Workers’ compensation insurance is a category of business insurance that provides benefits for employees injured on the job or suffering from a work-related illness. Employers pay for workers’ compensation insurance not only to cover injured employees financially until they recover but also to provide benefits for workers in case of disability.
It was enacted into state law through the Boynton Act of 1913. Before then, injured workers had to file a civil suit against employers, often ending up empty-handed. The Boynton act replaced the need for a civil suit with a no-fault insurance system that allowed employees to receive benefits while shielding employers from lawsuits.
Who Qualifies for Workers’ Comp Benefits in California?
Every person who is an employee and suffered a job-related accident or injury is covered by workers’ compensation insurance and eligible for benefits, regardless of whether they work full-time, part-time, or seasonally. Anyone who has an employee status qualifies for workers’ comp benefits, as employers are legally mandated to carry workers’ comp insurance even if the company only has one other employee, including family members.
The only ones who are exempt from workers’ comp coverage are independent contractors or subcontractors, business owners, volunteers, federal employees, railroad employees, and maritime workers. If you are a federal worker, railroad employee, or maritime/longshore worker, you will receive your workers’ compensation benefits through a separate system such as the FECA (Federal Employee’s Compensation Act) or the Longshore and Harbor Workers’ Compensation Act.
What Steps Should I Take to File a Workers’ Compensation Claim?
The first and most important step you need to take is reporting your injury, preferably in writing. It is extremely important to notify a supervisor as soon as you have been hurt, or shortly after you notice an illness or chronic condition may have developed as a result of repeated exposure to workplace conditions. Even though you have up to 30 days to report your injury, it is best not to wait until the last minute. If you fail to provide a timely report and allow your employer enough time to investigate what happened, you may not be able to receive benefits.
You will also need to seek medical care for your injuries, and your employer may want to tell you where you should go for treatment. Finally, fill out and file a DWC1 claim form and give it to your employer, keep a copy for your own records. You should also retain a copy of any and all paperwork you submit, including medical reports. Make sure to comply with the doctor’s orders and follow the treatment prescribed to you.
What Will Workers’ Comp Benefits Cover and for How Long?
Workers’ Compensation will provide financial coverage for an injured employee for as long as it is medically necessary and until that person can return to work safely.
While there are monetary caps for certain categories of medical treatments ( such as a total of 24 physical therapy visits), workers’ comp benefit will typically provide five basic benefits:
- Medical care (paid by your employer);
- Temporary disability benefits (coverage for lost wages due to a prolonged recovery time);
- Permanent disability benefits (coverage for an employee who does not recover completely);
- Supplemental job displacement benefits (coverage for employees who need skill enhancement or retraining because they didn’t recover completely and didn’t return to work for the same employer);
- Death benefits (paid to a spouse or surviving family of an employee who dies on the job).
If you are unsure about how to file for workers’ comp or have questions, or if you believe your claim was unfairly denied, you don’t need to try to navigate it all by yourself. It might be in your best interest to consult a personal injury and workers’ comp law firm to get some guidance and knowledgeable answers to your questions.
What Should I Do if I Was Hurt on the Job and My Employer Is Uninsured?
Every employer in the state of California is required to carry workers’ compensation insurance regardless of the size of their business. If an employer relies on employee labor to conduct business, then they are required to either obtain workers’ compensation insurance or qualify to be self-insured. Failure to do so is considered a misdemeanor, which is a criminal offense subject to hefty fines and even jail time. An uninsured employer can face $10,000.00 in fines or up to one year in county jail and may receive a state-issued penalty of up to $100,000.00.
In addition, the employer is still responsible for all your medical bills and all bills related to your workplace injury. If your employer is not insured, you may file a civil lawsuit to seek compensation for your injuries, and you can also file a workers’ compensation claim. You cannot file a civil suit if your employer carries workers’ comp insurance, with very few exceptions.
The laws surrounding workers’ compensation insurance claims have changed a lot over the decades and evolved in complexity, making it harder for the average person to navigate them – especially when something out of the ordinary occurs, such as denied claim or an employer that is not following the law. This is when seeking the help of a seasoned attorney may make the difference for you. Our team at Sweet Lawyers has helped countless injured workers to receive the benefits they are entitled to so they can get back on their feet. Contact us today for a free case assessment – we are here to help.