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California Workers' Compensation: How & When To Get Benefits
Workers' comp insurance exists primarily for your benefit, but you have to act fast if you've been injured on the job
An injury can happen even in the safest workplace, and California workers' compensation laws are designed to protect both you and your employer. See what to do if you've suffered a work-related injury.
Almost everyone will work for the majority of their lifetime. Even if you have a desk job or are in a profession that doesn't seem particularly dangerous, injuries can (and do) still happen.
Certainly, the type of injury you're likely to experience at a more sedentary job is different from the types of injuries that happen to construction workers, truck drivers, roofers, or others in high-risk jobs, but there are no guarantees of a hazard-free workplace.
In fact, the Centers for Disease Control and Prevention (CDC) says that the most common office accidents are slip and falls, which are also the most disabling injuries.
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Facing facts Someone who works in an office is 2 to 2.5 times more likely to become disabled from a fall than someone who works outside an office.¹
Even though injuries are common in traditionally "non-hazardous" workplaces, fatalities aren't. The Bureau of Labor Statistics identifies construction, transportation and warehousing, and agriculture (including forestry, fishing, and hunting) as the 3 industries with the highest fatality rates.
This article explores the most dangerous professions, the California workers' compensation system, and how to obtain benefits for a work-related injury or illness.
Most common work-related injuries
The most common work-related injuries include falls resulting from:
- Tripping (for example, over electrical cords or wires, loose carpet, objects in walkways, over open desk drawers)
- Bending or reaching from an unstable chair
- Slipping on a wet floor
- Poor lighting
- Standing on a chair to reach an object on a shelf
Another cause of injury is lifting — even if you're lifting small loads like a stack of file folders, reams of paper, or a computer monitor.
A messy or poorly organized office can be a dangerous workplace environment. People bump into desks, doors, file cabinets, office equipment, or even other people. They also can be injured when items fall from shelves, cabinets tip if not properly balanced, or a door opens suddenly.
Of course, if an accident like this does occur, it doesn't necessarily mean the office was messy or disorganized — many people spend as much time in their office space as they do at home, and accidents are bound to happen.
Other injuries happen without a specific accident or incident. Musculoskeletal problems like carpal tunnel syndrome and other neck and back injuries can happen gradually, and they're often related to your position relative to your work station, repetitive motions, or other situational causes.
| Work-related fatality statistics in California (2017) | |
|---|---|
| Total | 376 |
| Violence and injuries by people or animals | 66 |
| Transportation-related | 139 |
| Fires and explosions | 4 |
| Falls, slips and trips | 82 |
| Exposure to substances or environments | 29 |
| Contact with objects and equipment | 52 |
| Non-fatal work-related accident statistics in California (2017) (based on number per 100 full-time equivalent workers)² |
|
|---|---|
| Specialty hospitals | 17.9 |
| Tire manufacturing | 17.4 |
| Psychiatric and substance abuse hospitals | 15.0 |
| Museums, historical sites, and similar institutions | 14.4 |
| Performing arts, spectator sports, and related industries | 11.8 |
California workers' compensation basics
Workers' compensation is insurance provided by your employer to cover your medical costs and lost wages if you suffer a work-related injury. Every California business with at least 1 employee is required to carry coverage.
Workers' compensation benefits both you and your employer.
- It's no-fault insurance, which means you receive coverage regardless of whether the accident that caused your injury was the fault of your employer, another employee, or even your own. It's designed to compensate you for lost wages and treatment, and get you back to work without a lengthy process of assigning liability.
- Workers' compensation is designed to take the place of a personal injury lawsuit. Once you reach a settlement with the insurance company, the employer is protected from having to defend itself in court.
What's covered under California workers' compensation?
Workers' compensation benefits can include:
- Medical treatment, including doctor or hospital visits, diagnostic testing, medication, equipment, and travel costs.
- Death benefits for a worker killed on the job. Workers' comp insurance provides benefits to the deceased person's spouse, children, or other financial dependents.
- Supplemental job displacement benefits, which are vouchers that pay for retraining if you can't return to your previous job.
- Temporary disability benefits, which are lost wages you can receive if your injury prevents you from doing your usual job during your recovery time.
- Permanent disability benefits, which are payments received if you don't recover completely and suffer a complete loss of physical or mental function.
You usually can't sue your employer for an on-the-job injury, but you can get #workerscomp benefits even if you're a temporary or part-time employee. Tweet this
How to file a workers' compensation claim
If you were injured at work, you must notify your supervisor as soon as possible. If your injury is the result of repeated exposure or developed gradually, you must notify your employer as soon as you become aware that your condition is work-related.
You might lose your right to receive workers' compensation benefits if you don't report the injury within 30 days.When you seek medical treatment for an injury or illness, it's important to tell your doctor that it's work-related. It will be essential that this is documented in your medical records.
Once you've notified your employer about the injury, they're required to provide you with a claim form within 24 hours that you must return to them with your portion completed.
Always keep a copy of every form submission, and keep a record of when and how you provided it to your employer. (If you sent it by mail, use certified mail so you have a return receipt and proof of delivery). It's the employer's responsibility to complete the form and submit the claim to the insurance company, along with returning one copy to you. If your employer doesn't comply, you must submit the form yourself.
The insurance company must mail you a letter within 14 days that informs you of the status of your claim.
Enjuris tip: You can see your own doctor for diagnosis or treatment of a work-related injury if your doctor is predesignated. That means before you're injured, you must have provided the name and address of your selected personal physician to your employer.
What is workers’ compensation fraud?
Workers’ compensation fraud involves someone making a false statement in order to benefit financially from workers’ compensation insurance.
Workers’ compensation fraud can be committed by an employee or an employer. Here are some common examples of workers’ compensation fraud:
- An employee fakes or exaggerates a job injury to receive workers’ compensation benefits.
- An employee submits duplicate claims for payment of a healthcare benefit covered by workers’ compensation insurance.
- An employer incorrectly classifies an employee to avoid having to pay workers’ compensation insurance.
Workers’ compensation fraud is punishable as a misdemeanor or felony depending on your criminal history and the egregiousness of the fraud.
| California workers’ compensation fraud penalties | ||
|---|---|---|
| Penalty | Misdemeanor | Felony |
| Fine | Restitution and a fine up to $150,00 or double the amount of the fraud, whichever is greater | Restitution and a fine up to $150,00 or double the amount of the fraud, whichever is greater |
| Probation | Informal probation | Formal probation |
| Jail | Up to 1 year in county jail | Up to 5 years in county jail |
Real Life Example:On July 11, 2022, Q'Orianka Kilcher, the star of the television show Yellowstone, was charged with two felony counts of workers' compensation fraud.
Q'Orianka allegedly injured her neck in 2018 while filming a live-action adaptation of the children's television show Dora the Explorer.
In 2019, Q'Orianka informed her workers' compensation insurer that she was unable to work due to the severity of her neck pain. Based on these statements, Q'Orianka received approximately $96,838 in temporary disability benefits between October 2019 and September 2021.
A subsequent investigation conducted by the California Department of Industrial Relations revealed that Q'Orianka had nevertheless worked on the television show Yellowstone from July 2019 to October 2019—the period she claimed she was too injured to work.
Q'Orianka pleaded not guilty to the charges, according to Los Angeles County Superior Court records.
Q'Orianka allegedly injured her neck in 2018 while filming a live-action adaptation of the children's television show Dora the Explorer.
In 2019, Q'Orianka informed her workers' compensation insurer that she was unable to work due to the severity of her neck pain. Based on these statements, Q'Orianka received approximately $96,838 in temporary disability benefits between October 2019 and September 2021.
A subsequent investigation conducted by the California Department of Industrial Relations revealed that Q'Orianka had nevertheless worked on the television show Yellowstone from July 2019 to October 2019—the period she claimed she was too injured to work.
Q'Orianka pleaded not guilty to the charges, according to Los Angeles County Superior Court records.
When do I need a lawyer for a workers' comp claim?
Whether or not you need a lawyer depends on how smoothly your claim is resolved. If your claim is accepted and the payments or settlement offer are satisfactory, you likely don't need to go any further. If your claim is denied, though, it means the claims administrator doesn't think your injury is covered under workers' compensation. If that happens, you can file an application to have your case heard by a judge.
If the judge is willing to hear your case, you'll first attend a mandatory settlement conference, which is between you, the claims administrator, the judge, and any involved attorneys. At this point, it's advisable to have your own workers' compensation attorney.
Remember this:
You might be at a disadvantage if you appear at a hearing without a lawyer. That's because the claims administrator, their attorney, and the judge, all have a level of expertise on workers' compensation benefits and settlements. They know "the system" inside and out, and they've likely handled hundreds of claims.
There could be elements in a settlement related to your Social Security, future disability payments, and other things, and you don't want to jeopardize any of it because you're not as familiar with how it all works. Your lawyer is trained and experienced to handle the "fine print" in a workers' compensation claim, and it's their role to advocate for your rights.
Is a California work injury ever a personal injury lawsuit?
The workers' compensation system is designed to provide a remedy for a person who suffers a work-related injury, but also to protect employers against lengthy and costly litigation. In most circumstances, workers' compensation benefits are the only financial recovery you can receive.
But there are some limited situations when a personal injury lawsuit is necessary and allowed. We've already said that workers' compensation insurance is, by definition, no-fault coverage. But what if there is fault or liability by a third party?
There could be a situation when your injury is caused by a defect or negligence on the part of someone who's not your employer or a coworker.
For example:
- You fell on your construction site when a scaffold broke because of a defect in the manufacturing of the scaffold.
- You were driving your own car for a work-related errand when you were hit by someone who was driving drunk. Your car was totaled, and you suffered extensive injuries, including pain and suffering.
- You were attending a meeting in an office building that's not owned by your employer. You fell as a result of tripping on a cracked floor tile. The building owner or manager could be at fault in a premises liability lawsuit.
In each of these examples, the injury was caused by the negligence of a third-party that doesn't work for your employer. A personal injury lawsuit in each of these scenarios would be a way to recover non-economic damages that aren't included in workers' compensation benefits.
A personal injury lawyer can evaluate your claim to determine whether there's a negligence case or if you're limited to workers' compensation benefits for your injury.
Is your injury work-related or not?
If your injury happened in the workplace during work hours, it's work-related for the purposes of workers' compensation benefits. The exceptions to this would be if you were under the influence of drugs or alcohol, or participating in some other illegal activity when you were injured.
But what if you were on your commute, lunch break, or running a work errand?
That's a little trickier.
Your commute in your personal vehicle isn't covered by workers' compensation, so if you're injured on your way to or from work, you'd handle it like a regular car accident personal injury claim.
Your lunch and other breaks are also not covered when you leave the premises.
But if your job requires you to drive to other locations, attend off-site meetings, or if you need to travel on a work-related errand, workers' compensation insurance covers you during those activities, both during transportation and while off-site.
Anything that falls within your job description, assigned tasks, or is requested by your supervisor or manager is considered "work-related."
What if you're an independent contractor?
An independent contractor is not eligible for workers' compensation coverage in California.
However, working under an independent contractor agreement or contract doesn't mean that the Labor Code views you as such for the purposes of workers' compensation.
The test to determine whether someone is an independent contractor is typically reviewed on a case-by-case basis, but determining factors include:
- Whether the person is in an occupation or business that's different from the employer's business or industry.
- Whether the work is part of the employer's regular business.
- Whether the person supplies their own tools and equipment for performing the work.
- Whether the person is subcontracting additional help.
- Whether the type of work performed requires special skills.
- The length of time the work will take place and degree of permanence of the relationship.
- The method of payment.
These factors all matter for making a decision for whether someone is an independent contractor, but there's not a specific test to determine eligibility.
How to find a workers' compensation lawyer
Workers' compensation is complicated, there's no question about it. But it exists so that you can get the financial recovery you need and deserve if you're injured at work. A California workers' compensation lawyer is only a click away. Talk to an attorney who is competent, knowledgeable, and experienced with the nuances of labor and insurance laws, and they'll work to get your benefits covered.
Sources:
¹ Albert Einstein College of Medicine, Environmental Health and Safety
² U.S. Department of Labor Bureau of Labor Statistics, State Occupational Injuries, Illnesses, and Fatalities
Common workplace injuries in California
Amputation & disfigurement
Severe burn injuries
Head & traumatic brain injuries
Neck, back & spinal cord injuries
Slip and fall injuries
California Personal Injury Guide
Did you know slip and falls are the leading cause of workers' comp claims in the US? Tweet this
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