In California, the workers comp codes can be found in the California Labor Code. The vast majority of worker’s comp codes can be found in the Labor Code’s Division 4: Worker’s Compensation and Insurance, which contains code sections 3200 to 6002. Here are some of the code sections most helpful to injured workers.
This section of the code covers medical treatment. It says the employer must provide medical treatment (which includes surgical, chiropractic, acupuncture, and hospital treatment) that is reasonably required to cure or relive the injured worker of the injury. It also covers when you can choose your doctor to treat your work-related injury and when you cannot. (California Labor Code Section 4600.)
This code section covers the situation where the employer’s worker’s comp insurance company denies that you have a compensable injury (that is, any work-related injury for which the insurance company is obligated to pay you), and how a medical-legal evaluation should be arranged to decide the issue. (California Labor Code Section 4060.)
This code section covers what happens when the insurance company has accepted your claim but disputes the extent of your permanent disability (impairment). It includes instructions on how to proceed with getting a medical-legal evaluation to decide the issue, depending on whether or not you have hired a worker’s comp attorney. (California Labor Code Section 4061.)
This code section covers how disputes other than the compensability of your injury or the extent of your permanent disability should be handled. For instance, you may need to get a medical-legal evaluation because you and the insurance company disagree over whether you have reached “maximal medical improvement” (meaning that temporary disability payments will end). (California Labor Code Section 4062.)
This code section has to do with deadlines for your employer’s insurance company to make payments and the penalties that will be assessed if it is late making payments.
If your work-related injury causes you not to be able to work for more than three days, your employer’s insurance company has 14 days from the date it was notified of your injury to start making temporary disability payments. (California Labor Code Section 4650(a).) However, if the insurance company is denying your worker’s comp claim or delaying a decision in order to investigate your claim, the insurance company can instead send you a letter listing the reasons for the denial or delay (but it still must authorize medical treatment for you, up to $10,000, until it denies or accepts the claim).
If your injury has caused any lingering impairment after two years of temporary disability payments or after the doctor says that you have improved as much as you will improve (called maximal medical improvement, or permanent and stationary), whichever is earlier, the insurance company must start paying you permanent disability (PD) benefits. The insurance company has 14 days from when your temporary disability payments stop to start the PD payments, whether or not your permanent disability rating (the extent of permanent impairment) has been established. (California Labor Code Section 4650(b).)
If the insurance company is late paying payment your benefits or medical treatment, you could be entitled to a 10% penalty on the value of the late benefits or medical treatment. For instance, if you’re out of work due to your injury, the insurance company should pay you temporary disability payments every two weeks. If the insurance company is late, it must tack on the 10% penalty to your payment (which some, but not all, insurance companies do automatically). (California Labor Code Section 4650(d).)
There’s also another type of code used in the worker’s comp system: classification codes. Any insurance company that provides compensation insurance calculates the cost of premiums through the classifications that are assigned by the WCIRB, the Worker Compensation Insurance Rating Bureau. The WCIRB applies a classification code to every employer in the state by assessing the tasks performed at each job and the environment in which the job is performed. (California is one of the few states that does not use the classification codes put out by the National Council on Compensation Insurance (NCCI).)
Each different position is assigned a classification code using formulations set by the WCIRB after examining every aspect of the occupation, the physical conditions of the job, the tasks to be performed and their potential for injury, and the involvement of the employer in the safety awareness and occupational training process. For instance, someone who works in an office will be given a much lower risk code than a person who works in a factory where forklift trucks are used. These classification codes are used by the insurance company to set rates paid by the employer.