California Workers Compensation Claims: Eligibility, Filing and Appeals

Employers must provide workers compensation to covered employees by paying for workers compensation insurance. California has a state fund that acts as a workers compensation insurer, called the State Compensation Insurance Fund. This is the largest of the 12 state run funds that manage worker’s compensation insurance.

Employers must provide workers compensation insurance if they have one or more employees. An exception is made if you and/or your spouse are the sole employees of a company. If a worker is injured and the employer was not properly insured, the Uninsured Employer’s Benefit Trust Fund will pay worker’s compensation insurance benefits. The UEF will then attempt to recover the money from the illegally uninsured employer.

Common Covered Work Related Injuries

Injuries arising at work and related to the job are covered. 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.

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. Do this before seeking medical treatment if possible, as your employer may refer you to a physician covered by their workers compensation insurer.

After you have obtained treatment, fill out a DWC (Department of Workers Compensation) Form 1. You can obtain this form from your employer or from the California Department of Industrial Relations. You should give this form to your employer as soon as possible. Claims administrators are required to authorize up to $10,000 in medical expenses within one day after you submit a claim.

You may have to see a qualified medical examiner as part of the claims process in order to evaluate your claim and the extent of your disability.

Workers Compensation Claim Denials

Claims may be denied as a result of improperly submitted paperwork or insufficient evidence of disability.

Appealing a California Workers Compensation Denial

If you disagree with your employer or insurer about a benefits decision, you can file a request for adjudication of a claim. The appropriate form is available from the Department of Industrial Relations and from your employer. Filing an application for adjudication will result in your appeal being heard by the local Worker’s Compensation Appeals board. You must include a copy of your claim for benefits, as well as proof of service.

The Appeals Board will hold a hearing and make a determination on your claim. The decision of the appeals board is final in most cases, but can be appealed to an appellate court in cases of abuse of discretion or other misapplication of the law.

Collecting California Workers Compensation Benefits

California Workers Compensation Insurance pays for all medical expenses related to the injury, as long as the medical expenses are approved. In some cases, you may have to select a doctor or provider within the medical provider network.

Temporary and permanent disability benefits are also available if you are unable to work. Temporary disability pays 2/3 of pre-tax wages  lost while temporarily disabled, up to a weekly maximum. The weekly maximum was $840 as of 2006. There may be up to a 90-day delay in your first payment while your claim is pending approval. Permanent disability benefits are based on a percentage of your previous wages, and a percentage of the impairment you suffered as a result of the work related injury. Disability benefits are not taxable.

Hiring a California Workers Compensation Lawyer

You are not required to have an attorney, but the guidance of an attorney can be useful in navigating the complex workers compensation laws. The Department of Workers Compensation provides resources for finding qualified workers compensation attorneys.

California Workers Compensation Office Locations

Anaheim
1661 N. Raymond Avenue, Room 200
Anaheim, CA 92801-1162
714-738-4038

Bakersfield
1800 30th Street, Suite 100
Bakersfield, CA 93301-1929
661-395-2514

Eureka
100 "H" Street, Suite 202
Eureka, CA 95501-0481
707-441-5723

Fresno
2550 Mariposa Mall, Suite 4078
Fresno, CA 93721-2280
559-445-5355

Goleta
6755 Hollister Avenue, Suite 100
Goleta, CA 93117-3018
805-968-4158

Grover Beach
1562 Grand Avenue
Grover Beach, CA 93433-2261
805-481-3296

Long Beach
300 Oceangate Street, Suite 200
Long Beach, CA 90802-4339
562-590-5001

Los Angeles
320 W. 4th Street, 9th Floor
Los Angeles, CA 90013-1105
213-576-7389

Marina del Rey
4720 Lincoln Blvd., 2nd and 3rd Floors
Marina del Rey, CA 90292
310-482-3820

Oakland
1515 Clay Street, 6th Floor
Oakland, CA 94612-1402
510-622-2861

Oxnard
2220 East Gonzales Road, Suite 100
Oxnard, CA 93036
805-485-3528

Pomona
732 Corporate Center Drive
Pomona, CA 91766-1601
909-623-8568

Redding
2115 Civic Center Drive, Suite 15
Redding, CA 96001-2796
530-225-2047

Riverside
3737 Main Street, Suite 300
Riverside, CA 92501-3337
951-782-4347

Sacramento
2424 Arden Way, Suite 230
Sacramento, CA 95825-2403
916-263-2718 & 916-263-2741

Salinas
1880 North Main Street Suites 100 & 200
Salinas, CA 93906-2204
831-443-3058

San Bernardino
464 W. Fourth Street, Suite 239
San Bernardino, CA 92401-1411
909-383-4522

San Diego
7575 Metropolitan Drive, Suite 202
San Diego, CA 92108-4402
619-767-2082

San Francisco
455 Golden Gate Avenue, 2nd Floor
San Francisco, CA 94102-7002
415-703-5020

San Jose
100 Paseo de San Antonio, Room 241
San Jose, CA 95113-1482
408-277-1292

Santa Ana
28 Civic Center Plaza, Suite 451
Santa Ana, CA 92701-4070
714-558-4597

Santa Rosa
50 "D" Street, Suite 420
Santa Rosa, CA 95404-4760
707-576-2452

Stockton
31 East Channel Street, Room 344
Stockton, CA 95202-2314
209-948-7980

Van Nuys
6150 Van Nuys Blvd., Suite 105
Van Nuys, CA 91401-3373
818-901-5367 ext. 3541