The Golden State’s workers’ compensation system provides a safety net for employees who have sustained an injury or illness on the job. What steps should you take as an injured worker, what benefits can you expect to collect, and why would insurance companies dispute a claim? This article addresses California workers’ compensation laws and regulations in more detail.
The Workers’ Compensation System in California
California’s workers’ compensation system operates on a no-fault basis. Employees may claim compensation for workplace injuries or occupational diseases, regardless of whose actions led to the injury or illness. In return, employees forfeit their right to file a civil lawsuit against their employer.
All employers in California must carry workers’ compensation insurance, even if they have only one employee. However, this law doesn’t apply to sole proprietors, independent contractors, some volunteers, and domestic employees related to the employer.
You may be eligible for workers’ compensation if:
- You are an employee, whether you work full- or part-time
- You suffer from a work-related injury or illness
What Counts as a Workplace Injury or Illness?
Your injury or illness may be work-related if:
- It occurred in the work environment and on payroll hours
- It occurred while performing work-related duties, even off the clock or outside work premises
- An incident or exposure at work caused or aggravated your condition
For example, if your boss calls you after work hours and asks you to run a quick errand for the company using a personal vehicle, and you suffer an injury while running that errand, your injury would probably count as work-related. However, an injury you sustained while commuting or during your lunch break would usually be ineligible for workers’ compensation coverage.
An experienced attorney can evaluate your case and tell you whether California law considers your injury or illness work-related.
Benefits Available to Injured Employees in California
Under California workers’ compensation laws and regulations, you may be eligible for the following benefits:
- Medical coverage, including the cost of medical check-ups, treatment, prescription drugs, surgery, and medical equipment. Workers’ compensation also covers traveling for medical care.
- Temporary disability, usually amounting to two-thirds of your weekly wages (up to a certain cap). Workers typically collect temporary disability for up to two years. This period may extend to 240 weeks in cases of temporary total disability that involve serious conditions like severe burns, amputations, and chronic lung disease.
- Permanent disability (up to 14 years) if your injury prevents you from returning to your former position or seeking another job. The payouts would depend on your permanent disability rating, with influencing factors like the type and severity of your injury, your age, and your line of work.
- Life pension if you have a 70% to 99% permanent disability rating. Eligible workers can collect life pensions and permanent disability payments for the rest of their lives.
- Vocational retraining if you cannot return to your former job. Employees eligible for this benefit may enjoy coverage of up to $6,000 for retraining and education in state-approved institutions.
Spouses or dependents of employees who suffered a fatal workplace injury can claim death benefits, including burial expenses, with caps depending on the number of dependents.
What To Do After a Workplace Accident
If you suffered a workplace injury in Orange County, you should:
- Inform your employer or direct supervisor of the injury. You generally have 30 days to report an injury, or you risk losing your eligibility for compensation.
- Seek medical attention. Unless it’s an emergency, ask your employer or HR department for a list of approved healthcare providers under the company’s workers’ compensation policy.
- Let the healthcare provider know you believe your injury or illness is work-related.
- Save all your medical records and other evidence, like photos of the location where the accident occurred and testimonies from co-workers.
- Contact an experienced local workers’ compensation lawyer to learn your rights and ensure your claim complies with the insurer’s requirements.
California’s statute of limitations imposes a one-year deadline on workers’ compensation claims. In cumulative trauma claims (i.e., claims that involve gradual-onset occupational diseases or conditions like carpal tunnel syndrome), the one-year window starts from the time the worker should reasonably have known their condition is work-related.
Why Workers’ Compensation Claims May Encounter Denial
Claim denial after your workplace injury or illness can be an unexpected blow. Some reasons for workers’ compensation claim disputes include:
- Missing a filing deadline or otherwise failing to comply with California workers’ compensation laws and regulations
- Injuries that occur because of horseplay, intoxication, or violation of safety protocols
- The insurer arguing that a workplace illness or injury occurred because of a pre-existing condition
- Lack of medical records (e.g., in cases when the employee didn’t seek medical attention after a workplace accident)
- The injured employee’s use of out-of-network medical care providers
Some claim disputes occur because of procedural confusion or misunderstandings. In other cases, insurance providers may act in bad faith. For example, perhaps you developed chronic lung disease from prolonged exposure to toxic fumes, but the insurer tries to pin the condition on your asthma.
Sometimes, employers may interfere with legitimate workers’ compensation claims or penalize workers who file a claim because every claim raises their insurance premiums.
Working with a skilled workers’ compensation lawyer will help protect your interests and improve the chances of a quick, stress-free claim resolution. Your attorney will ensure your claim follows the necessary procedures, source and present compelling evidence, handle negotiations with the insurance company, and appeal a denied claim if necessary.
Khalil Law Group: Representing Injured Workers and Their Families in Orange County, CA
At Khalil Law Group, we provide the legal guidance and support employees and their families need after a workplace injury. We’ll handle the entire process of your claim, from ensuring compliance with California workers’ compensation laws and regulations to presenting a powerful, well-documented case and fighting for maximum payout on your behalf.
Call (714) 617-7870 or contact us online for a free consultation with a workers’ compensation attorney in Newport Beach, CA.