State of california how to file a workers comp claim

Refer to your employee handbook or ask your supervisor how to report the injury. They can help you navigate the complicated process and report the injury. This form must be completed and submitted within the given deadline. Be sure to follow the instructions on the form and list each part of your body that was harmed in the incident. Your employer will also fill out part of the form. They should submit it to their insurance company.

In most cases, you should hear from the insurance company within 14 days letting you know the status of your claim. They will send you a letter that either states that your claim has been approved or denied. If your employer does not deny your claim within 90 days, then the state of California assumes that the claim is accepted, and you will receive benefits. 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 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:. 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. 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.

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. Postal Service. Your employer should fill out its portion, submit the completed form to its insurance company, and give you a copy. 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.

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 and you meet the requirements for a presumption that the illness is work related.

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 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. The department is responsible for arranging treatment with the employer selected physician or medical facility within the Medical Provider Network MPN , or with the employee's pre-designated personal physician or medical group.

The employee must have provided the department written notification of the name of the physician or medical group prior to the date of injury, and the physician must have indicated a willingness to provide treatment in the event of an industrial injury or illness. It is important to inform the treating physician that the employee's injury or illness is or may be work related. After receiving treatment, the injured employee must inform their employer of the physician's advice concerning their ability to resume work responsibilities.

Although no time is charged against leave credits on the day of injury, a notation must be made to show the date of injury on the STD A statement from the attending physician is required each time the injured employee is seen regarding the work-related injury or illness.

All physician statements must be attached to the STD and forwarded to the attendance clerk or Personnel Office. The employer must ensure employees receive prompt medical care, if such care is believed necessary by either the employer or the employee, by arranging for treatment by either the employer selected physician or the employee's pre-designated physician or medical group. A supervisor or designee can accompany the injured employee to the doctor, and find out from the doctor if the injured employee will be able to return to work.

If the employee is not able to return to work immediately, attempt to find out how long the employee will be off work. A description of the employee's normal duties, or of alternate "light duty" work that may be available, may help the doctor make a decision. Give the employee a copy of the completed form and forward to State Fund within one day of receipt. If the claim is accepted, medical treatment will continue to be paid by the employer.

This form must be received by State Fund within five days of your department's knowledge of an injury or illness. First aid is defined as any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, and so forth, which do not ordinarily require medical care.

Such one-time treatment and a follow-up visit for the purpose of observation are considered first aid, even if provided by a physician or registered medical personnel. The RTWC or personnel office will ensure timely delivery of all forms to State Fund and will also ensure that the injured employee has received the appropriate forms and notifications. The Temporary Disability Verification of State Employees or a letter from State Fund is used to notify the departments of claim acceptance.

State Fund makes all liability determinations based on medical documentation and relevant facts. State Fund ensures the injured employee receives all benefits to which they are legally entitled including medical care, temporary disability, permanent disability, supplemental job displacement and death benefits. In addition, State Fund provides legal representation for issues that fall under the jurisdiction of the Workers' Compensation Appeals Board.

Medical treatment is provided to the employee to cure or relieve the effects of the injury. This includes medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches and apparatus, including orthotic and prosthetic devices and services Labor Code Section Medical treatment is subject to utilization review UR.

Temporary disability benefits are payments for lost wages paid to the injured employee while they are recovering from an injury or illness and are unable to return to work.

Payments must begin within 14 days of the employer's knowledge that a work-related injury or illness occurred, unless the employer contests the claim for workers' compensation benefits Labor Code Section No payments are due for the first 3 days unless the disability continues for more than 14 calendar days, the employee is hospitalized, LC Section or is the victim of a criminal assault Labor Code Section See the State Controller's Office Payroll Procedures Manual Sections E through E for details on processing payroll for employees receiving temporary disability benefits.

Minimum and maximum TD rates are set by the legislature. Injured employees who have sufficient leave credits can supplement their TD payments, but their TD payments plus supplemental check cannot be more than their net salary.

TD payments are issued by State Fund, sent directly to the injured employee and have no mandatory or voluntary deductions withheld. The supplementation payments, which are paychecks issued by the State Controller's Office, are paid by the employer and are subject to all mandatory deductions including taxes, retirement contributions, garnishments, and union dues.

Voluntary deductions, such as health, dental, and vision benefits or life insurance, can also be withheld. Deductions can only be made as long as there are sufficient leave credits. Mandatory deductions will have priority over voluntary deductions.

An injured employee is entitled to a continuation of health, dental, and vision benefits even if they choose not to supplement their TD payments.