The Ins and Outs of Workers’ Comp Benefits in California

accident injury claim compensation

In 2014, the Bureau of Labor Statistics revealed that over 460,000 workers’ compensation claims were filed in California.1 Workers’ compensation insurance allows employees of a company to receive monetary benefits in the event that they become injured while at work. These benefits provide wage replacement, as well as funds for any medical care which may be required following injury.

A Brief History of Workers’ Compensation Law

Today’s California workers’ compensation laws actually originated in ancient times when Sumerian law stated compensation for injury to the body parts of a worker in 2050 B.C. Monetary compensation for specific injuries was also seen in the laws of China, Rome, and Greece. They went further, to outline the differences between an injury that impaired a worker’s ability to function, and one that caused a disability, a distinction which can be found in today’s laws.

The Industrial Revolution saw the creation of factories, where workers were exposed to a host of risks due to the extreme working conditions and many hazards that were typically present. In those days, workers rarely were awarded compensation for their injuries, thanks to incredibly restrictive laws that favored employers

It wouldn’t be until 1871 that a Prussian Chancellor would implement the Employers’ Liability Law offering employees of mines, railroads, quarries, and factories protection via social insurance. However, the most recent contributor to today’s compensation framework would be Bismarck’s adamant support of Workers’ Accident Insurance. Today, all businesses in California that have employees are required by law to purchase workers’ compensation insurance.

The Importance of Compensation

Thankfully, compensation is an absolute necessity for employees, and it is the law for employers. With the support of work comp attorneys, today’s employees are protected from the health and safety risks they face at work, and employers are protected from lawsuits from employees. The costs of living and medical care continue to rise, making it vital for employees to have the option of compensation in the event of injury.

What Do Workers’ Compensation Benefits in California Include?

Workers’ compensation in California can include several benefits, depending on the severity of neurological, heart, or other injuries an employee has sustained. Some of the California workers’ compensation rates are below.

Death Benefits

In the event that employees’ job injuries or illnesses result in their deaths, compensation may be paid to their spouses, children, or any others identified as dependents, as follows:

  • Up to $5000 for burial expenses if the injury occurred before 2013, and up to $10,000 if the injury occurred after 2013.
  • $320,000 total if the injury occurred in 2006 or later.

For children who are totally dependent at the time of an employee’s death, benefits are paid until they reach the age of 18. If children are mentally or physically incapacitated, their benefits will continue until their deaths.

Benefits for Supplemental Job Displacement

This compensation helps the employee pay for skills enhancement or retraining, and it is offered to employees injured in 2004 or later who:

  • Have been deemed eligible for permanent disability benefits.
  • Have not been offered work by their employer.
  • Have not returned to work for their employers.

Benefits from $4,000 to $10,000 can be offered to employees who became injured between 2004 and 2012. Employees injured in 2013 or later can receive $6,000.

man suffering from back and neck pain

Permanent Disability

Benefits are offered for employees who do not completely recover from their injuries and where an injury causes measurable loss of mental or physical function. The amount of compensation that an employee can receive depends on the following factors:

  • How much the employee earns per week prior to the injury.
  • Number of employees that were working for the employer at the time injury was sustained.
  • Age of the employee at the time of injury.
  • Type of occupation.
  • Location and severity of injury sustained.

Temporary Disability

Employees may be eligible for temporary disability benefits if they lost wages due to their recovery preventing them from doing their usual job. Although payment amounts are not yet available for 2017, the Department of Industrial Relations for the State of California’s Guidebook for Injured Workers states a maximum weekly payment of $1, 128.43 in temporary total disability in 2016.2

Medical Expenses

Workers’ compensation in California also covers medical care costs for employees. This compensation helps them recover from injuries or illnesses sustained as the direct result of conditions at work. Coverage for medical care includes:

  • Travel costs to receive medical care.
  • Equipment costs for treatment.
  • Prescriptions written for work-related injuries.
  • Medical tests.
  • Other treatment services deemed eligible.

Disability vs. Workers’ Compensation in California

Employees who become injured on the job can file a disability claim. However, they will not usually receive disability benefits and compensation benefits for the same time period. This is because disability insurance pays only for injuries sustained outside of work, whereas compensation pays for heart, neurological, or other injuries which are work-related and includes compensation for disability.

California Workers’ Compensation Requirements

There are things you must ensure that you do after you’ve become injured in order to be eligible to receive benefits. You need to report your illness or injury to your employer as soon as possible after it occurs. You will also need to ensure that you complete and file all of the necessary paperwork within a certain period of time.

Statute of Limitations and Important Points

In order to be eligible for benefits, you must submit a completed DWC-1 form to your employer within 30 days of sustaining or becoming aware of your illness or injury. Not doing so can cause you to miss out on compensation for lost wages and medical care.

When visiting doctors for treatment of a workplace-related injury, it’s vital that you tell them your injuries were sustained at work, as this will help you to establish your case. Doing so will also ensure that your employer is billed for your medical treatments.

Your letter from your employer’s insurance company confirming your claim should arrive within 14 days of your employer having received your DWC-1 form. You will need to contact your employer’s insurance company if you did not receive the letter within this timeframe.

It’s important to remember that fraud on workers’ compensation claims is punishable by law. That said, being honest with all of the information you provide on your claim forms is crucial.

Smiling lawyer holding file in courtroom

If You Couldn’t File on Time or Your Employer Denies Your Claim

Workers’ compensation laws in California are incredibly complex—even more so when necessary forms are not filed on time. This can also cause several delays in the awarding of compensation for your injuries, making it incredibly important to file in a timely manner. If you are unable to file within 30 days of sustaining an injury, you can get help from an experienced workers’ compensation attorney.

If your employer disputes or denies your claim outright, you still have options. One option is to seek out a qualified medical evaluator. These individuals offer an examination on a completely impartial basis that you can use in court and can also provide you with a second opinion on the nature, severity, and prognosis of recovery from your injury.

Becoming injured at work can leave you feeling completely overwhelmed, and choosing to represent yourself may result in you getting less compensation than you deserve. The Law Office of Jim T. Rademacher understands the complexities of California workers’ compensation laws. Our team is willing to fight for you every step of the way to get you the most compensation possible. Don’t settle for less in your compensation case. Discover how we can help by claiming your free consultation today.