Workers’ Compensation in California
If you have incurred a work-related injury or illness in the state of California, the clinics of the UrgentMED Network specialize in such medical examinations and are ready to assist with your workers’ compensation claim. All 14 of our Southern California locations are contracted with workers’ compensation insurances (however, the specific providers may vary). Check with your employer whether a clinic part of the UrgentMED Network is qualified via their workers’ compensation insurance provider.
What is Workers’ Compensation?
California’s Workers’ Compensation Act entitles injured employees to have their medical costs covered by the employer, meaning both the initial doctor’s visit as well as any medical treatment required thereafter. This law also entitles an injured employee to a partial wage replacement in the event that said employee is unable to work during the recovery process.
However, this compensation is not automatic and requires particular actions to be taken in a precise order. Being examined by a doctor that specializes in workers’ compensation is only the first step towards receiving your deserved benefits.
Visit a licensed physician from the UrgentMED Network for your workers’ compensation examination today in order to file your claim as soon as possible.
Am I Eligible for Workers’ Compensation Benefits?
The majority of California residents are covered for workers’ comp since the state of California requires all employers to pay for this type of insurance. No matter the size of the business, employees are required to provide insurance either through a private insurance company or through the State Compensation Insurance Fund (SCIF). In the instance that your employer has been illegally refusing to provide coverage, the Uninsured Employers Benefit Trust Fund (EUBTF) is available in lieu of insurance benefits.
One-time accidents, injuries incurred from repetitive motions (known as cumulative injury), or illness due to the working environment are all eligible for workers’ compensation. The most common workplace injuries that occur are due to accidents such as falling, injury when lifting/moving heavy objects, or being struck by a vehicle.
Insurance companies typically deny workplace-induced illnesses that cannot be directly attributed to being caused by the place of employment (i.e. stress-related sickness or psychiatric injury). Additionally, employees can expect to be denied compensation for any injuries that are their own fault, including:
- Self-inflicted injury
- Injury during fighting or horseplay
- Injuries sustained during a crime
- Injuries occurring under the influence of alcohol/drugs
How to File a Workers’ Compensation Claim in California
Eligibility to receive workers’ compensation benefits in California is a relatively simple process. It begins by reporting the injury and is followed by time-sensitive paperwork that must be completed by the injured employee and the employer. Missing the deadline for the paperwork or failing to make a claim within 30 days of your injury could cause you to lose your workers’ compensation benefits, so be very mindful of the specific timeline of this process.
Step One: Reporting the Injury
Notify your employer with a written notice as soon as an injury work work-related sickness is incurred. Failing to report the injury or illness within the first 30 days of its occurrence could render you ineligible to receive workers’ comp benefits. While this is possible for accident-based injuries which provide a clear date of injury, there are other instances that are not so black and white and can make reporting a work-related injury more difficult.
Step Two: Get a Medical Evaluation
Once you have reported the injury to your employer, receiving an official medical evaluation and diagnosis by your doctor is imperative. Doctors, like those of the UrgentMED Network, are crucial in determining how severe your injury is, and thus, in making sure you are adequately compensated for all necessary medical procedures.
Not all doctors treat work-related injuries, so be sure that the physician is aware of the specific nature of your appointment. In the State of California, injured employees must be seen by a doctor selected by your employer, which virtually eliminates the possibility that such a conflict could occur. Doctors that handle workers’ compensation cases will be required to fill out specific documentation detailing the specifics on your condition, such as necessitating time off work, job duty modifications, or determining whether you have a permanent injury.
If your work-related injury is a medical emergency, visit a medical facility as soon as possible – you will not be penalized for going out-of-network in emergency situations.
Step Three: File Form DWC-1
After you have reported your work-related injury your employer should provide a workers’ compensation claim form, formally known as the DWC-1. If your employer doesn’t provide this form, you can download it directly from the California Worker’s Compensation website. After the form is filled by both you and your employer, it is recommended that you mail this via USPS first class or certified mail. Your employer will have had to submit a form directly to the insurance company, so be sure that you receive a copy.
Step Four (Optional): File an Application for Adjudication of Claim
If you have a disagreement with either the employer or the insurance company, the Application for Adjudication of Claim (Form WCAB-1) is required in order to make your case eligible for appeal. It must be filed within one year of the date of injury, the last day of employer-provided medical benefits, or the last day of temporary disability benefits.
How Long Does it Take to Receive Workers’ Compensation Benefits?
After submitting the DWC-1 form, the employer’s insurance company will investigate to determine whether the workers’ compensation claim is valid. Until a decision has been reached, the insurer is liable for up to $10,000 in medical costs. If the claim hasn’t been denied within 90 days of submitting the DWC-1 form, the claim can be considered to be approved.
If your workplace injury results in missing work, temporary disability benefits should be provided within 14 days of the reported injury. If it takes any longer than 14 days, it will result in the insurer being subject to a 10% penalty for untimely distribution of benefits. Temporary disability covers two-thirds of average weekly salary – the maximum payout in 2018 being $1215.27.
Finding a Doctor for Your Workers’ Compensation Claim
Not all doctors treat workers’ compensation cases, but the doctors of the UrgentMED Network are here and ready to assist with all your California workers’ comp needs. If you suspect that you have incurred a work-related injury such as back strains, lacerations, stress-related ailments, or require x-rays or foreign body removal, the licensed physicians within the UrgentMED Network are available seven days a week to evaluate your injury or illness.
Injured employees can be seen with no appointment necessary and physical therapy is available on-site. Visit the clinics within the UrgentMED Network to receive a fast medical examination for your workers’ compensation claim and begin your filing process as quickly as possible.