Here are some frequently asked questions about workers' compensation benefits in California.
There are two aspects to reporting an injury in the California workers’ compensation system: telling your employer about the injury and filing a workers’ comp claim.
Generally, you need to give your employer written notice of the injury within 30 days of the date you’re injured. But for injuries that happen over time, you need to report your injury to the employer within 30 days of the date you suffer a temporary disability (that is, when you lose time from work or seek medical treatment) and you realize (or should have realized) that the injury was due to work. (California Labor Code Section 5412.) If you have a union representative, you should also report your injury to that person as soon as possible.
You also have to officially file your workers’ comp claim by filing California workers’ comp claim form, the DWC-1 claim form. You file this form by giving it to your employer, who will forward it to its workers’ comp insurance company. The time limit to file this form is within one year from the date of injury, but filing it sooner than later is to your advantage.
To save time, you can kill two birds with one stone: you can use DWC-1 to give written notice to your employer; just make sure you give it to your employer within 30 days of your date of injury.
If you don’t report your injury to your employer within 30 days, you might not be able to collect workers’ comp benefits (medical expenses or cash benefits), unless you can show that your employer knew or should have known about the injury within the 30-day time period. For instance, if you’ve been complaining that your back hurts from lifting boxes at work, your employer was on notice that you might have a back injury; or, if another employee tells your employer that slipped and fell on the factory floor, that counts as notice. (California Labor Code Section 5402.)
If you didn’t report your injury within 30 days and neither of these exceptions applies to your situation, you should talk to a workers’ compensation attorney—a lawyer may be able to prove that your failure to report your injury didn’t harm your employer’s standing as to your workers’ comp claim and that you should have the right to collect workers' comp benefits. (California Labor Code Section 5403.)
One way to get to choose your own doctor is to give your employer a form designating who you want your doctor to be in case of injury—before an injury occurs. In California, the doctor you choose must be your regular primary care physician, and you have the right to “predesignate” your doctor only if your employer provides group health coverage. (California Labor Code Section 4600.3.) The Department of Workers’ Compensation offers a form for this purpose: DWC Form 9783,Predesignation of Personal Physician.
If you didn’t predesignate a doctor, you’ll likely need to see a doctor chosen by your employer or who is in your employer's medical provider network. But if your employer hasn’t followed certain rules, such as not telling you that you could predesignate a doctor, not giving you a workers' comp claim form after learning of your injury, or not posting required notices of your workers’ comp rights, California law says that you have the right to choose your own doctor, outside of your employer’s network. (California Labor Code Section 3550(e).)
If your employer didn’t pay for workers’ comp insurance coverage and was not “self-insured” (California allows certain large companies to set aside funds for workers’ comp claims), you have the right to sue the employer in civil court for your medical expenses and lost wages, as well as pain and suffering (which aren’t allowed in a workers' comp case). Or, you have the right to file a workers’ comp claim against the employer and collect from California’s Uninsured Employers Benefits Trust Fund. (California Labor Code Sections 3715 and 3716.) In either case, you’ll need to hire a workers’ comp lawyer to represent you.
If your employer’s insurance company rejects your claim, you have the right to request a hearing before the California Workers' Compensation Appeals Board. Though you are not required to bring a lawyer to this hearing, if your injury was serious, you’ll want to hire a workers’ comp attorney to represent you to make sure your claim is accepted. For more information, see our article on how to appeal a workers' comp denial in California.