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Many Californian employees work long, backbreaking hours to help local businesses succeed. They're proud of the labor they give to help these companies to thrive. Unfortunately, some people learn after a workplace accident that employers may not appreciate their loyalty, hard work, and dedication.

Employees can suffer devastating, life-altering injuries after a workplace accident. They may undergo emergency surgeries to treat the trauma. Once stabilized, these workers may need ongoing medical care and rehabilitation to help them recuperate. Injured workers may also lose wages because they cannot work.

Sadly, these expenses multiply quickly. Many of these employees would qualify for workers' compensation to help them pay for their ongoing bills. Some workers are too scared to apply for these essential benefits. They believe they'll lose their jobs once they report their injuries to a supervisor. Additionally, their boss may beg them not to file a claim, if they ask to apply for workers comp with an attorney.

It's a complicated process to apply for workers' compensation. Employees must present sufficient medical evidence to receive benefits. Workers also have to submit paperwork to the state before the statute of limitations runs out.

If you're an injured employee, we know that navigating the workers' compensation process can be difficult. You shouldn't apply for workers' compensation without the help of a good workers comp attorney. In today's post, you'll learn more about the workers' compensation process in California.

What is Workers' Compensation?

In 2017, 667,426 Californians applied for workers compensation according to the state's Department of Industrial Relations. According to the 2017 Social Security's Annual Statistical Supplement, workers compensation is the first form of social insurance developed in the United States. These policies provide cash benefits and medical care to employees that suffer workplace injuries or illnesses. Additionally, their dependents can file for survivor claims following work-related accidents.

These policies provide the following compensation for employees:

  • Medical care - This coverage includes physicians’ visits, prescription medications, and surgeries.
  • Temporary disability benefits - These are indemnity benefits. The payments cover lost wages if injuries prevent workers from doing their regular jobs.
  • Permanent disability benefits - The insurance policy provides compensation if workers don't recover completely from your physical injuries.  
  • Supplemental job replacement benefits - California provides vouchers to help pay for skill enhancement or retraining for a new field if a worker doesn't recover from the accident.
  • Death benefits - It provides payments to the spouses, children, and other dependents of workers that die in on-the-job accidents.

Employers also benefit from the workers' compensation program. The policies insulate them from expensive lawsuits, large tort verdicts, and settlements. Companies give up some rights in exchange for these legislative protections. They cannot present common-law defenses in civil litigation.

The federal government first established workers' compensation in 1908. The policies provided benefits to people injured on hazardous job sites. By 1911, nine states passed workers' compensation laws. Currently, all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands provide workers compensation programs. Most states require private companies to carry coverage, except Texas. In the Lone Star State, employers who don't carry workers' compensation policies lose common-law defenses in civil lawsuits.

California's Workers' Compensation Programs 

The state's workers' compensation system is more than a century old. The program began as the Workers' Compensation Insurance Rating Bureau of California (WCIRB) in 1915. The WCIRB provides wage replacement benefits to almost 800,000 injured workers annually.

The state's Labor Code Section 3700 requires all employers to give their workers compensation benefits. Businesses must get policies from the State Compensation Insurance Fund (SCIF) or licensed insurers. California requires all companies to purchase workers compensation insurance regardless of the number of employees they have.  More than 200 insurance companies provide coverage to 700,000 businesses.

If a California worker has insurance, but their employer doesn't have enough coverage, the state's Uninsured Employer's Benefit Trust Fund (UEBTF) will provide benefits in place of the insurer. The organization will then try to collect the funds from the underinsured employer.

What is a Work-Related Injury?

Workplace injuries are ones that employees received while doing performing a job for an employer. Most industrial injuries occur in the workplace, but this isn't always the case. Some employees receive injuries outside the workplace (like car accidents). These are scenarios where you could suffer an illness or injury. 

One-time incidents - These single events are usually accidents. Examples include: 

  • A rooftop fall injuries a construction worker.
  • A driver suffers injuries while delivering products for his job.
  • A person receives third-degree chemical burns in a workplace explosion.

These incidents must occur in the course and scope of employment. Accidents that occur while someone travels to work or in non-work activities would not qualify for a workers' compensation claim. 

Occupational Diseases - These workplace illnesses develop due to repeated exposure to toxins. They are also injuries that workers receive because of repetitive activities.

  • A worker hurts his wrist due to increased use/motion.
  • An employee suffers hearing loss because of loud noise at work.
  • A person develops a chronic illness due to repeated exposure to chemicals.

Psychiatric and Stress-Related Illnesses - California also recognizes mental, emotional, and psychiatric illnesses that develop following a workplace accident. Employees must have six months of work history with the employer before they can file for workers compensation. They must also satisfy the following requirements.

  • The American Psychiatric Association must recognize the condition in its Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
  • Employees must prove that employment-related events caused their mental illnesses.
  • Psychiatric conditions caused by nondiscriminatory workplace actions don't qualify. For example, if an employer asks you to show up to work on time or improve your appearance.
  • Employees can't sue for psychological issues if they developed them during the litigation process.
  • Employees don't qualify if they developed an emotional illness after a company fires them.
  • Stress is not considered a psychiatric illness under the DSM-IV.

Who Qualifies for Benefits?

Employees must receive regular wages from a specific employer to receive workers' compensation benefits. The state's workers' compensation insurance covers all medical expenses related to on-the-job injuries as long as these bills are approved.

Some injured employees assume they can't file a workers compensation claim depending on who was at fault. Others believe their citizenship status may prevent them from receiving compensation. In California, people can receive benefits as long as they received job-related injuries that required medical treatment beyond first-aid care.

Did you know that:

  • You may be eligible to collect benefits from an employer, even if you're a temporary or part-time worker?
  • Workers don't need to be legal residents of the United States to collect benefits.
  • Independent contractors can't collect benefits since they are not employees.
  • Partners or owners of a business are not eligible for workers' compensation.
  • Volunteers are not eligible to collect these benefits if they're injured while volunteering.

Injured workers may collect temporary disability benefits if they are unable to work for a short period. Temporary compensation pays two-thirds of workers' average weekly wages up to a maximum amount. The highest amount that injured persons can collect is $1,215.17 in 2018. Once your the state approves your claim, payments begin within 14 days (two weeks).

Some workers worry that their employers will fire them if they submit a workers' compensation claim. The state prohibits discrimination and retaliation against people that file workers' compensation claims. Most employers don't like their employees to file these claims. They ask their employees not to file a claim. Workers who don't file end up paying expensive medical bills on their own. Don't let your employer stop you from filing. Hire a workers comp attorney to defend your rights.

Collecting Workers' Compensation in California

California's Division of Workers' Compensation oversees the administration of claims. It also provides administrative and judicial services to resolve disputes that arise from workers compensation benefits. There is a three-step process for California workers to submit a workers' compensation claim.

  1. Employees must report a work-related injury to their employers. - Alert them immediately, unless you need emergency medical attention. You must tell an employer about the injury within 30 days, or you lose your right to file for benefits.
  2. Get medical treatment for your injuries. The company may require you to select a physician within their medical provider network. Tell the medical staff that your injury or illness is job-related. If you don't need emergency treatment, see a doctor as soon as possible. You should receive treatment from a physician who understands your illness. The doctor must be a qualified medical examiner certified by the Division of Workers' Compensation's Medical Unit. These doctors can examine injured workers, evaluate disabilities, and write medical-legal reports.
  3. Fill out the Division of Workers' Compensation Form 1 and give it to your employer. They will turn it into the workers' compensation company. After you file your claim, your company must provide you with medical care. They must do this whether or not you miss work.
  4. File an Application for Adjudication of Claim within one year of your injury. You must submit this application to receive your worker's compensation claim.

Unfortunately, filing for workers' compensation is a complicated process. If you don't submit the right paperwork, the state can decline your application. Contact a san francisco workers compensation attorney to help process your claim.

Why Insurance Companies Deny Claims

Sometimes, an employer's insurance company will deny claims filed by workers. They could deny your workers compensation for the following reasons:

  • An insurer can't find sufficient evidence of an injury.
  • The employee's injury isn't work-related.
  • A worker received the injury at another job.
  • The employee doesn't need medical treatment.
  • An employee can return to work.

How to Challenge a Benefits Decision

In California, workers can dispute the amount an insurer has awarded them. They can also appeal when an insurer denies their workers' compensation claim. Employees should file a Declaration of Readiness to Proceed with the Worker' Compensation Appeals Board (WCAB). Serve the form to your employer. Ask them to fill out a proof of service form. The appeal board will make a final ruling about your claim. You can submit your claim the San Francisco's Bay Area office here:

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

If an insurer denies your claim, you may need to seek legal advice from workers compensation lawyers in bay area.


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