If you’ve suffered an injury or illness because of your job in California, you may be entitled to benefits under California's Workers Compensation Act. If you’re an eligible employee with a work-related injury or illness, the law requires your California employer to pay for your medical treatment and partial wage replacement while you’re away from work and recovering. But if you want to receive these and other workers’ comp benefits in California, it’s your responsibility to file a claim on time.
In most cases, filing a workers’ comp claim in California is actually a three-step process:
There are time limits for each of these steps. In some circumstances, you might get away with being late on first two steps. But if you’ve missed the deadline for the last step—and your employer’s insurance company balks at providing or continuing benefits—you could be out of luck. Read on for the details.
For all the steps involved in filing a workers’ comp claim, the deadlines for taking action start on the date of your injury. That date is pretty clear if you were hurt in a workplace accident, like falling off a ladder. But it’s a little more complicated if you think you have what’s known as a cumulative trauma injury (like a repetitive stress or strain injury) or an occupational disease (such as COVID-19 from exposure to the coronavirus on the job or lung disease from exposure to toxic chemicals). In those situations, the time period for reporting and filing your claim starts when both of the following happen:
(Cal. Labor Code §§ 5411, 5412 (2020).)
When you’ve been injured while working, you should get immediate medical treatment. If it’s an emergency, you can go anywhere for medical care. Otherwise, if your employer or its insurance company has a medical provider network, you may have to go to a doctor in that network. (Learn about treating doctors in California workers’ comp cases.) Be sure to tell the treating physician that your injury or illness is job-related.
As soon as you can, you should report your injury or illness to your employer. You could lose your right to workers’ comp benefits if you don’t give your employer written notice within 30 days after the date of the injury. But there are exceptions, including when your employer (including a supervisor) knew about the injury. (Cal. Labor Code §§ 5400, 5402(a) (2020).)
Besides, any delay could hold up your benefits—so the sooner the better.
Within one working day after you report your injury or illness, your employer should give you a workers’ compensation claim form (known as Form DWC-1), along with information about your rights and potential eligibility for benefits, what you have to do get those benefits, and other details about the workers’ comp process. If you didn’t get the DWC-1 form from your employer, you can download it from the forms page of the California Workers’ Compensation (DWC) website.
Follow the instructions on the form for filling out the employee’s portion. Be sure to list each part of your body that was injured. After you’re done, either hand the form to your employer in person, or send it by first-class or certified mail (with the U.S. Postal Service). Your employer should fill out its portion, submit the completed form to its insurance company, and give you a copy. (Cal. Labor Code § 5401 (2020).)
Once you’ve submitted the claim form, your employer’s insurance company must authorize payment for your medical treatment while it’s investigating the claim to decide if it’s valid. Until it makes a decision, the insurer is responsible for up to $10,000 in medical bills. Generally, the claim will be considered approved if the insurer doesn't deny it within 90 days after you’ve submitted the form. However, the insurer has less time to make this decision if you've filed a claim based on COVID-19 and you meet the requirements for a presumption that the illness is work related. (Learn more in our article on getting workers' comp benefits in California for COVID-19.) (Cal. Labor Code §§ 3212.87, 3212.88, 5402(b), (c) (2020).)
If you have to miss work because of your injury or illness, the insurance company should begin paying temporary disability benefits within 14 days after it learns about the injury and your temporary disability. If the insurer doesn’t either start the payments by then or respond to the claim by denying it or asking you for more information, it will have to pay a late penalty: an additional 10% on the late temporary disability benefits. (Cal. Labor Code § 4650(a), (d) (2020).)
If your employer’s insurance company has started paying your medical and temporary disability benefits, you may be tempted to think that all is well. That could be true if your injuries were minor, you recovered quickly and completely, and you don’t have any disagreements with the insurer about medical treatment or your need to miss work. But disagreements are common, and your medical condition may change. Even if you filed a claim with your employer, you won't be able to resolve any disputes unless you also opened a case with the WCAB by filing an Application for Adjudication of Claim. (For details on what comes next, see our article on the workers' comp appeals process in California.)
Generally, you must file the Application for Adjudication of Claim (Form WCAB-1, also available on the DWC forms page under “Court forms”) within one year after:
(Cal. Labor Code § 5405 (2020).)
Courts have found that an injured employee may have longer to file the application for adjudication of claim if the employer or its insurer advanced payments for medical expenses while knowing that the treatment could be related to a potential workers’ comp claim. In that case, the employee has five years from the date of injury to file the application—the time period used when there’s “new and further” disability, in Cal. Labor Code § 5410 (2020). But once the insurer gives notice that it’s denying the claim, the employee then has a year to file the application. (McDaniel v. Workers’ Comp. Appeals Bd., 218 Cal.App.3d 1011 (Cal. Ct. App. 1990).)
When you're seeking death benefits because you’re the dependent of someone who died because of work-related injuries, you have one year from the date of death to file the application for adjudication of claim.
If you need help completing the form, contact the DWC Information & Assistance Unit. You can find instructions for filing the application for adjudication of claim here, along with the links to get copies of all of the other documents that you need to include. The instructions also include a link to use if you don’t have the name and address of the claims administrator for your employer or its insurance company. (That information should be on the completed copy of the DWC-1 claim form, if you have that.) If you don’t have an attorney, the WCAB will send copies of your application to your employer and the insurance company. Otherwise, your lawyer will take care of that.
If you didn’t file a worker’s comp claim or the application for adjudication of claim on time, contact a California workers’ compensation attorney. The law in this area is complicated, and there are circumstances in which you might be excused for missing a deadline, or the time period is extended. An experienced workers’ comp lawyer can explain how the law applies to your situation and help protect your rights. An attorney can also represent you in an appeal if your employer denies your claim for any reason.