Understanding California Workers’ Compensation – Key Insights for Injured Workers

Written By Joe Tichio

Overview:
California's workers' compensation system provides essential benefits to employees who suffer work-related injuries or illnesses. Here's what injured workers need to know:

1. Eligibility and Benefits:

  • Medical Care: Injured workers are entitled to medical treatment necessary to cure or relieve the effects of the injury.

  • Temporary Disability Benefits: If unable to work due to the injury, workers may receive payments to partially replace lost wages.

  • Permanent Disability Benefits: If the injury results in a permanent impairment, workers may receive compensation based on the severity of the disability.

  • Supplemental Job Displacement Benefits: For injuries occurring in 2004 or later, if the employer does not offer regular, modified, or alternative work, the worker may receive a voucher to help pay for retraining or skill enhancement.

  • Death Benefits: Dependents of a worker who dies from a work-related injury or illness may receive benefits.

2. Reporting and Filing a Claim:

  • Immediate Reporting: Workers should report injuries to their employer as soon as possible to avoid delays in benefits.

  • Claim Form (DWC 1): Employers must provide a claim form within one working day after learning about the injury.

  • Filing the Claim: The completed form should be returned to the employer to initiate the claims process.

3. Medical Treatment and MPNs:

  • Medical Provider Networks (MPNs): Employers may have a network of approved medical providers. Injured workers must generally receive treatment within this network.

  • Changing Doctors: Workers may have the right to change doctors within the MPN after the first appointment.

4. Dispute Resolution:

  • Utilization Review (UR): All medical treatment is subject to UR to determine medical necessity.

  • Independent Medical Review (IMR): If UR denies treatment, workers can request an IMR to appeal the decision.

  • Qualified Medical Evaluator (QME): If there are disputes about the injury or treatment, a QME may be assigned to evaluate the case.

5. Legal Representation:

  • Hiring an Attorney: Workers have the right to consult with or hire an attorney to assist with their claim.

  • Attorney Fees: Fees are typically a percentage of the benefits and must be approved by the Workers' Compensation Appeals Board.

Learn more by visiting the DWC.

Joe Tichio
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