THE INJURED WORKER
Rights to Workers’ Compensation Benefits and How to Obtain Them
What Is Workers’ Compensation?
If you get an injury or illness on the job, your employer is required by
law to provide workers’ compensation benefits. You could get hurt by:
Department of Industrial Relations
• One event at work. Examples: hurting your back in a fall, getting burned
Division of Workers’ Compensation
by a chemical that splashes on your skin, getting hurt in a car accident
The information in this pamphlet is while making deliveries. It may include injuries, including psychiatric
true in most situations. However injuries, resulting from a workplace crime.
some rules, exceptions, and deadlines
not covered here may apply to you
and affect your case. To learn more, • Repeated exposures at work. Examples: hurting your wrist from doing
see the factsheet For More Informa-
the same motion over and over, losing your hearing because of constant
tion. The information here describes
the California workers’ compensation
system as of January 1998. It applies
to most private, state, and local
government employees whose ìdate of What Are The Benefits?
injuryî is 1994 or later.
Workers’ compensation benefits three days, or you are hospital-
ANY PERSON WHO MAKES OR can include: ized overnight. Payments must
CAUSES TO BE MADE ANY be made every two weeks, for as
Medical Care. Paid by your
KNOWINGLY FALSE OR FRAUDU- long as you are eligible.
employer, to help you recover
LENT MATERIAL STATEMENT OR
MATERIAL REPRESENTATION from an injury or illness caused Permanent Disability Ben-
FOR THE PURPOSE OF OBTAIN- by work. You should never efits. Payments if your treating
ING OR DENYING WORKERS’ receive a medical bill. doctor says you will never re-
COMPENSATION BENEFITS OR cover completely and will always
PAYMENTS IS GUILTY OF A Temporary Disability Benefits.
be somewhat limited in your
FELONY. Payments if you lose wages
ability to work. These payments
because you can’t do your usual
This pamphlet has been approved by
are limited, and may not cover
job while recovering. As a general
the Administrative Director of the all your lost income. The number
rule, you are paid two-thirds of
Division of Workers’ Compensation of weekly payments you will
the gross (pre-tax) wages you
and complies with the requirements receive is determined by a per-
of Labor Code ß138.4, ß139.6, lose after your third day off work
manent disability rating, based
ß3553, and ß5401 and Title 8, while recovering from an injury.
on (a) your medical condition,
California Code of Regulations ß9880 However, you cannot receive
(b) your date of injury, (c) your
and ß9882. It is based, in large part, more than the maximum weekly
on work performed by the Labor age when injured, and (d) your
amount set by law. (See Table on
Occupational Health Program, occupation. Permanent disability
page 5 for maximum benefit
University of California at benefit amounts are set by law.
Berkeley, under contract
rates.) These temporary disability
(See Table on page 5 for maxi-
with the Commission payments begin when your
mum benefit rates.) After the first
on Health & Safety and treating doctor says you can’t do
Workers’ Compensa- your usual work for more than What are the Benefits
tion. continued on page 2
What are the Benefits More About
continued from page 1
payment, permanent disability payments are made every 14
Can I choose the doctor who will
benefits must be paid every 14 days for as long as your are
treat me? It depends. If you want to
days. They end when you reach eligible. For injuries occurring on
choose the doctor who will treat
the maximum amount allowed or after January 1, 1994, there is
you for a job injury or illness, you
by law or when you settle your a $16,000 limit on all rehabilita-
must tell your employer the name
case and receive a lump sum. tion benefits. (See Table on page
and address of your personal
5 for maximum benefit rates.)
Vocational Rehabilitation. Job physician before you are injured or
placement counseling and become ill. You must do it in writ-
Death Benefits. Payments to
possibly retraining, if you are ing. This is called predesignating
the spouse, children, or other
unable to return to your old job your personal physician. If you
dependents of a worker who dies
and your employer doesn’t offer predesignate you will be allowed to
from a job injury or illness. (See
other work. Vocational rehabili- see your personal physician right
table on page 5 for maximum
tation maintenance allowance after you are injured or become ill.
benefit rates) Death benefits
benefits provide income support You may switch doctors later, if
must be paid every 14 days. A
while you are participating in necessary. If you don’t predesignate
burial allowance is also paid.
vocational rehabilitation. These your employer usually will have the
right to choose the doctor who
What Should I Do If Hurt On The Job?
If you are hurt on the job, you should:
• Report The Injury To Your Employer. Tell your supervisor right away. If your injury or illness devel-
oped gradually (like tendinitis or hearing loss), report it as soon as you learn it was caused by your job.
Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you
may need to avoid further injury. If your employer does not learn of your injury within 30 days, you could
lose your right to receive workers’ compensation benefits.
• Get Emergency Treatment If Needed. If it’s a medical emergency, go to an emergency room right away.
Your employer may tell you where to go for treatment. Tell the health care provider who treats you that
your injury or illness is job related.
• Fill Out A Claim Form. Your employer must give you a claim form within one working day after learning
about your injury or illness. You use it to request workers’ compensation benefits. Fill out and sign the
employee portion of the claim form. Describe your injury completely. Include every part of your body
affected by the injury. Give the form to your employer, which is called filing the claim form.
• Get Good Medical Care. Get good medical care to help you recover. You should be treated by a doctor
who understands your particular type of injury or illness. Tell the doctor about your symptoms and the
events at work that you believe caused them. Also, describe your job and your work environment.
• What Happens After I File The Claim Form? Your employer must fill out and sign the ìemployerî
portion of the claim form and give the completed form to a claims administrator. (This person handles
claims for your employer and usually works for your employer’s insurance company.) Your employer must
give you a copy of the completed form within one working day after you filed it. Keep this copy. The
claims administrator usually must decide within 90 days whether to accept or deny your claim.
Page 2 The Injured Worker
treats you during the first 30 days • Why is the choice of doctor gather information to support
after your employer learns about important? Your treating doctor your claim, keep track of dead-
your injury or illness. will: lines, and represent you in
1) Decide what type of medical hearings before a Referee (work-
How do I predesignate? You ers’ compensation judge) of the
care you’ll get.
can predesignate a doctor of medi- Workers’ Compensation Appeals
cine (M.D.) or doctor of osteopathy 2) Help identify the kinds of work Board. Most attorneys offer one
(D.O.) who treated you in the past you can do safely while recover- free consultation. If you hire an
and has your medical records. Or ing. attorney, the attorney’s fees will
you can predesignate the office, be be taken out of benefits that
3) Determine when you can return
clinic or hospital where the doctor you receive later. A Referee must
treated you. (If you give your approve the fee.
employer the name of your personal 4) Write medical reports that will
chiropractor in writing before you affect the benefits you receive. If you have a serious dispute
are injured, you may switch to this that may require a decision by a
chiropractor upon request during
What Should I Do If workers’ compensation referee
the first 30 days.) There is a Dispute? (workers’ compensation judge), an
Application for Adjudication must
If you have a concern, speak up.
Notify your employer in be timely filed, normally within one
See whether your employer or
writing. Your employer may give year from the date of your injury or
claims administrator can agree to
you a form to use. Make sure to the last date you were paid benefits.
resolve the problem. If this doesn’t
include the following information: work, don’t delay getting help. Try What Other
1) Name of your employer. the following: Rights Do I Have?
2) Statement that if you are injured • Contact an Information & Assis-
It is illegal for your employer to
or become ill on the job, you tance officer. State I & A officers
punish or fire you for having a job
designate your personal physi- answer questions and help
injury, or for filing a workers’ com-
cian or personal physician’s injured workers. They may
pensation claim when hurt on the
medical facility to provide medi- provide information and provide
job. The California Labor Code
cal care. Give the name, address, forms and help resolve problems
(section 132a) prohibits this kind of
and phone number. with your claim. They hold
workshops for injured workers.
3) Your name. To contact or find a local office, It’s also illegal for your employer
4) Your signature. check the Government Pages at to discriminate against you because
the front of the white pages of of a serious disability. The federal
5) Date. your phone book. Look under: Americans with Disabilities Act
Exceptions: Some employers State Government Offices/ (ADA) and the California Fair
have contracts with state-certified Industrial Relations/Workers’ Employment and Housing Act
health care organizations (HCOs) to Compensation. (FEHA) prohibit this. More informa-
treat workers hurt on the job. If tion about ADA is available by
• Consult an Attorney. Lawyers
your employer has this kind of calling the Equal Employment
who specialize in helping injured
contract, there are different rules on Opportunity Commission at 800-
workers with their workers’
choosing medical care. Your em- 669-3362. Information about the
compensation claims are called
ployer must give you written infor- state FEHA is available by calling
applicants’ attorneys. Their job is
mation about those rules. 800-884-1684.
to plan a strategy for your case,
The Injured Worker Page 3
Workers’ Compensation Maximum Benefits
FOR DATES OF INJURY ON OR AFTER: 7/1/94 7/1/95 7/1/96
TEMPORARY DISABILITY PAYMENT: $406.00 $448.00 $490.00
PERMANENT DISABILITY PAYMENT:
0 -14 3/4% $140.00 $140.00 $140.00
15 - 24 3/4% $148.00 $154.00 $160.00
25 - 69 3/4% $158.00 $164.00 $170.00
70 - 99 3/4% $168.00 $198.00 $230.00
100% $406.00 $448.00 $490.00
MAINTENANCE ALLOWANCE: $246.00 $246.00 $246.00
DEATH BENEFIT PAYMENT: $406.00 $448.00 $490.00
MAXIMUM AGGREGATE DEATH BENEFITS*
Single Dependents $115,000.00 $115,000.00 $125,000.00
Two Dependents $115,000.00 $135,000.00 $145,000.00
Three or More Dependents $150,000.00 $150,000.00 $160,000.00
BURIAL EXPENSES PAID TO A MAXIMUM OF $5,000
*Benefits paid to a totally dependent minor will be continued until the age of 18 regardless of the
Page 4 The Injured Worker
DWC PUBLICATIONS AND FACTSHEETS
Go to DWC’s web site HYPERLINK http://www.dir.ca.gov
www.dir.ca.gov and link to DWC or Commission on Health & Safety & Workers’ Compensation.
Call 1-800-736-7401 and leave a voice form message.
Write DWC at P. O. Box 420603, San Francisco, CA 94142 and specify the publication you would like to
Call the local DWC office found in the white pages under State Government/Industrial Relations/Workers’
Factsheets What Every Worker FACTSHEET #1
Should Know (#1) What Every Worker Should Know
What is workers’ compensation?
(Workers’compensation If you get hurt on the job, your employer
is required by law to provide workers’
compensation benefits. You could get
California • One event at work. Examples:
benefits and choosing
Workers’ hurting your back in a fall, getting
burned by a chemical that splashes on
Compensation your skin, getting hurt in a car
accident while making deliveries.
Af ter You Get Hur t on the Job • Repeated exposures at work.
What are the benefits?
Report the injury to
Get emergency treatment
a doctor in case you are hurt.) Examples: hurting your wrist from
doing the same motion over and over,
losing your hearing because of
constant loud noise.
They can include:
Medical Care. Paid for by your employer,
to help you recover from an injury or
illness caused by work.
Tell your supervisor right away. If your If it’s a medical emergency, go to an
injury or illness developed gradually (like emergency room right away. Your Temporary Disability Benefits. Payments
tendinitis or hearing loss), report it as employer may tell you where to go for if you lose wages because you can’t do
soon as you learn it was caused by your treatment. Tell the health care provider your usual job while recovering.
job. Reporting promptly helps prevent who treats you that your injury or illness
problems and delays in receiving benefits, is job-related. Permanent Disability Benefits. Payments
including medical care you may need to if you can’t recover completely and will
After You Get
avoid further injury. Fill out a claim form and always be somewhat limited in your
ability to work.
give it to your employer
Your employer must give you a claim Vocational Rehabilitation. Job placement
counseling and possibly retraining, if you
form within one working day after
are unable to return to your old job and
learning about your injury or illness.
your employer doesn’t offer other work.
You use it to request workers’
Hurt on the Job (#2)
compensation benefits. Death Benefits. Payments to the spouse,
children, or other dependents of a worker
Fill out and sign the “employee” portion who dies from a job injury or illness.
of the claim form. Describe your injury
completely. Include every part of your 1
body affected by the injury. Give the
form to your employer, which is called
filing the claim form. Do this right
away to avoid possible problems with
(Steps to take, getting appropriate
Get good medical care
Your claim form .......................... 2,5
Getting medical care ................... 2-4
Get good medical care to help you
recover. You should be treated by a
doctor who understands your particular
type of injury or illness. Tell the doctor
about your symptoms and the events at
medical care, working while recovering,
Working while recovering .......... 4-5
work that you believe caused them. Also
other financial help, and job discrimination.)
Other financial help ..................... 5
Facts about discrimination .......... 5 describe your job and your work
After You Get Hurt on the Jo b 1
Temporary Disability FACTSHEET #3A
Benefits (#3A) Temporary Disability Benef its
If you get hurt on the job and can’t do
(Benefits while you are
Workers’ your usual work for a while, you may
be eligible for temporary disability
Compensation (TD) benefits. Inside:
Two types of TD ............................. 2
TD benefits are payments you receive
if you lose wages because: Payment amounts ......................... 2
Permanent Disability Benef its Payments begin ............................. 4-5
Most workers recover from their
job injuries. But some continue to
recovering from a job injury or illness.) • Your treating doctor says you can’t
do your usual work for more than
three days, or you are hospitalized
Payments end ................................ 5
have medical problems. If your —and—
treating doctor says you will never
recover completely and will always • Your employer does not offer you
be somewhat limited in your ability other work that pays your usual
to work, you have a permanent wages while you recover.
disability. This means you are
probably eligible for permanent
disability (PD) benefits.
PD benefits are payments that help
make up for limitations in your
ability to work in the future.
However, you don’t have to lose
your current job to be eligible for
Other Benefits Besides PD
Disability Benefits (#3B)
PD benefits are limited. If you lose If you are permanently disabled, you
income, PD benefits may not cover may also be eligible to receive:
all the income lost. If you
experience loses unrelated to your • Medical care for your injury,
ability to work, PD benefits will described later in this factsheet.
not cover those losses.
(Medical reports, ratings,
• Vocational rehabilitation
services to help you find another
job. To find out about these
services, get the factsheet “For
More Information” (listed on Temporary Disability Benefits 1
payments, and settlements.)
• Other financial help, such
Medical reports ........................... 2-3
as Social Security Disability
Ratings ........................................ 3-4
Insurance and benefits offered
PD payments ............................... 5-6
by some employers and unions.
Settlement ................................... 6
To find out about these benefits,
get the factsheet “For More
Information” (listed on page 8).
Permanent Disability Benefits 1
For More Information (#4) FACTSHEET #4
(Written materials, places to For More Information
Your Employer ................................................................................ 1
The Claims Administrator .............................................................. 1
seek help with your claim,
State Division of Workers’ Compensation .................................... 1
State Industrial Medical Council ................................................... 2
Applicants’ Attorneys .................................................................... 2
California Your Treating Doctor ...................................................................... 2
FACTSHEET FOR YOUNG WORKERS Your Union ...................................................................................... 2
Workers’ Occupational Health Clinics .......................................................... 2
and other types of assistance.)
Compensation Injured Worker Support Groups .................................................... 2
Health & Safety Agencies and Organizations ............................... 2
Other State and Federal Agencies ................................................. 3
Hur t on the Job? Books and Other Materials ............................................................ 3
Questions & Answers About Attorneys ........................................ 5
Information Aler t for Teens Questions & Answers About State I&A Services ......................... 6
Every year, 70 workers under 18 die from job injuries in the U.S. and another 70,000
get hurt badly enough to go to a hospital emergency room. This is true even though s Your Employer. Your employer is s State Division of Workers’
child labor laws say employers can’t give workers under 18 the most dangerous jobs. required to post information and give Compensation. DWC administers
you written materials that explain workers’ compensation laws and
If you get hurt on the job, your workers’ compensation. If you have provides information and help to
employer is required by law to provide questions, you can contact your injured workers. Check the
workers’ compensation benefits. supervisor, someone else in Government Pages at the front of the
These include: management, or your employer’s white pages of your phone book. Look
personnel or benefits department. under: State Government Offices/
• Medical care for your injury,
Industrial Relations. See also the
whether or not you miss time
Department of Industrial Relations Web
from work. s The Claims Administrator. This site: www.dir.ca.gov.
person handles workers’ compensation
• Payments if you lose wages for claims for your employer and usually Information & Assistance. I&A
more than 3 days or if you are works for the employer’s insurance officers answer questions and help
hospitalized overnight. company. The claims administrator is injured workers resolve problems with
Hurt on the Job?
required to send you written their claims. Their services are free.
• Other benefits if you become information about your claim and may For more information, see “Questions
permanently disabled. answer questions. If you can’t reach and Answers About State Information
the claims administrator, ask to speak & Assistance Services” on page 6. For
with his or her supervisor. phone numbers, see page 7.
Did You Know?
Information Alert for Teens
x You can receive benefits x It’s illegal for your employer 1
to punish or fire you:
• even if you are under 18.
• for having a job injury; or
• even if you are a temporary
or part-time worker, no matter • for requesting benefits
how long you have had your job. when hurt on the job.
x You receive benefits no x You can’t sue your employer
matter who was at fault for
your job injury.
x You don’t have to be a U.S.
citizen to receive workers’
for a job injury (in most cases).
x You can see your own doctor
if you give your employer the
doctor’s name and address
(Factsheet for young workers.)
Injured Worker Guides:
compensation benefits. before you are injured.
The Injured Worker Page 5
These guides contain short instructions on
how to complete a step in your claim.
t How to File a Claim Form t How to File a Declaration of t How to File a Petition to Reopen
Readiness to Proceed
Guide 02 Guide 13
t How to Dismiss Your Attorney Guide 08 t How to Object to Your Summary
t How to File a Rehabilitation Rating
t How to File a Complaint with the Guide 14
Audit Unit Guide 09 t How to File a Lien
t How to File a Serious & Willful
t How to Request a Qualified
Medical Evaluation Guide 10 t Help in Returning to Work 1994
t How to File an Application for ñ a guide to vocational rehabilita-
Guide 05 tion
Adjudication of Claim
t How to File a Petition for Com-
mutation Guide 11 t Your Medical Evaluation
t How to File a Petition for Dis- (produced by Industrial Medical
Guide 06 Council)
t How to File a Petition for Recon-
sideration (Labor Code 132a)
Guide 07 Guide 12
Page 6 The Injured Worker