California Workers' Compensation Attorney

How California workers' comp works

California workers' compensation is a no-fault system. You do not have to prove that your employer was negligent. You have to prove that you were an employee, that the injury arose out of and in the course of employment, and that you gave notice within the statutory period. In exchange for giving up the right to sue your employer for most work injuries, California law entitles you to a defined set of benefits regardless of fault.

In theory the system is simple. In practice it is not. Denials, treatment delays, utilization review disputes, QME disagreements, apportionment arguments, and surveillance of injured workers all combine to make the process harder than it should be for the person who did nothing wrong and got hurt at work.

Benefits you are entitled to

• Medical treatment. Reasonable and necessary care to cure or relieve the effects of the industrial injury, for life if needed, under the utilization review rules.
• Temporary disability (TD). Two-thirds of your average weekly wage, tax free, while you are medically unable to work, up to the statutory maximum.
• Permanent disability (PD). A scheduled benefit based on your impairment rating, age, and occupation when the injury leaves a lasting impairment.
• Supplemental Job Displacement Benefit. A voucher for retraining if you cannot return to your prior job.
• Death benefits. Payable to dependents when a work injury causes death.
• Mileage and travel. Reimbursement for travel to and from medical appointments.

The QME process

When a medical issue in your workers' comp case is disputed, the dispute goes to a Qualified Medical Evaluator. If you are represented, the parties use the Agreed Medical Evaluator or a three-name QME panel from the state. The QME's report frequently drives the permanent disability rating and therefore the settlement value. Choosing the right QME specialty, getting the right records to the QME, and preparing you for the exam are some of the most important tasks in the case.

Common reasons claims get denied or underpaid

• Late reporting. California law requires notice of injury within 30 days. Late reporting is the carrier's go-to defense.
• Post-termination filing. Claims filed after a layoff face a statutory defense under Labor Code 3600(a)(10). The defense has exceptions.
• Going and coming. Injuries during a regular commute are usually not covered. There are exceptions for special missions, company vehicles, and paid travel.
• Apportionment. The carrier will try to assign part of your impairment to a pre-existing condition to reduce the PD rating.
• Utilization review. Medical treatment requests are screened by UR. Denials can and should be challenged through Independent Medical Review.
• Surveillance. Carriers hire investigators. Be straight with your doctors. Do nothing that contradicts your restrictions.

What to do after a California work injury

• Report the injury to your supervisor in writing. Keep a copy.
• Ask for a DWC-1 claim form. Your employer must provide it within one working day.
• Get medical treatment. If you predesignated a doctor, use that doctor. Otherwise treatment will be directed through the employer's Medical Provider Network.
• Write down what happened, including time, place, witnesses, and the exact mechanism of injury.
• Do not sign anything with the adjuster without legal review.
• If your employer retaliates, document every detail. Retaliation is separate from the comp claim and has its own remedy.
• Call us.

Third-party claims alongside workers' comp

When a party other than your employer caused your on-the-job injury, you may have a separate personal injury claim in addition to workers' comp. Common examples include a work-related car accident caused by another driver, a defective product on the job site, or a subcontractor's negligence on a multi-employer site. We evaluate both tracks. In many cases the third-party recovery dwarfs the comp recovery.

Retaliation under Labor Code 132a

Labor Code 132a prohibits an employer from discriminating against an employee because that employee filed or made known an intent to file a workers' comp claim. If you were fired, demoted, had hours cut, or were otherwise disciplined after filing, that is a separate cause of action with its own remedy, including lost wages and reinstatement.

Frequently Asked Questions