Workers' Compensation in California: How to File a Claim for Benefits

The Workers' Compensation laws of California protect the rights of the injured worker and thus the State maintains what is referred to as a 'No Fault' system. The compensability of a claim is not subject to whether an accident was the fault of the employer, employee, or a third party. However, if an injury is found to be the result of the actions of a third party, the insurance company has the right to seek the recovery of indemnity through subrogation.

When someone is injured in the "Course and Scope" of their employment, they are entitled to Workers' Compensation benefits. These benefits may include medical treatment; mileage expenses; wage loss payments, and potential permanent disability compensation. However, before an employer or their insurance carrier can authorize or pay any benefits, they must be made aware of the accident/injury.

Report Workplace Accidents

After an accident, the first thing someone should do is report the matter to a person in charge. Although it may sound like common sense, many individuals fail to say anything to anyone. This is one of the most important steps in filing a claim, report the accident! An insurance carrier can use ‘late reporting’ as a reason to delay the authorization of benefits and investigate a claim.

DWC1

An employer is obligated to provide an injured employee with a Claim Form/DWC1 within 1 working day from the date of their knowledge of a claim. If the employer fails to comply, the worker can contact the employer's insurance company and request the form. The insurance company must then provide one to the employee within 3 business days. If an employee does not know who the employer's insurance carrier is and the employer will not cooperate, the employee may contact their local Workers' Compensation Appeals Board (WCAB) and speak to the Information and Assistance Officer.

The DWC1 should be completed and returned immediately upon receipt by the employee. In addition, all body parts affected by the accident, whether there is pain or not, should be listed on the form, and damage to items such as eyeglasses, hearing aids, dentures and/or medical braces should also be included.

The DWC1 may be returned by mail or personal delivery and the employee should make sure to keep a copy for their records. When the insurance company has a Claim Form on file they are obligated to provide certain benefits such as medical treatment of a delayed claim during the period of investigation.

Any employee has the right to pre-designate a doctor for evaluation and treatment in the event of an industrial injury, however, the designation must be done prior to an accident. When there is a pre-designation on file, the employer must allow an injured employee to see that doctor, provided the physician is qualified to treat said injury.

During the initial medical evaluation, the worker should outline as thoroughly as possible how the accident occurred and all the body parts affected. Also, if any additional pain or problems develop, the employee should report them to the physician as soon as possible.

Having an accident can be a traumatic experience and most employers and insurance carriers are sympathetic. The goal of the employer and insurance carrier is to help an employee get back to work as soon as medically possible, however, sometimes the right time to return to work may become an issue. In addition, there may be other issues such as the amount or type of medical treatment or the parts of body affected by the accident. When a worker is having these types of issues they may wish to consult with an attorney, especially one who is a Certified Specialist in Workers' Compensation.

*This information is general and not intended to be a substitute for legal advice. There may be changes in the law or specific facts of a case which may result in legal interpretations different than those presented here.