California Law
California Workers' Compensation Law
Workers' Compensation Law
Each year thousands of California employees suffer work-related injuries. Like most states, California has a workers' compensation system to compensate employees for accidental injuries occurring in the workplace. Workers' compensation law is complicated and frequently subject to change. This chapter provides a basic overview of workers' compensation law in California. People with specific questions concerning workers' compensation should seek information from their employers or from the California Department of Industrial Relations, Division of Workers' Compensation, Information and Assistance Unit. An injured employee whose employer has refused to pay benefits should consult an attorney.
Workers' Compensation: The Basics
Workers' compensation is a state program requiring employers to have an insurance policy covering employees for accidental work-related injuries. If an employee is injured on the job, the employer or the insurance company provides payments for medical care and lost wages due to the injury, regardless of fault. None of the costs of the premium or benefits may be charged to employees. Though the employer pays the insurance premium, the cost of workers' compensation ultimately is passed to the consumer in the form of higher prices for goods and services.
The notion of employers paying for employees' work-related injuries originated in Germany during the latter half of the 19th century. Among the chief proponents of a German workers' compensation program was Bertha von Krupp of the famed German manufacturer, Krupp Works. Krupp had long believed that taking care of workers was in the best interest of business and in 1884 successfully persuaded Chancellor Otto von Bismark to support workers' compensation for all of Germany.
Workers' compensation did not come to the United States until about 1910, when New York and Massachusetts adopted programs. California adopted its workers' compensation program in 1917. This program is administered by the California Department of Industrial Relations, Division of Workers' Compensation. The California Division of Labor Standards Enforcement, known as the Labor Commissioner's Office, enforces all state labor laws, including those requiring businesses to have workers' compensation coverage. The Labor Commissioner's Office receives reports of unsafe conditions or violations of workers' compensation rules.
The advent of workers' compensation relieved injured employees from having to sue their employers to collect any sort of damages. Before workers' compensation, an employee had to prove that the employer had negligently failed to provide a safe work environment. Under workers' compensation, however, employees usually collect benefits regardless of fault. That is, even if an employee is responsible for his or her own accidental injury, the employee is covered by workers' compensation under most circumstances, as long as the injury occurred on the job. The main restriction to the program is that in most cases, workers' compensation benefits are the only form of remedy for workplace injuries. After receiving benefits, an injured employee may not sue his or her employer for further compensation.
Who Is Covered
Generally, California law requires that all employers with one or more employees have workers' compensation insurance coverage. Only employees are eligible for benefits. Broadly defined, an employee is anyone under oral or written appointment, contract for hire, or apprenticeship, working on a full- or part-time basis. This definition encompasses even aliens who are unlawfully employed, minors, and prisoners in work programs. Not included in this definition, however, are most domestic workers in private homes, volunteers in non-governmental entities, amateur athletes, casual laborers, independent contractors, and anyone who is not subject to the control and direction of the employer.
An employee's injury must arise "out of and in the course of employment" to be covered by workers' compensation. Basically, this means that the injury has to occur while the employee is involved in some activity directly related to his or her job. An employee injured at the job site performing tasks at the direction of the employer is covered, as is an employee who is injured on a business trip, as long as the employee is engaged in employment duties. Workers' compensation coverage even extends to an emergency during which an employee leaves work intending to save life or property. An employee is not covered, however, while participating in off-duty work-related or work-sponsored social, athletic, or recreational events, unless participation is required by the employer. An employee is not covered while traveling to or from the place of employment, except if the employer asks the employee to perform a special duty on the way or if the employee is paid for the commute time. Employees are not covered when voluntarily participating in employer-sponsored alternative commute programs, unless the employer elects to provide coverage. Employees injured during work breaks when no work is being performed also may not be covered, depending on the circumstances. Employees are not covered if injured while intoxicated at the workplace or if their injuries are wilfully self-inflicted. An employee also will not be covered if injured during "horseplay" with another employee, unless the employer knows of and condones such horseplay.
Workers' compensation benefits primarily cover accidental injuries. Injuries are accidental if they happen unexpectedly, without design or plan. This includes many repetitive stress injuries such as carpal-tunnel syndrome, as well as heart attacks, strokes, and other physical problems caused by work. In addition to accidental injuries, employees sometimes recover benefits if a pre-existing physical condition is made worse by work.
Available Benefits
The benefits available to workers include permanent or temporary total disability, permanent or temporary partial disability, and medical and related expenses. Workers' compensation entitles an employee to all reasonable and necessary medical care related to the injury. This includes visits to an approved health care provider, surgery, hospital care, dental care, prescription drugs, and crutches and other medical supplies ordered by an approved physician. An injured employee also may be entitled to payment for lost wages. The benefit amount is determined by state guidelines and usually is two-thirds of the worker's salary at the time of the injury. If, as a result of the injury, the employee is unable to return to work after more than 14 days, the employee is entitled to a portion of the lost income. An employee also is entitled to lost wages benefits if he or she is able to work, but earns less than his or her full pre-injury wages, or has suffered a permanent loss of a bodily function as a result of the injury. Injured employees unable to return to work also may be entitled to rehabilitation and training provided through the Division of Workers' Compensation, Vocational Rehabilitation Unit and local community colleges. The employer must provide notice of rehabilitative services to an employee whose disability continues for a total of 90 days. The employee's doctor must determine if the employee is medically eligible for vocational rehabilitation services. An employee's use of these services is not mandatory, but an employee who elects not to use the services must notify the employer in writing of this choice.
If an employee dies as result of a work-related injury, the employee's spouse, dependent children, or dependent parents are entitled to death benefits of up to $150,000 (with certain exceptions). Workers' compensation benefits are not considered taxable income.
Reporting an Injury and Collecting Benefits
If an employee is injured on the job, he or she must notify the employer within 30 days of the date of the injury, the date when the injury's effects first become apparent, or the date when a medical expert first discovers the injury. Failure to meet this deadline may threaten the right to benefits. The notice must be in writing and must be signed by the employee or, in the event of a death, by a dependent or someone on his or her behalf.
Within one working day of receiving notice of the injury, the employer must provide the employee with a claim form (called the "Employer's Report of Occupational Injury or Illness" form) and notice of potential eligibility for benefits. If the employer fails to provide one, an employee may obtain a claim form by contacting any Division of Workers' Compensation office. The employee should complete the form and return it to the employer. The employer must sign and date the form, give one copy to the employee, and send another copy to the workers' compensation insurance carrier. The employer must notify the insurance carrier within five days of receiving notice of the injury. After an employer has been notified of an injury, the employer or insurance carrier is obligated to provide the necessary medical treatment. The employer or carrier has the right to authorize the treating physician, but may not coerce or threaten the employee in the selection of a physician.
Employers are prohibited from discharging or threatening employees for asserting valid claims for workers' compensation benefits.
When an Employer or Carrier Refuses Benefits
If the employer or the insurance carrier refuses to pay for medical care or lost wages, an injured employee should call the Division of Workers' Compensation, which will attempt to remedy the problem through an informal resolution process. If that does not work, the employee will have to file a claim for benefits. If an injured worker has not yet consulted an attorney, it would be wise to do so at this point. Filing a claim can be complicated and failure to do so properly may threaten a worker's rights to benefits.
If the parties still cannot settle the dispute, they must seek help from the Workers' Compensation Appeals Board, which has exclusive jurisdiction over all disputes involving both insured and self-insured employers. The dispute will be referred initially to an Arbitration Board judge, who may conduct a hearing and may take testimony. The findings and order of the judge will be reviewed by the Arbitration Board, which may accept, reject, or modify the findings. A party who is dissatisfied with the results of the arbitration proceedings may apply to have the case reviewed by the California Supreme Court or by the appellate court for the district in which he or she resides.
A final point: filing a false claim for workers' compensation benefits is a felony and has serious consequences.
Resources
For questions concerning workers' compensation, contact the California Department of Industrial Relations, Division of Workers' Compensation, Information and Assistance Unit at (415) 975-0700. Call (800) 736-7401 for information about a local office.
Christopher A. Ball, How to Handle Your Workers' Compensation Claim: A complete Guide for Employees (Nolo Press, Berkeley, CA).