California Workers' Comp

Part I: All About Workers’ Compensation

1. Introduction to Workers’ Comp

• A. What Is Workers’ Compensation?
• B. What an Injured Worker Is Entitled To
• C. Where to Get Additional Information and Help
• D. How to Use This Book
• E. What This Book Does Not Cover

2. Overview of a Workers’ Compensation Claim

• Step 1. Notify Your Employer of the Injury
• Step 2. Get Medical Treatment If Needed
• Step 3. Paying for Medical Treatment If Your Employer Denies Your Claim
• Step 4. Tell the Doctor About Your Injuries
• Step 5. The Doctor Decides Whether You Need Time Off
• Step 6. Complete Workers’ Compensation Claim Form and Application for Adjudication of Claim Form
• Step 7. Secure Control of Your Medical Care
• Step 8. You May Receive Temporary Disability Benefits
• Step 9. Handling a Denial of Your Claim or Benefits
• Step 10. Taking Problems to the Appeals Board
• Step 11. After It Is Determined That You Are Permanent and Stationary (P&S) or Have Reached Maximal Medical Improvement (MMI)
• Step 12. You May Recover Completely and Return to Work
• Step 13. You May Be Entitled to Vocational Retraining
• Step 14. You May Be Partially Permanently Disabled
• Step 15. Go to Trial If There Is No Settlement
• Step 16. Judgment Is Paid or the Matter Is Appealed

3. Is Your Injury Covered by Workers’ Compensation?

• A. Is Your Job Covered by Workers’ Compensation?
• B. Do You Have a Compensable Injury?
• C. Injuries Not Covered by Workers’ Compensation

4. Cumulative Trauma Disorders

• A. What Is a CTD?
• B. Becoming Aware of Your Injury
• C. Diagnosis and Treatment
• D. Recovery and Permanent Injuries
• E. Returning to the Workforce
• F. Further Medical Treatment

Part II: Protecting Your Rights

5. What to Do If You’re Injured

• A. Request Medical Treatment
• B. Report the Injury Within 30 Days
• C. File Your Workers’ Compensation Claim
• D. The Insurance Company’s Answer
• E. Take Steps to Protect Your Rights

6. Keep Good Records to Protect Your Claim

• A. Set Up a Good Record-Keeping System
• B. Read and Understand What You Receive in the Mail
• C. Gather Important Records Pertaining to Your Claim
• D. Request Copies of Documents and Evidence
• E. Keep Your Address Current

7. The Insurance Company’s Role

• A. Self-Insured Employers
• B. The Insurance Company’s Responsibilities
• C. Your Responsibilities as an Injured Worker
• D. Who’s Who in the Insurance Company
• E. How to Deal With the Insurance Company
• F. Tactics Insurance Companies Use to Deny or Minimize Claims
• G. Settling Your Case

8. Dealing With Your Employer

• A. Self-Insured Employers
• B. The Employer/Insurance Company Relationship
• C. The Employer’s Responsibilities
• D. If You’re Out of Work Due to the Injury
• E. Bankruptcy or Other Employer Financial Problems

9. Taking Charge of Your Medical Case

• A. What the Treating Doctor Does
• B. Choose Your Treating Doctor (Get Medical Control in Your Case)
• C. Be Sure You Receive Excellent Medical Care
• D. Changing Treating Doctors
• E. When Your Condition Becomes Permanent and Stationary (P&S) or Has Reached Maximal Medical Improvement (MMI)

10. Medical-Legal Evaluations

• A. Rules for Medical-Legal Evaluations
• B. Compensability of Injury (Labor Code § 4060)
• C. Nature and Extent of Permanent Disability or Need for Future Medical Treatment (Labor Code § 4061)
• D. Other Issues to Be Resolved by Medical-Legal Evaluations (Labor Code § 4062)
• E. Picking a Qualified Medical Evaluator (QME)

Part III: Workers’ Compensation Benefits

11. Medical Benefits

• A. Limitations on Medical Treatment
• B. Payment for Current Medical Treatment and Evaluations
• C. Future Medical Care Costs
• D. Penalties

12. Temporary Disablity Benefits

• A. Qualifying for Temporary Disability
• B. Amount of Temporary Disability Payments
• C. How Payments Are Made

13. Permanent Disability (and Life Pension)

• A. How Permanent Disability Payments Compensate You
• B. Kinds of Permanent Disability Awards
• C. Establishing Your Permanent or Maximal Medical Improvement Disability Status
• D. How Permanent Disability Benefits Are Paid
• E. Amount of Permanent Partial Disability Benefits
• F. Life Pension Benefits
• G. Permanent Total Disability Benefits

14. Vocational Rehabilitation/Supplemental Job Displacement Benefit

• A. Vocational Retraining and Offers of Alternative or Modified Work
• B. What Is Vocational Rehabilitation?
• C. Six Steps in a Vocational Rehabilitation Plan
• D. Eligibility for Vocational Rehabilitation (QIW Status)
• E. How to Start Vocational Rehabilitation
• F. Delays and Failure to Provide Rehabilitation Services
• G. Preparing a Vocational Rehabilitation Plan
• H. Completing a Vocational Rehabilitation Plan
• I. Where to Get Help With Vocational Rehabilitation
• J. Supplemental Job Displacement Benefit

15. Death Benefits

• A. Who May Receive Death Benefits
• B. Death Benefit Amount
• C. Additional Payments for Dependent Minor Children
• D. Burial Expense for Deceased Worker
• E. Unpaid Temporary or Permanent Disability Payments
• F. How Death Benefits Are Distributed

16. Extraordinary Workers’ Compensation Benefits and Remedies

• A. Subsequent Injuries Benefits Trust Fund
• B. The Uninsured Employers Benefits Trust Fund
• C. Discrimination Benefits (Labor Code § 132(a))
• D. Employer’s Serious and Willful Misconduct

17. Benefits and Remedies Outside the Workers’ Compensation System

• A. State Disability Insurance (SDI)
• B. Social Security Benefits
• C. Claims or Lawsuits for Personal Injuries
• D. Claims or Lawsuits Based on Discrimination

Part IV: Settling Your Case

18. Rating Your Permanent Disability

• A. Obtaining a Rating
• B. What Is Involved in the Rating Process?
• C. How to Rate a Disability Using the New Rating Schedule
• D. Other Considerations in Rating a Permanent Disability
• E. How to Rate a Disability Using the Old Rating Schedule
• F. How to Use the Pre‑1997 Rating Manual

19. Figure Out a Starting Settlement Amount

• A. What You May Receive in a Settlement
• B. Two Kinds of Settlements
• C. Determine the Value of Your Claim Using the Settlement Worksheet
• D. What to Do Next

20. Negotiating a Settlement

• A. Deciding Whether to Negotiate Your Own Settlement
• B. The Concept of Compromising
• C. How to Negotiate a Settlement
• D. Review and Sign Settlement Documents
• E. Attend an Adequacy Hearing

Part V: The Workers’ Compensation Appeals Board

21. Preparing Your Case

• A. Identify Possible Issues in Dispute
• B. How to Prove (or Disprove) Disputed Issues
• C. Depositions
• D. Subpoenaing Witnesses and Documents
• E. Preparing for a Pre-Trial Hearing
• F. Preparing for a Trial

22. Arranging for a Hearing or Trial

• A. Kinds of Hearings
• B. Trial on Preliminary Issues
• C. Trial on Entire Case (the Case-in-Chief)
• D. File a Declaration of Readiness to Proceed to Set Your Case for Hearing
• E. Copy, Serve, and File Documents
• F. Receiving Notice of a Hearing

23. How to File and Serve Documents

• A. What Is Service of Documents?
• B. How to Serve Documents by Mail
• C. How to Serve Documents Personally
• D. How to Serve Documents by Fax
• E. How to File Documents With the Workers’ Compensation Appeals Board

24. Going to a Hearing or Trial

• A. Finding Your Way Around the Appeals Board
• B. Pre-Trial Conferences
• C. Trial
• D. Findings and Award

25. Appealing a Workers’ Compensation Decision

• A. The Three-Step Appeal Process
• B. Petition for Reconsideration
• C. Writ of Review With the Appellate Court
• D. Writ of Appeal to the California Supreme Court

Part VI: Beyond This Book

26. Lawyers and Other Sources of Assistance

• A. Information and Assistance Officers
• B. Hiring a Lawyer

27. Legal Research

• A. Find a Law Library
• B. The Basics of Legal Research

28. Case Law Review

• Chapter 3—Is Your Injury Covered by Workers’ Compensation?
• Chapter 5—What to Do If You’re Injured
• Chapter 9—Taking Charge of Your Medical Case
• Chapter 10—Medical-Legal Evaluations
• Chapter 11—Medical Benefits
• Chapter 12—Temporary Disability Benefits
• Chapter 13—Permanent Disability (and Life Pension)
• Chapter 14—Vocational Rehabilitation/Supplemental Job Displacement Benefit
• Chapter 15—Death Benefits
• Chapter 16—Extraordinary Workers’ Compensation Benefits and Remedies
• Chapter 18—Rating Your Permanent Disability
• Chapter 19—Figure Out a Starting Settlement Amount
• Chapter 20—Negotiating a Settlement
• Chapter 21—Preparing Your Case
• Chapter 22—Arranging for a Hearing or Trial
• Chapter 24—Going to a Hearing or Trial

Appendixes

• 1 Workers’ Compensation Office Addresses and Code Lists
• 2 Temporary Disability Benefits Compensation Chart
• 3 Permanent Disability Indemnity Chart
• 4 Maximum Life Pension Weekly Payments
• 5 Workers’ Compensation Forms

Forms to File With the Division of Workers’ Compensation

• DWC-1: Workers’ Compensation Claim Form
• Application for Adjudication of Claim
• Declaration in Compliance With Labor Code Section 4906(G)
• Subpoena Duces Tecum
• Subpoena
• Declaration of Readiness to Proceed
• Declaration of Readiness to Proceed to Expedited Hearing (Trial)
• Pre-Trial Conference Statement
• Notice of Change of Address
• Proof of Service
• Document Cover Sheet
• Document Separator Sheet
• Cover Letter to Workers’ Compensation Appeals Board
• Record-Keeping Forms and Worksheets
• Record of Income and Benefits Received
• Record of Time Off Work
• Record of Medical Expenses and Request for Reimbursement
• Medical Mileage Expense Form
• Settlement Worksheets and Documents
• Settlement Worksheet: Value of Workers’ Compensation Claim
• Stipulations with Request for Award
• Compromise and Release

Forms to File With Your Employer

• Employee’s Designation of Personal Physician
• Letter to Employer Requesting Copies of Documents and Evidence
• Objection to Treating Physician’s Recommendation for Spinal Surgery

Index