Frequently Asked Questions

1. What Types Of Injuries Are Covered By Workers' Compensation?

A work injury may be the result of a single incident such as dropping an object on your foot, or cutting your finger on a machine. This type of injury is referred to as a "Specific Injury."

An injury may also be a result of work activities over a period of time. For example, a person whose job requires the lifting of heavy objects over a period of time may develop back or neck pain due to repetitive trauma on the job.

Another example would be a person whose job requires repetitive motion of the hands or wrists such as assembly work or typing at a computer. This worker might develop carpal tunnel syndrome or repetitive use syndrome of the hands or wrists, and this would also be a work injury entitling a person to the same benefits as if it had been a specific injury.

A work injury may also be the result of an occupational disease or illness that the work place has produced. An example would be a worker who develops asbestosis due to exposure to asbestos products on the job.

An incident or activity on the job which aggravates a previous injury or condition is also considered a work injury. An example of this would be an employee who has had prior back problems and then re-injures the back while lifting on the job. That person is entitled to work injury benefits for the re-injury. In some instances, a person may be entitled to workers' compensation benefits even if the injury did not occur while at the work site. For example, if the injury occurred in the company parking lot on the way to or from work, it is considered a work injury. A heart attack or stroke which is due to work stress may be a work injury, even if the heart attack or stroke occurs at home.

2. What Should I Do If I Am Injured At Work?

Report your work-related injury or illness, regardless of the nature or severity, to your supervisor immediately. Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor.

Fill out the "Employee" section of the claim form accurately and return it to your supervisor as soon as possible. Be sure to indicate all the parts of your body you feel may be affected or hurt by the work-related injury or illness.

Keep a copy of the completed claim form as your receipt. Request that your employer return the claim form to you with the "employer" section filled out. According to the law, your employer has 24 hours to return the completed form to you.

Advise your supervisor immediately if you need medical care. If you have filed a Personal Physician Pre-Designation form with your employer before the work-related injury or illness occurred, request to see your designated treating doctor as soon as possible. If you did not file a Personal Physician Designation form, request that your employer send you to a treating doctor as soon as possible. This requires your employer to refer you for medical treatment within 24 hours of filing the claim form.

Accurately describe in detail to the treating doctor how your work-related injury or illness occurred. Tell the doctor about all the parts of your body that have been affected or hurt by the work-related injury or illness.

Attend all medical appointments. Keep copies of all medical slips and notes - such as notes excusing you from work - given to you by the treating doctor. Keep copies of all correspondence from your employer or the insurance carrier regarding your work-related illness or injury.

Keep accurate records of the following:

1. Days off work
2. Dates of all medical treatment
3. All round trip mileage incurred for the medical treatment
4. Receipts for all out-of-pocket medical and prescription costs.

Do not abuse the Workers' Compensation system. Injuries or illnesses that you know are not work-related should not be reported. All statements and facts that you provide regarding your work-related injury or illness must be true and accurate.

You should immediately notify your employer as soon as you know or suspect that you have a work related injury or illness. Your employer must give you a claim form within one day after reporting the injury. Waiting to report an injury or illness can cause a delay or denial of workers' compensation benefits.

A claim may not be valid under California law if you wait until after you are terminated to file it, unless it can be shown that your employer had knowledge of the injury or there is evidence of the injury in your prior medical records.

3. Will I Get Fired If I File a Workers' Compensation Claim?

The law protects you from any form of discrimination by your employer due to being injured on-the-job or filing a claim. No one can guarantee that you will not be fired. We have no control over employers, but we can protect your rights if your employer decides to retaliate.

4. Do I Have To See My Employer's Doctor?

If you are covered by a group health plan you are allowed to pre-designate a treating physician (MD only) of your choice. The doctor must have previously been your primary care physician, and must agree to be pre-designated. You can begin treatment immediately after the injury with a pre-designated doctor.

If you have not pre-designated a treating physician, the law provides (as of Jan. 1, 2005) for indefinite control of treatment by an employer when it has set up an approved Medical Provider Network ("MPN"). You must select a physician within the MPN. However, you may change physicians within the MPN an unlimited number of times. If there is no approved Medical Provider Network, the law provides for a 30-day period of treatment control by the employer. Even if you have not pre-designated a treating physician, you may be entitled to treat with a physician of your choice outside of the Medical Provider Network if your employer or the insurance company fail to provide you with the required notices regarding their MPN.

5. What Is A Medical Provider Network?

A Medical Provider Network is an entity or group of health care providers set up by an insurer or self-insured employer and approved by the administrative director of the Division of Workers' Compensation ("DWC") to treat workers injured on the job.

6. What Is Utilization Review?

Utilization Review is the program employers or insurance companies use to make sure treatment given to injured workers is consistent with medical treatment guidelines.

All employers or the insurance companies handling their workers’ compensation claims are required by law to have a Utilization Review program. This program will be used to decide whether or not to approve medical treatment recommended by your doctor.

Unfortunately, many insurance companies are now using Utilization Review as an excuse to deny reasonable and necessary medical treatment to injured workers. Contact us if you believe you have been denied medical treatment that your doctor has recommended.

For more information, see the DWC Utilization Review Fact Sheet.

7. I Was Injured In An Auto Accident At Work. What Are My Rights?

You are entitled to workers' compensation benefits if you are injured in an accident while working for your employer, even if you were at fault. If you were not at fault, you may have a separate personal injury claim against the negligent driver of the other vehicle.

8. How Are Workers' Compensation Attorneys Paid?

Applicant's workers' compensation attorneys provide free consultation. The attorney's fee is taken out of your benefits when your case settles. The fee usually ranges from 9% to 15% of your final permanent disability settlement or award, plus an additional amount if you receive vocational rehabilitation benefits. A judge must approve the fee.

9. Where Can I Find More Information?

For a comprehensive overview of the California workers' compensation system, see A Guidebook for Injured Workers.