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.
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.
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.
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. If you fail to report your injury within 30 days, you might lose your right to collect benefits.
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).
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 is $1,215.27 for 2018. If your injury is covered, payments should begin within 14 days.
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.
Your employer’s insurance company might deny your claim if it believes that:
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.
732 Corporate Center Dr.