Workers Compensation Laws in California

The following laws are taken from the Labor Code. For a comprehensive discussion of frequently asked questions regarding workers compensation, you can also follow this link: https://www.dir.ca.gov/dwc/WCFaqIW.html#Basics

Labor Code 4610 - Utilization Review.

Utilization Review is the process employed by insurance companies to deny medical treatment for injured workers. When your doctor recommends a treatment, he or she will send a Request for Authorization (RFA) to the insurance company. The insurance company is required to respond within a strict time frame, forwarding the RFA to a Utilization Review Company. This third-party company, contracted by the insurer, reviews the request according to Medical Guidelines to determine whether the requested treatment is reasonable under the given circumstances. As you might expect, many treatments for injured workers are denied.

If you receive a denial letter in the mail regarding your treatment, this decision stems from the Utilization Review process. There are specific time limits for appealing the UR decision to an Independent Medical Review. We strive to ensure these deadlines are met and will take the insurance companies to court to compel them to comply with the law and provide necessary treatment.

Labor Code Section 5401 - Employer Must Provide Injured Worker a Claim Form.

Your employer is obligated to give you a workers compensation claim form within one business day of your injury. Upon sustaining an injury, you should notify your employer in writing as soon as possible. The claim form is a legal document with significant implications, so it is essential to fill it out accurately to avoid complications later.

Often, employers fail to provide a claim form or do not send an injured worker to see a doctor. If you find yourself in this situation, do not hesitate to assertively request a claim form or contact us—we can help you complete one and send it to your employer.

Labor Code 5402 - Employer Has 90 Days to Accept or Deny Your Claim.

Once you submit your claim form, your employer has 90 days to decide whether to accept or deny your claim. This delay can lead to considerable hardships for injured workers who require financial assistance, as the insurance company will not issue temporary disability payments while the case is under review. For more details about the 90-day delay period, you can read more here.

Labor Code 3600 - Employee Gets Benefits Even If Totally At Fault.

Injured workers are entitled to various benefits even if they were entirely at fault for their injury. Employers may attempt to misclassify injured workers as independent contractors to deny access to benefits. We frequently encounter this situation and have successfully proven that workers labeled as contractors are actually employees entitled to workers compensation benefits.

Labor Code 4650 - Temporary Disability Benefits.

An injured worker may receive what is known as temporary disability benefits, calculated at two-thirds of the worker's regular salary, for up to two years. To qualify for these payments, a Primary Treating Physician must confirm that you are unable to work or that you have restrictions that your employer cannot accommodate. Therefore, it’s crucial to seek treatment from a physician who is sympathetic to the needs of injured workers rather than one who prioritizes the preferences of insurance companies. If you are currently seeing a doctor chosen by your employer or the insurance company, it’s advisable to seek alternative care as soon as possible.

There are instances when injured workers are denied Temporary Disability benefits, or when insurers underpay them. Payments for Temporary Disability will cease once a doctor declares that the worker is Permanent and Stationary. This marks a pivotal moment in your case; however, it is not uncommon for a doctor to classify someone as Permanent and Stationary even when additional treatments, including surgery, are necessary. Seeking second opinions from a Panel Qualified Medical Evaluator and obtaining supplemental reports may be essential as evidence in court.

Once a doctor asserts that a worker cannot work, the insurance company has 14 days to commence payments. If they fail to make timely payments, penalties may be incurred.

Labor Code 4656 - Permanent Disability Benefits.

Permanent Disability benefits begin when the treating physician establishes that the employee is Permanent and Stationary. This transition marks the end of Temporary Disability payments and the commencement of Permanent Disability payments. Unfortunately, Permanent Disability payments will be deducted from any final settlement amount, whereas Temporary Disability payments typically are not. Therefore, it is crucial to continue receiving Temporary Disability rather than switching to Permanent Disability too soon, as insurance companies often aim to expedite this transition.

Permanent Disability is usually paid as a lump sum upon case settlement and calculated using a complex system that rates each injured body part. A doctor determines a percentage of impairment for each injured part.

A qualified workers compensation lawyer plays an integral role in this calculation, as it is a complicated process that should not be entrusted to those lacking the necessary training to interpret the AMA Guides used to assess impairment. Furthermore, ensuring thorough documentation of all injured body parts is vital, as insurance companies will often attempt to minimize the body parts allowed in the claim.

Our dedicated staff will advocate for you to receive treatment for all affected body parts, thereby enhancing your permanent disability rating. Our experienced work comp attorney is skilled in making sure that doctors apply the AMA Guides correctly and will ask the critical follow-up questions to keep the doctors focused on the specifics of your case.

Labor Code 4659 - Life Pension.

If your injuries combine to yield up to 70% Permanent Disability, then 1.5 percent of the average weekly earnings for each 1 percent of disability beyond 60 percent will be paid throughout the injured worker's lifetime, following the maximum number of weeks defined in Labor Code Section 4658. The average weekly wage is capped at $515.38. For more information, please refer to our blog.

Labor Code 4600 - Medical Care and Procedures for Injured Worker.

Workers' compensation insurance is mandated to cover all necessary medical treatments, medications, procedures, and therapies for injured workers. You have the right to select your doctor, and we can assist you in making the appropriate choice. Securing appointments with medical providers is becoming increasingly challenging as insurance companies often delay the authorizations needed to arrange visits. We frequently pursue penalties for delaying care in accordance with Labor Code 5814 and address failed payments under Section 4650.

There are numerous other laws within the Labor Code that are vital to be aware of. The positive news is that you don’t need to memorize them all; you can simply call for assistance from one of our friendly attorneys:

Joshua Harrer and Aaron Steinberg  

Workmans Comp Lawyers  

310-961-0588  

Torrance, CA 90504

We can explain how injured workers can get disability benefits or assist you with the forms without any charge for inquiring about help with your work injury, as outlined in the Labor Code concerning workers compensation.