. PacifiCenter Dr.
Anaheim, CA 92806
(714) 414-1801 
AHM@dir.ca.gov

 

Riverside office:
3737 Main St., Rm. 300
Riverside, CA 92501
(951) 782-4347 
RIV@dir.ca.gov

 

 

Bakersfield office:
1800 30th St., Ste. 100
Bakersfield, CA 93301
(661) 395-2514

 

Sacramento office:
160 Promenade Circle, Ste. 300
Sacramento, CA 95834
(916) 928-3158 
SAC@dir.ca.gov

 

Eureka office:
100 H St., Rm. 202
Eureka, CA 95501
(707) 441-5723 
EUR@dir.ca.gov

 

Salinas office:
1880 North Main St., Ste. 100
Salinas, CA 93906
(831) 443-3058 
SAL@dir.ca.gov

 

Fresno office:
2550 Mariposa Mall, Rm. 2035
Fresno, CA 93721
(559) 445-5355 
FRE@dir.ca.gov

 

San Bernardino office:
464 W. Fourth St., Ste. 239
San Bernardino, CA 92401
(909) 383-4522 
SBR@dir.ca.gov

 

Goleta office:
6755 Hollister Ave., Rm. 100
Goleta, CA 93117
(805) 968-4158 
GOL@dir.ca.gov

 

San Diego office:
7575 Metropolitan Dr., Ste. 202
San Diego, CA 92108
(619) 767-2082 
SDO@dir.ca.gov

 

Long Beach office:
300 Oceangate St., Ste. 200
Long Beach, CA 90802
(562) 590-5240 
LBO@dir.ca.gov

 

San Francisco office:
455 Golden Gate Ave., 2nd flr
San Francisco, CA 94102
(415) 703-5020 
SFO@dir.ca.gov

 

Los Angeles office:
320 W. 4th St., 9th flr
Los Angeles, CA 90013
(213) 576-7389 
LAO@dir.ca.gov

 

San Jose office:
100 Paseo de San Antonio, Rm. 241
San Jose, CA 95113
(408) 277-1292 
SJO@dir.ca.gov

 

Marina del Rey office:
4720 Lincoln Blvd., 2nd flr
Marina del Rey, CA 90292
(310) 482-3820 
MDR@dir.ca.gov

 

San Luis Obispo office:
4740 Allene Way, Ste. 100
San Luis Obispo, CA 93401
(805) 596-4159 
SLO@dir.ca.gov

 

Oakland office:
1515 Clay St., 6th flr
Oakland, CA 94612
(510) 622-2861 
OAK@dir.ca.gov

 

Santa Ana office:
605 W Santa Ana Blvd, Bldg 28, Rm. 451
Santa Ana, CA 92701
(714) 558-4597 
ANA@dir.ca.gov

 

Oxnard office:
1901 N. Rice Ave., Ste. 200
Oxnard, CA 93030
(805) 485-3528 
OXN@dir.ca.gov

 

Santa Rosa office:
50 D St., Rm. 420
Santa Rosa, CA 95404
(707) 576-2452 
SRO@dir.ca.gov

 

Pomona office:

732 Corporate Center Dr.
Pomona, CA 91768
(909) 623-8568 
POM@dir.ca.gov

 

Stockton office:
31 East Channel St., Rm. 344
Stockton, CA 95202
(209) 948-7980 
STK@dir.ca.gov

 

Redding office:
2115 Civic Center Dr. Rm. 15
Redding, CA 96001
(530) 225-2047 
RDG@dir.ca.gov

 

Van Nuys office:
6150 Van Nuys Blvd., Rm. 105
Van Nuys, CA 91401
(818) 901-5367 
VNO@dir.ca.gov

by: , J.D.

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