To get workers’ compensation payments in California for a work-related accident or sickness, you must complete many paperwork within the prescribed time restrictions.
If you have been injured or become sick as a result of your employment in California, you may be eligible to compensation under the state’s Workers Compensation Act.
If you are a qualified employee who has suffered a job-related accident or sickness, the law requires your California employer to pay for your medical care as well as partial salary replacement while you are off work and recuperating.
However, if you want to obtain these and other workers’ compensation benefits in California, you must submit a claim on time.
How to File a Workers’ Compensation Claim in California
In most circumstances, submitting a workers’ compensation claim in California consists of three steps:
Please report the injury.
File a “application for adjudication of claim” with the Workers’ Compensation Appeals Board as well as the actual claim with your employer (WCAB).
Each of these processes has a time constraint. In certain cases, you may be able to get away with being late on the first two stages. However, if you miss the deadline for the last stage and your employer’s insurance carrier refuses to provide or continue coverage, you may be out of luck. Continue reading for more information.
When Does the Clock Begin to Run?
The deadlines for taking action for all stages involved in filing a workers’ compensation claim begin on the day of your injury. If you were injured in a job accident, such as falling off a ladder, that date is quite obvious.
However, if you believe you have a cumulative trauma injury (such as a repeated stress or strain injury) or an occupational illness, the situation becomes a bit more difficult (such as COVID-19 from exposure to the coronavirus on the job or lung disease from exposure to toxic chemicals).
In some cases, the time limit for reporting and submitting your claim begins when both of the following events occur:
You initially missed work or went to the doctor because of the injury or sickness, and you knew or should’ve known that it was caused by your job—usually because the doctor told you.
(Labor Code Sections 5411, 5412 (2022).)
What is the California Workplace Injury Reporting Deadline?
If you do not notify your employer in writing within 30 days after the date of the injury, you may lose your access to workers’ compensation payments. However, there are certain caveats, such as when your employer (including a supervisor) was aware of the damage. (5400, 5402(a) (2022) of the California Labor Code.)
That implies you shouldn’t put off informing your employer about your injuries or sickness. Furthermore, any delay might jeopardize your advantages, so the sooner the better.
If you are hurt at work, you should seek medical attention right once. In an emergency, you may seek medical attention anywhere. Otherwise, if your employer or its insurance company maintains a network of medical providers, you may be required to see a doctor in that network. (Learn how to handle physicians in California workers’ compensation claims.) Make it a point to inform your medical physician that your injury or sickness is work-related.
How to File a California Workers’ Compensation Claim
Your employer should give you a workers’ compensation claim form (known as Form DWC-1) within one working day of reporting your injury or illness, along with information about your rights and potential eligibility for benefits, what you need to do to get those benefits, and other details about the workers’ comp process.
If your employer did not provide you with the DWC-1 form, you may get it from the forms area of the California Workers’ Compensation (DWC) website.
Fill out the employee component of the form according to the directions on the form. Make a list of every area of your body that has been harmed. After you’ve completed the form, either present it to your employer in person or submit it through first-class or certified mail (with the U.S. Postal Service).
Your employer should complete its section of the form, submit it to its insurance carrier, and provide you with a copy. (California Labor Code 5401 (2022).)
California’s Workers’ Compensation Claim Deadline
In California, you have one year from the date of your injuries to make a workers’ compensation claim.
Following the Claim: Response of the Insurance Company
After you submit the claim form, your employer’s insurance company must approve payment for your medical care while it investigates the claim to see if it is legitimate.
The insurance is liable for up to $10,000 in medical expenditures until it makes a decision. In most cases, the claim will be deemed authorized if the insurer does not refuse it within 90 days of receiving the form.
However, if you submitted a claim based on COVID-19 and fulfill the standards for a presumption that the illness is work-related, the insurer has less time to make this determination. (For further information, see our COVID-19 page on obtaining workers’ compensation payments in California.) (See California Labor Code sections 3212.87, 3212.88, and 5402(b), (c) (2022).)
If you are unable to work due to an accident or sickness, the insurance company should begin paying temporary disability payments within 14 days of learning about the injury and your temporary impairment.
If the insurer does not begin payments by then or responds to the claim by rejecting it or requesting further information, it will be subject to a late penalty of 10% on the late temporary disability benefits. (California Labor Code 4650(a), (d) (2022).)
To resolve disputes, file an Application for Claim Adjudication.
You may be tempted to believe that everything is well if your employer’s insurance provider has begun paying your medical and temporary disability payments. That may be true if your injuries were small, you healed quickly and fully, and you have no problems with the insurer over medical care or your need to leave work.
However, conflicts are frequent, and your medical state is subject to change. Even if you submitted a claim with your employer, you won’t be able to address any disagreements unless you also filed an Application for Adjudication of Claim with the WCAB. (For more information on what happens next, visit our page on the California workers’ compensation appeals procedure.)
In general, you must submit the Application for Adjudication of Claim (Form WCAB-1, which is also accessible on the DWC forms website under “Court forms”) within one year after the following events:
the date of the accident (see the discussion above for how to determine that date in cases of cumulative trauma or occupational illnesses)
the final day of medical benefits supplied by your employer, or the last day of any temporary disability benefits.
(California Labor Code 5405 (2022).)
Courts have ruled that if an employer or its insurer advanced payments for medical expenditures while knowing that the treatment may be connected to a prospective workers’ comp claim, the injured employee may have to wait longer to make the application for adjudication of claim.
In such situation, the employee has five years from the date of injury to submit the application—the time frame utilized in Cal. Labor Code 5410 when there is “new and additional” impairment (2022). However, after the insurer notifies the employee that the claim has been denied, the employee has a year to submit the application. McDaniel v. Workers’ Compensation Appeals Board, 218 Cal.App.3d 1011 (Cal. Ct. App. 1990).
You have one year from the date of death to make an application for adjudication of claim if you are the dependant of someone who died as a result of work-related injuries.
If you need assistance filling out the form, please contact the DWC Information & Assistance Unit. Instructions for submitting the application for adjudication of claim may be found here, as well as links to get copies of any additional papers required.
The guidelines also give a link to utilize if you don’t know the name and address of your employer’s or its insurance company’s claims administrator. (If you have a full copy of the DWC-1 claim form, that information should be on it.)
If you do not have a lawyer, the WCAB will send copies of your application to your employer and insurance provider. Otherwise, your lawyer will handle it.
Have you missed a Workers’ Compensation deadline in California? Speak with an Attorney
Contact a California workers’ compensation attorney if you did not submit a worker’s compensation claim or an application for adjudication of claim on time.
The legislation in this area is intricate, and there are times when you may be pardoned for missing a deadline or the time period may be extended. An expert workers’ compensation attorney can explain how the law relates to your circumstances and assist you in protecting your rights. If your employer declines your claim for whatever reason, an attorney may assist you in an appeal.