California Workers Compensation Laws
Workers' compensation systems are intended to compensate employees for job-related injuries or illnesses and to limit the liability of employers and other employees. California was one of the first states to establish a workers' compensation program when it enacted a voluntary program in 1911. With the passage of the Boynton Act in 1913, the state adopted a compulsory workers' compensation system that provides the basic structure for the system that is in effect in California today (see References). State law requires all California employers either to purchase workers' compensation insurance or to obtain a certificate of consent to self-insure from the state Director of Industrial Relations (Calif. Labor Code 3700).
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Medical Treatment
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An employee who is injured on the job should report the injury to a supervisor, obtain emergency medical treatment if needed and file a workers' compensation claim. The claims administrator (an insurance company official, or a third party administrator who processes claims for employers) must authorize medical treatment within one day after an employee files a claim. Medical treatment while the administrator's decision on the employee's claim is pending is limited to $10,000. Treatment for a work-related injury continues for as long as it is needed, although state law places limitations on some kinds of treatment. For injuries sustained since 2004 California law limits treatment to 24 chiropractic visits, 24 physical therapy visits and 24 occupational therapy visits, unless the claims administrator approves additional treatment (see References).
Medical Provider Network
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A medical provider network (MPN) is a group of health care providers established by a workers' compensation insurer or by a self-insured employer to treat work-related injuries. In California, an employee who is injured on the job must receive care from an MPN provider unless the employee has pre-designated (before a work-related injury occurs) his personal physician as the care provider for job-related injuries. The pre-designation option is available to an employee only if his employer provides group health coverage, the physician has previously treated the employee and has his medical records, the physician has agreed to treat the employee for work-related injuries or illnesses and the employee has notified the employer of the designation (see References).
Temporary Disability Benefits
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Temporary disability benefits compensate an employee for wages lost while recovering from a job-related injury or illness. California law provides for temporary total disability benefits for employees who cannot work during recovery and temporary partial disability benefits for employees who are able to do some work during the recovery period. Temporary disability generally pays two-thirds of an employee's gross wages during recovery. However, state law sets a maximum weekly cap on the amount of temporary disability benefits that an employee may receive (see References).
Permanent Disability Benefits
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Benefits are also available if a physician determines that an employee's work-related injury or illness has resulted in a permanent disability. The amount of permanent disability benefits that an employee may receive is established by state law and is based on the employee's disability rating (the extent of disability, expressed as a percentage), the date of the injury and the employee's wages before the injury occurred. A claims administrator must begin the payout of permanent disability benefits within 14 days after an employee's temporary disability benefits end (see References).
Death Benefits
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The California workers' compensation system provides for death benefits if an employees dies from a work-related injury or illness. The death benefits are paid to the surviving spouse, children or other surviving dependents.
Return to Work and Retraining
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The physician who treats an injured employee determines whether there are any limits (work restrictions) to the employee's ability to perform job functions. If the physician does not list any work restrictions, the employer as a general rule must return the employee to his pre-injury job and pay rate. If the physician does identify work restrictions, the employer must comply with those restrictions in assigning work to the employee. California law provides for some retraining benefits for employees with permanent work restrictions that will keep them from returning to their pre-injury jobs. Employees injured during or after 2004 may qualify for the state's supplemental job displacement benefits program. This program provides vouchers for retraining or skill enhancement (see References).
Uninsured Employers
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An employer's failure to comply with the requirement to obtain workers' compensation coverage is a misdemeanor, subject to up to a year in jail and a fine of up to $10,000, as well as additional monetary penalties. An injured employee of an uninsured employer may file a lawsuit against the employer. The employee may also file a benefits claim with the California Uninsured Employers' Benefit Trust Fund (see References).
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