If you have suffered a work-related injury and live in California, you have a right to benefits under California's Workers Compensation Act. Under the Act, an employer is required by law to provide medical treatment and pay workers' compensation benefits to any injured employee. Your obligation is to file a claim for worker’s comp benefits on time.
What to Do After an Injury
After an injury, an injured worker should get immediate medical treatment. In an emergency, the worker can go anywhere for medical treatment and the employer must pay. (Otherwise, the employer may provide where the employee must go for treatment.) Once at the hospital or doctor’s office, the employee should inform the treating physician that the injury or illness is job-related.
An injured employee should report the injury to his or her employer immediately or within 30 days at the most. If the injury or illness has developed over time, the employee should report it to the employer as soon as the employee misses work or sees a doctor for the injury or illness -- and believes the injury was caused by his or her job. If the employer is not informed in a timely way, the worker could lose his or her right to receive workers' compensation benefits. In addition, any delay may unnecessarily hold up the employee's benefits.
Filing a Workers’ Compensation Claim
Reporting an injury to your employer or doctor simply informs them that you’ve suffered a work-related injury; this does not count as filing a workers’ compensation claim. To officially file a workers’ comp claim, the employee has to file the following documents:
- a DWC-1 claim form
- an Application for Adjudication of Claim
- a Declaration Pursuant to Labor Code 4906(g)
- a Document Cover Sheet, and
- Document Separator Sheets.
DWC-1 Claim Form
Form DWC-1, Workers’ Compensation Claim Form and Notice of Potential Eligibility, is the workers’ comp claim form. Form DWC-1 asks for your name and address and the date, time, and location of your injury, as well as a description of the injury. Instructions for filling out the claim form can be found on the form itself. Be sure to name each body part that has been injured. You submit this form to your employer (by handing it to the employer or sending it by certified mail), and the employer is required to submit it to its workers’ compensation insurance company.
Application for Adjudication of Claim
To complete your official filing of your workers’ comp claim, you need to file this form, WCAB Form 1, Application for Adjudication of Claim, with the Workers’ Compensation Appeals Board (WCAB). You’ll need to know the name of your employer’s insurance company for fill out this form; you should be able to find the name on the carbon copy of the DWC-1 claim form that your employer returned to you. If you don’t have a copy of the DWC-1, contact the Workers’ Compensation Insurance Rating Bureau (WCIRB), which keeps a list of all California employers’ workers’ compensation insurance carriers. You can file this form personally at the WCAB district office (recommended) or by serving it on the WCAB (sending it by mail with a proof or service form).
Declaration Pursuant to Labor Code 4906(g)
You must submit this form when you submit an Application for Adjudication of Claim, above. In this DWC form, Declaration Pursuant to Labor Code 4906(g), you swear that you haven’t asked a doctor, hospital, or medical facility to submit any fraudulent information to the DWC.
Document Cover Sheet
Include one Document Cover Sheet, available at the DWC website, for the package of forms that you’re filing.
Document Separator Sheets
Place a Document Separator Sheet, available at the DWC website, after each form in your package.
When to File the Workers’ Comp Claim
You should try to file your DWC-1 form within 30 days of your injury, but if you didn’t, here are the rules on when your claim may be denied for being past the “statute of limitations.”
- If your employer’s insurance company provided benefits after the injury (for example, paid for your medical treatment or paid you for time off work), you have five years from the date of injury to officially file your claim (this includes filing the DWC-1 form and an Application for Adjudication of Claim).
- If the insurance company either ignored or denied your report of injury or request for benefits, you have one year from the date of injury to officially file your claim.
- If you are trying to collect benefits on behalf of a relative who died due to a work-related injury, you have one year from the date of death to officially file your claim.
If you did not file a worker’s comp claim within the above time frames, contact a California workers’ compensation attorney. There are circumstances in which you can be excused for missing the statutes of limitations deadline, such as if your employer didn’t advise you of your right to file a workers’ comp claim or post the proper notices.
The Insurance Company's Response
The workers’ compensation insurance company must respond to your claim within 14 days. The insurance company must either begin making temporary disability payments or will send you a letter denying your claim or stating that the insurance company is investigating your claim to see if it is valid. If the insurance company doesn't respond one way or another within 14 days, it's liable for a 10% penalty on the temporary disability payments you should have received within the first 14 days.
If the insurance company tells you it's investigating your claim before it decides whether to accept or deny it, it has 90 days (from the receipt of your claim) to decide. While the insurance company is deciding whether to accept or deny your claim, the claims administrator must authorize payment for your medical treatment, up to a maximum of $10,000.