Frequently Asked Questions (FAQs)
for Injured Workers Dealing with
Workers’ Compensation in California
Introduction
Navigating the workers’ compensation system in California can be overwhelming for injured
workers. Here are some frequently asked questions and their answers to help you understand
your rights and the steps you can take.
FAQs
1. What is Workers’ Compensation?
Workers’ compensation is a system that provides financial and medical benefits to injured
workers who suffer work-related injuries or illnesses. It aims to assist injured workers by
providing some form of medical treatment, and providing compensation if impairment is found
by a doctor. However, its aim and the actual reality of the system may be different. This is why it
may be important for you to seek legal representation from an attorney.
2. Who is Eligible for Workers’ Compensation?
All employees who are injured at work in California are generally eligible for workers’
compensation benefits, regardless of their immigration status. This includes full-time, part-time,
and temporary workers. Independent contractors are not eligible. However, an injured worker
may be considered an employee if the employer has control over the worker’s time to show up
and end their work, take a lunch break, etc., which starts to look more like an employee.
3. What Should I Do If I Get Injured at Work?
If you get injured at work, you should:
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Report the injury to your employer as soon as possible.
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Seek medical treatment immediately. Although it is an employer’s responsibility to refer you to an industrial clinic, you may want to seek medical attention on your own, especially if you are in need of medical attention. These medical visits can later be used to prove that you injured yourself at work. Additionally, an attorney representing you should find a doctor to provide you some form of treatment at no cost to you.
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Complete a Workers’ Compensation Claim Form (DWC-1) and submit it to your employer if your employer hands you the form. This is your employer’s responsibility.
4. What Types Of Injuries Can You File In California For Workers’ Comp?
There are two types of work-related injuries that can be filed in court: a specific injury or
cumulative trauma. A specific injury is filed when an injured worker is injured at work on a
specific day. However, if the injury occurred or happened over a period of time due to repetitive
work, this is what is referred to as a cumulative injury. In this circumstance, an injured worker
may not even know if their injury was due to their work until they see a doctor and they are told
by a doctor. You should file your claim as soon as possible to avoid being barred from filing your
claim.
5. Do I Have To Pay For Medical Bills In Workers’ Comp?
No. Generally, your employer’s workers’ compensation insurance will pay for a workers’
compensation doctor you end up seeing. In certain cases where the employer does not have
workers’ compensation, your employer can be on the hook for the treatment.
6. What Benefits Can I Receive?
Workers’ compensation benefits can include:
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Medical care for your injury or condition.
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Temporary disability benefits/payments if you are unable to work and placed on disability by a doctor. For most cases, the maximum amount of temporary disability payments from an insurance company one can get is 104 weeks. Disability benefits are calculated based on roughly two-thirds of an injured worker’s weekly wage.
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If the case ends up being denied, a workers’ compensation doctor may be able to help you certify EDD benefits by placing you on disability. But EDD benefits depend on whether your employer was taking out of your paycheck a percentage for EDD. EDD benefits are also limited to a maximum of 1 year—depending if you have enough funds in your EDD account and if the certifying doctor keeps you on disability.
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Permanent disability benefits if you do not fully recover. This will eventually be determined in part by a treating physician or an independent medical examiner (e.g., a doctor whose role is to simply evaluate you—a PQME or AME—see below), your job occupation at the time of injury, and your age at the time of injury.
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Supplemental job displacement benefits (SJDB) if your employer fails to make you a job offer within 60 days of a final medical report that show more than 0% of impairment for a body part or condition. You may qualify for a $6,000 voucher to use at a vocational school or community college for retraining purposes. If you qualify for the voucher, the voucher can then be registered with the State of California so that you can get a check from the State for $5,000.
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Death benefits to your dependents if you die because of a work-related injury or illness.
7. How Long Do I Have to File a Claim?
You should file your workers’ compensation claim as soon as possible. In California, you have
up to one year from the date of injury to file your claim, but it is best to act promptly. However,
although this is the general rule, there are exceptions to this rule. For instance, if you have been
treating for your injury, you may be able to file your claim one year from your last date of
treatment. Or if you did not know that your injury was due to repetitive work until you went to see
a doctor, you may be able to file a claim as soon as you find out.
8. Can I Choose My Own Doctor?
Initially, you may need to see a doctor chosen by your employer or their insurance company.
After 30 days, you may be able to switch to a doctor of your choice. If your employer’s workers’
compensation insurance has a Medical Provider Network (MPN), you must choose a doctor
within that network. An attorney representing you can help you navigate choosing a trusted
doctor in the MPN or outside the MPN if the case is denied.
9. What If My Claim Is Denied?
If your claim is denied, and if you obtain legal representation, your attorney should be able to
help you find a doctor who can act as your primary treating physician. Even if the case is
denied, you should not have to pay for medical treatment under California’s workers’
compensation system. Additionally, an attorney representing you can help establish whether
your injury was due to work by using medical reports and/or going to trial to prove this portion of
your case in court. It is advisable to seek legal assistance to navigate this process.
10. Do I Need a Lawyer?
While you are not required to have a lawyer to file a workers’ compensation claim, having legal
representation can help ensure that you receive the full benefits to which you are entitled to. An
attorney can assist with filing your claim with the court, finding a doctor for you, gathering
evidence, and representing you in deposition, hearings and appeals if necessary. Your attorney
will be paid to represent you based on the percentage of benefits your attorney obtains from the
level of compensation from your case.
11. What Is a PQME or AME?
A Panel Qualified Medical Evaluator (PQME) is a doctor who evaluates injured workers when
there are disputes about their medical condition or treatment. An Agreed Medical Evaluator
(AME) is chosen by agreement between your attorney and the insurance company to resolve
medical disputes. Most of the time, the insurance company will not accept the findings of your
primary treating physician to settle a case—even if in their MPN. But the primary treating
physician’s reporting will become important as a way to document your condition and have as a
medical opinion that can be used at trial as a counterweight against a PQME’s report that may
not be favorable.
12. What Is My Case Worth Or How Much Compensation Or Money Can I Get?
The monetary value of your case ultimately depends on the nature of your injury. In order to
determine the value of your case, once there are final reports from a primary treating physician,
a PQME, or AME, the percentage of each body part or condition found to be industrial by one of
these doctors, along with the age that you had at the time of injury, and the type of job you had,
provides a good start to determine the level of compensation your case might be worth.
However, while you are undergoing treatment, you may qualify for temporary disability
benefits/payments from the insurance company, or EDD benefits/payments, if your doctor
places you on disability or your employer cannot accommodate your work restrictions. Other
factors such as mileage reimbursement, and money that is needed to account for your future
medical care, can also be taken into consideration when settling your case. However, if there is
no resolution between the parties when trying to seek settlement, then the only option will be for
a judge to decide whether you are entitled to compensation after a trial takes place. In essence,
the judge will make his or her decision for the parties involved for the amount of compensation
generally based on medical reporting, other legal documentation, and testimony.
13. How Much Time Will My Workers’ Comp Case Take To Settle Or Resolve?
Roughly, that can depend in large part on the seriousness of your injury or condition, the
different types of medical specialties required (if necessary), the level of treatment you may
need or get before there is a determination of your impairment or permanent disability based on
the medical opinion of doctors. If you are sent to a doctor, that doctor will provide some form of
evaluation and/or treatment for a period of time while your condition reaches a point where he or
she can determine the level of impairment for each body part or condition. This can ebb and
flow depending on whether the treatment is authorized, and how long the recovery may be
needed for some treatment. If the case is denied, it may also be necessary to prove whether
your injury was due to your work, before any compensation can be determined. Although the
insurance company and you and your attorney can engage in settlement negotiations at any
time during the case to close it out, it may be necessary to go to trial to seek compensation
when there is no agreement between the parties.
14. What Should I Do If I Need Legal Representation?
You can contact us at (323) 219-5856 for a free consultation to seek legal representation by the
Law Office Of Odir Alonso Hernandez (hablamos Espanol para una consulta gratis).
15. Final Thoughts
Understanding your rights under the workers’ compensation system is crucial for ensuring you
receive the benefits you deserve. If you are injured at work, follow the appropriate steps, seek
medical attention, and file your claim promptly. Don’t hesitate to seek legal representation if you
encounter any issues or need further guidance.
DISCLAIMER: The information provided by The Law Office of Odir Alonso Hernandez is for
informational purposes only and is intended to be used as a non-legal guide prior to consultation
with an attorney familiar with your specific legal situation. No such legal advice or counseling is
either expressly or impliedly intended in this website. This should not be relied upon and is not
intended as a substitute for the advice or counsel of an attorney—who should discuss your
situation with you directly. If you require legal advice, please feel free to reach out and ask for a
personal consultation.