Risk Management FAQs
1. Hurt on the Job?
That can be a terrible experience. But fortunately, the California workers' compensation system takes away a lot of the worry about job injuries and illnesses. It's no-fault insurance, paid for by employers and supervised by the state.
2. What is Workers' Compensation?
California workers' compensation law, passed by the state Legislature more than 85 years ago, guarantees prompt, automatic benefits to workers injured on the job. Before workers' compensation, injured workers had to sue their employers to recover medical costs and lost wages. Lawsuits took months and sometimes years. Juries and judges had to decide who was at fault and how much, if anything, would be paid. Too often, the injured worker got nothing. It was costly, time consuming and unfair. Today, workers' compensation is faster and fairer. If you can't work because of a job injury, workers' compensation pays your medical bills and provides money to help replace your lost income until you can return to work.
3. Who's Covered?
Nearly every working Californian is protected by workers' compensation, but there are a few exceptions. People in business for themselves and unpaid volunteers may not be covered. Maritime workers and federal employees are covered by federal laws.
4. What's Covered?
Any injury or illness caused by your job is covered-everything from first-aid type injuries to serious accidents. Job-related illnesses are covered too. (For example, common colds and flus aren't covered, but if you catch tuberculosis while working at a TB hospital, that's covered.) Workers' compensation even covers injuries or illnesses, including psychiatric injuries, that may arise if you are the victim of a crime at the workplace. The key is whether the injury or illness is caused by your job.
5. When am I covered?
Coverage begins the first minute you're on the job and continues anytime that you are working. You don't have to work a certain amount of time or earn a certain amount before you're protected. Coverage is automatic and immediate.
6. How do I get Benefits?
Report the injury to your employer or supervisor immediately and complete a simple claim form if more than first aid is required. The claim form will ask what, where, when and how it happened. Your employer or supervisor will see that you get medical help right away and file the necessary reports. Prompt reporting is the key. You may not be able to get benefits if you don't file a claim within one year of the date of injury, the date you knew the injury was work related, or the date the benefits were last provided. Insure your right to benefits by reporting every injury, no matter how slight. Even a cut finger can lead to disability if an infection develops.
7. What are the benefits?
California law guarantees three kinds of workers' compensation benefits: Medical treatment to cure the injury. Not just doctor bills, but also medicines, hospital costs, fees for lab tests, x-rays, crutches-even travel expenses for required medical treatment. There's no deductible and all costs are paid directly by the workers' compensation claim administrator, so you should never see a bill. Cash Payments to help replace lost wages. Most injuries only keep you from working temporarily, and you'll receive "temporary disability" payments until the doctor says you're able to return to work. Additional cash payments will be made after you're able to work, if there's a permanent disability-for example, the loss of a finger or an eye-or if you can't return to work at all. If the injury results in death, benefits will be paid to your surviving dependents. Rehabilitation services necessary to return to work. This is just an extension of medical treatment-for example, physical therapy to strengthen muscles. However, if the injury keeps you from returning to your regular work, your employer will advise you if your regular job can be modified or if another position can be provided to accommodate your permanent disability. Many employers are subject to laws governed by the Americans with Disabilities Act or the Fair Employment Housing Act. An employer subject to these laws must provide reasonable accommodation-if possible-to qualified disabled individuals who can perform all the essential job functions. If you are not able to return to your regular job because of a disability, you may have rights under these laws. For more information, call the Equal Employment Opportunity Commission at 1-800-669-4000. If you can't return to work with your employer because of your disability, you may qualify for vocational rehabilitation benefits. A trained counselor will develop a plan to create new job opportunities for you. Again, workers' compensation insurance directly pays all costs up to a maximum set by state law.
8. How much are cash payments?
Temporary disability payments generally are two-thirds of your wages-up to a maximum set by the state Legislature. See the State Mandated Benefits Page . Temporary disability payments are based on the rate in effect on the date of injury, though payments made two years or more after the injury are adjusted to reflect the current maximum if justified by earnings. Compensation isn't paid for the first three days you're unable to work-unless you're hospitalized as an inpatient or unable to work for more than 14 days. In these instances, even the "waiting period" will be paid. If you report the injury promptly, your first temporary disability check should be mailed within 14 days. After that, you'll receive a check every 2 weeks until the doctor says you can go back to work. After you recover to the fullest extent possible, the doctor who treated you will evaluate the permanent effects of your injury. You and your employer may agree to rely on the treating doctor's report to establish your permanent disability payment. If you have questions about the report you may contact an information and assistance officer at the Division of Workers' Compensation. If you don't agree on the treating doctor's report, and you aren't represented by an attorney, you must choose an evaluating doctor from a panel of three independent doctors provided by the state. If you are represented by an attorney and you don't agree on the treating doctor's report, the attorney will arrange the medical evaluation. Your permanent disability payments will be based on the results of the doctor's evaluation and factors such as your age and pre-injury occupation. The weekly benefit is two-thirds of your income, subject to minimums and maximums set by the state. The minimums and maximums vary according to the date if injury. If you have a permanent disability, the calculation of the benefit will be fully explained in a letter. Death benefit payments to survivors are set by state law based on the number of dependents. Payments are made at the same rate as temporary disability benefits. Workers' Compensation payments are tax free. There are no deductions for state or federal taxes, Social Security, union or retirement fund contributions, etc. For some workers the compensation check will be close to regular take home pay.
9. What if there is a problem?
Fortunately, most claims-9 out of 10-are handled routinely. After all, workers' compensation benefits are automatic and the amounts are set by the Legislature. But, mistakes and misunderstandings do happen. If you think you haven't received all your benefits, contact your employer or workers' compensation claim administrator. Many questions can be cleared up with a phone call. If you still have questions, contact the nearest office of the State Division of Workers' Compensation. Information and assistance officers are employed by the state to protect your rights, review your claim, and let you know what steps you can take. For example, they can tell you about the procedures for resolving medical disputes and direct you on how to proceed. The information and assistance service is free. For the nearest office check the white pages of the phone book under State Government Offices/Industrial Relations/Workers' Compensation or call 1-800-736-7401. Some problems may need to be resolved by the Workers' Compensation Appeals Board, the state agency responsible for handling disputes. The Appeals Board is a court of law. you can represent yourself or you may want to hire a lawyer. If you hire an attorney, the fee will be deducted from any benefits awarded b the Appeals Board. Attorney fees generally are 9 to 12 percent of your award. For example, if you were awarded $10,000 less 12 percent for attorney fees, your attorney would receive $1,200 and you would receive $8,800. If it's necessary to go to the Appeals Board to resolve your claim, be sure to do it within one year from the fate of the injury or one year from the date of your last medical treatment. Waiting longer could mean losing your rights to benefits. Keep in mind, it's illegal for an employer to fire or discriminate against employees just because they file, intend to file, or settle a workers' compensation claim-or because they testify for a co-worker who was injured. A worker who proves this kind of discrimination will receive lost wages and benefits, a 50 percent increase in workers' compensation benefits (up to $10,000) plus costs and expenses up to a maximum set by the Legislature.
10. Other Benefits...
If the injury is very serious-one where you won't e able to work for a year or more-you may be eligible for additional benefits from Social Security. For information, contact the nearest office of the Social Security Administration (listed in the white pages of the phone book under "United States Government") or discuss it with your employer or claim administrator. Workers' compensation sometimes is confused with another state program, State Disability Insurance (SDI). They seem similar, but there are important differences. Workers' compensation takes care of on-the-job injuries and illnesses, and is paid for by your employer. On the other hand, SDI covers off-the-job injuries or sickness and is paid for by deductions from your paycheck.
11. Where can I get more information?
Ask your employer or the workers' compensation claim administrator (the name, address and phone number are posted at your workplace). Or talk to an information and assistance officer at the State Division of Workers' Compensation. The nearest local office is posted at your workplace and listed in the white pages of the phone book under State Government Offices/Industrial Relations/Workers' Compensation. The state also has a toll-free number (1-800-736-7401) with recorded information about workers' compensation. The state's information and assistance services are free and the information and assistance officers can explain your rights, solve problems, and provide other information.
12. More about Medical Care...
Good medical care is important- to you, your family and your employer. Quality medical treatment is the quickest way to recovery. If there's a first-aid facility at your workplace, get immediate treatment and report where, when and how the accident happened. (If it's an emergency, get the best treatment available, then report the injury to your employer as soon as possible). If it's more than a first-aid injury, your employer will give you a claim form. To make sure you get all your benefits, complete the form and return it to your employer as soon as possible. If additional treatment is necessary, the claim administrator will arrange for medical care. If you haven't selected a physician or health care organization prior to the injury you may be sent to a doctor you don't know, but that doesn't mean it's a "company doctor". Often, the doctor is a specialist for the specific injury. In addition, the doctor will be familiar with workers' compensation requirements and will report promptly so your benefits will be paid. If you want to change doctors for any reason, ask your employer or claim administrator. They're as interested as you are in your prompt recovery and return to work, and will give you a list of other doctors to choose from. You're entitled to be treated by your own personal physician if you've notified your employer of the doctor's name and address in writing before the injury. Contact your employer for further information. If you haven't predesignated a physician prior to the injury, you can switch to your own doctor after the employer's medical control expires. This can range from 30 days up to a year after reporting the injury, so check with your claim administrator. If you're thinking of changing doctors, consider this decision carefully-most people don't have a family surgeon, for example. If you want advice about specialists, talk to your claim administrator. In any event, report your choice as soon as you make it so your bills will be paid for you. Above all, don't treat yourself. Even minor injuries need expert care. Prompt, quality medical treatment is the best investment you can make.