If you have a workers’ comp claim in California—or you’re thinking of filing a claim for your work-related injury or illness—you may want to learn more about the state’s workers’ compensation system. The rules governing workers’ comp cases mostly come from state law. If you know the rules, you can better understand what’s going on with your case and what you can do to protect your right to benefits. You can also learn a lot from Nolo’s articles that go into more detail about specific workers’ comp problems. A good place to start is our FAQ on California Workers’ Comp Benefits.
This article gives you the highlights of the most helpful statutes dealing with important issues in your case, including:
Labor Code sections 3600 and 3208 to 3208.3 include the basic rules on which injuries are covered under workers’ comp in California. In general, you can get benefits for injuries and diseases “arising out of and in the course of employment” meaning that you were hurt while doing your job, and work activities or conditions caused your injury or illness. The statutes also detail the requirements for some specific illnesses and injuries, as well as certain circumstances that rule out workers’ comp coverage. (Learn more about what’s considered a work-related injury or illness.)
Labor Code sections 5400 to 5405 set out the procedures and deadlines for reporting on-the-job injuries or occupational diseases to your employer, as well filing a workers’ comp claim. If you don’t meet these deadlines, you could lose your right to benefits. These rules are explained in detail in our article on how and when to file a workers’ comp claim in California.
Labor Code section 4600 covers your right to receive necessary medical treatment for your work-related injuries or illness, along with the rules on when you can and can’t choose your own doctor. See details about these rules in our article on how to select and change treating doctors in your California workers’ comp case.
Labor Code section 5402(c) requires your employer’s insurance company to authorize medical treatment while it’s evaluating your claim. The insurer has to pay up to $10,000 in medical costs during the investigation period, even if it ultimately rejects your claim.
Labor Code section 5402(b) says that your claim will usually be considered valid if the insurance company doesn’t explicitly reject it within 90 days after it’s filed.
If the insurer denies your claim, you can challenge that decision by getting a hearing before a workers’ comp judge. But first, you have to open your case officially by filing an application for adjudication of claim. Labor Code section 5405 spells out the time limits for doing that.
Different statutes outline the rules for setting up medical evaluations when you and the insurance company disagree about certain issues in your case, including:
Labor Code sections 4650 to 4654 contain the complicated rules for determining how much you can receive in temporary disability (when you’re out of work recovering from your injury) and permanent disability (when your injury has left you with permanent limitations). For an explanation of these rules, see our articles on how workers’ comp payments are calculated in California and workers' comp benefits for permanent disability in California.
Labor Code section 4650 includes the deadlines for payments of temporary and permanent disability benefits, as well as the penalties the insurance company will have to pay you if it doesn’t send your checks on time.
California’s workers comp statutes can be complicated and sometimes difficult to understand. In addition, regulations and court decisions may affect how those statutes are interpreted and applied. Unless your injury was very minor and your employer’s insurance company hasn’t balked at providing benefits, you would be well served by speaking with a workers’ comp lawyer. An attorney who’s experienced in this area can explain how the laws apply to your situation, and can help you protect your rights throughout the process. Learn more about how a workers’ comp lawyer can help your case and how much a workers’ comp attorney costs in California.