The workers’ compensation system began as an agreement between employers and their employees. Employers provide no-fault insurance against workplace injuries and, in return, employees do not file lawsuits if and when they get hurt or sick because of work.
The Division of Workers’ Compensation oversees the administration of claims and runs the workers’ compensation court system that helps resolve disputes over benefits.
Workers’ compensation benefits include:
- Medical Care: Employees receive prompt medical treatment;
- Temporary disability benefits: Employees receive payments if they can’t work while recovering;
- Permanent disability benefits: Employees receive payments if they don’t completely recover;
- Supplemental job displacement benefits: Employees receive vouchers to help pay for retraining or skill enhancement if they can’t recover completely and do not return to work;
- Death benefits: The children or other dependents of employees can receive payments if the employee dies from a job injury or illness.
California employers are required by law to carry workers’ compensation insurance, even if they have just one employee. Employers should know:
- Failure to carry workers’ compensation insurance is a criminal offense;
- Employers cannot ask employees to pay or offset the cost of the policy;
- Workers’ compensation benefits include all employees, including part-time employees;
- It is illegal to demote or fire an employee for filing a workers’ compensation claim.
Here is what an employer needs to do if an employee is injured at work:
- First, provide the employee with a claim form (DWC form 1) within one working day of finding out about the injury. Complete the employer portion of the returned claim form and provide a copy to the employee;
- Within one day after delivering the claim form, an employer must authorize medical treatment to a maximum of $10,000 during investigation of the claim;
- Second, complete form DLSR 5020 (Employer’s Report of Occupational Injury or Illness) and send to the claims administrator within five days of knowing about the injury;
- Next, stay involved and maintain communication with the employee – don’t assume the claims administrator is taking care of everything;
- Finally, get your employee back to work after the injury. If an employer with 50 or more employees offers suitable regular, modified, or alternative work to an injured employee, weekly workers’ compensation payments may be reduced by 15%. If the employer does not make such efforts, weekly payments are increased by 15%.
Within 14 days, the insurance company should send a notice indicating whether it accepts, denies, or delays the employee’s claim for review.
- If the insurance company accepts the claim, the employee will receive benefits and services;
- If the insurance company delays the claim, an investigation can take up to 90 days. During the investigation, the employee receives no benefits other than medical treatment. The employee may be able to collect state disability payments during the investigation period, which must be applied separately at the Employment Development Department;
- If, after 90 days, the insurance company does not send a final notice either accepting or denying the claim, the claim will be presumed accepted.