California Workers' Compensation Claims: Eligibility, Filing and Appeals

By Beth Laurence

The California workers’ compensation program, like all other states’ workers’ comp systems, is regulated and operated by the state, not the federal government. This article gives you a clear overview of how the workers' comp laws work in California.

Workers' Comp Basics in California

In a nutshell, California employers must provide workers’ compensation benefits to employees by paying for workers’ compensation insurance from one of the many licensed insurers in the state, or from the State Compensation Insurance Fund (SCIF). All employers must purchase workers’ compensation insurance, regardless of the number of employees. When a worker suffers a work-related accident or becomes ill due to conditions on the job, the insurance company pays for the employee’s medical treatment, lost wages, and possibly compensation for a permanent impairment.

If a worker is injured and the employer was not properly insured, California’s Uninsured Employer’s Benefit Trust Fund (UEBTF) will step into the place of the insurance company to pay worker’s compensation insurance benefits. The UEBTF will then attempt to recover the money from the illegally uninsured employer.

Common Work-Related Injuries

The most common workers’ comp injuries in California are from car (or truck) accidents, falls, and lifting or moving objects. Almost all injuries and illnesses arising at work and related to the job are eligible for workers’ compensation benefits. This includes injuries caused by a one-time accident, cumulative injuries (injuries caused by doing the same motion over and over), and illnesses arising out of the job environment or work tasks. For information on injuries that happen off the jobsite and injuries that may have been the employee’s fault, see our article on which particular injuries and workers are covered by workers’ comp.

How to File a California Workers Compensation Claim

You should notify your employer as soon as you are injured or know that a work-related illness has developed. Unless you have a medical emergency, do this before seeking medical treatment, as your employer may refer you to a physician who is part of its medical provider network.

After you have obtained treatment, fill out DWC (Division of Workers’ Compensation) Form 1 and give it to your employer, who will in turn give it to its workers’ compensation insurance company. You will also need to file an Application for Adjudication of Claim within one year of your injury to officially file your worker’s comp claim.

There are several other forms you need to file with the Application for Adjudication of Claim—for more information, see our article on filing a worker’s comp claim in California (this article also covers how and when the insurance company must reply to your claim).

Collecting Workers' Compensation Benefits in California

California workers’ compensation insurance pays for all medical expenses related to the injury, as long as the medical expenses are authorized. At least at first, you may have to select a doctor within the medical provider network.

Temporary disability benefits are also available if you are unable to work for a period of time. Temporary disability pays two-thirds of your average weekly wage while you are temporarily disabled, up to a weekly maximum. The weekly maximum was $987 for 2010 and 2011. There may be up to a 90-day delay in your first payment while your claim is pending approval.

If your ability to work has been permanently impaired, partially or totally, you will also be eligible for permanent disability benefits. Permanent disability payments are based on the percentage of the impairment you suffered as a result of the work-related injury. Workers' compensation benefits are not taxable.

For more information on workers’ compensation benefits and payments, see our article on how workers’ comp payments are calculated in California.

Workers' Compensation Claim Denials

Your employer’s insurance company might deny your claim if it believes that:

• there is insufficient evidence of an injury
• your injury isn’t work-related
• your injury is due to another job
• you don’t need medical treatment, or
• you can return to work.

Appealing a California Workers' Compensation Denial

If you disagree with your employer or insurer about a benefits decision, including the denial of your claim, you can file a Declaration of Readiness to Proceed with the Worker’ Compensation Appeals Board (WCAB). You must also serve this form on your employer’s insurance company and include a proof of service form. The Appeals Board will hold a hearing and make a determination on your claim. For further information, see the article on appealing a denial of a California workers’ comp claim.

California Workers' Compensation Appeals Board Locations

Anaheim office:
1065 N. PacifiCenter Dr.
Anaheim, CA 92806
(714) 414-1801
AHM@dir.ca.gov

Bakersfield office:
1800 30th St., Ste. 100
Bakersfield, CA 93301
(661) 395-2514
BAK@dir.ca.gov

Eureka office:
100 H St., Rm. 202
Eureka, CA 95501
(707) 441-5723
EUR@dir.ca.gov

Fresno office:
2550 Mariposa Mall, Rm. 2035
Fresno, CA 93721
(559) 445-5355
FRE@dir.ca.gov

Goleta office:
6755 Hollister Ave., Rm. 100
Goleta, CA 93117
(805) 968-4158
GOL@dir.ca.gov

Long Beach office:
300 Oceangate St., Ste. 200
Long Beach, CA 90802
(562) 590-5240
LBO@dir.ca.gov

Los Angeles office:
320 W. 4th St., 9th flr
Los Angeles, CA 90013
(213) 576-7389
LAO@dir.ca.gov

Marina del Rey office:
4720 Lincoln Blvd., 2nd flr
Marina del Rey, CA 90292
(310) 482-3820
MDR@dir.ca.gov

Oakland office:
1515 Clay St., 6th flr
Oakland, CA 94612
(510) 622-2861
OAK@dir.ca.gov

Oxnard office:
1901 N. Rice Ave., Ste. 200
Oxnard, CA 93030
(805) 485-3528
OXN@dir.ca.gov

Pomona office:
732 Corporate Center Dr.
Pomona, CA 91768
(909) 623-8568
POM@dir.ca.gov

Redding office:
2115 Civic Center Dr. Rm. 15
Redding, CA 96001
(530) 225-2047
RDG@dir.ca.gov

Riverside office:
3737 Main St., Rm. 300
Riverside, CA 92501
(951) 782-4347
RIV@dir.ca.gov

Sacramento office:
160 Promenade Circle, Ste. 300
Sacramento, CA 95834
(916) 928-3158
SAC@dir.ca.gov

Salinas office:
1880 North Main St., Ste. 100
Salinas, CA 93906
(831) 443-3058
SAL@dir.ca.gov

San Bernardino office:
464 W. Fourth St., Ste. 239
San Bernardino, CA 92401
(909) 383-4522
SBR@dir.ca.gov

San Diego office:
7575 Metropolitan Dr., Ste. 202
San Diego, CA 92108
(619) 767-2082
SDO@dir.ca.gov

San Francisco office:
455 Golden Gate Ave., 2nd flr
San Francisco, CA 94102
(415) 703-5020
SFO@dir.ca.gov

San Jose office:
100 Paseo de San Antonio, Rm. 241
San Jose, CA 95113
(408) 277-1292
SJO@dir.ca.gov

San Luis Obispo office:
4740 Allene Way, Ste. 100
San Luis Obispo, CA 93401
(805) 596-4159
SLO@dir.ca.gov

Santa Ana office:
605 W Santa Ana Blvd, Bldg 28, Rm. 451
Santa Ana, CA 92701
(714) 558-4597
ANA@dir.ca.gov

Santa Rosa office:
50 D St., Rm. 420
Santa Rosa, CA 95404
(707) 576-2452
SRO@dir.ca.gov

Stockton office:
31 East Channel St., Rm. 344
Stockton, CA 95202
(209) 948-7980
STK@dir.ca.gov

Van Nuys office:
6150 Van Nuys Blvd., Rm. 105
Van Nuys, CA 91401
(818) 901-5367
VNO@dir.ca.gov

Have a Work Injury Case?

Get Your Case Reviewed. Talk to a Workers Comp Lawyer Now

Want to Learn More?

Check out Nolo's Do-It-Yourself Resources

How to Win Your Injury Claim

Win Your Lawsuit

Accident Claim Worksheet

Notice of Insurance Claim

Represent Yourself in Court

California Workers' Comp

eBook - $32.99 | Book & eBook - $34.99

eBook - $37.99 | Book & eBook - $39.99

eForm - $14.99

eForm - $14.99

eBook - $37.99 | Book & eBook - $39.99

eBook - $37.99 | Book & eBook - $39.99