How to File a Claim for Workers Compensation in California

When you become injured at your job in the state of California, you may be entitled to receive benefits from your employer to compensate for medical treatment and the time spent not working during your recovery. In order to qualify to receive workers’ compensation benefits, you must report the injury to your employer within 30 days of its occurrence. You must then complete the necessary documentation required by the California State Division of Workers’ Compensation (DWC) to begin receiving your benefits. If your claim is denied, there are further procedures to follow to take your claim to trial.

Part 1

Part 1 of 5:

Responding Initially to the Injury

If the injury is one that requires emergency care, that is your first priority. If less serious, get first aid at the site and then see your doctor if necessary. If possible, inform the hospital or doctor that the injury is from a work-related accident or incident.^{[1]XResearch source}
2
Report the injury to your employer. If the injury was from a single identifiable accident or incident, you should report it right away, but definitely no later than 30 days after the accident. If you fail to report within that time, you may not remain eligible for compensation benefits.^{[2]XResearch source}
- If your claim is based on a developing condition rather than a single injury, but you still believe it is work-related, you must report the condition to your employer within 30 days of identifying that the condition was work-related.
3
Continue to receive medical care. Your employer is required by law to provide you with the necessary medical care for a work-related injury. Your doctor may not bill you for this care, if it is clear that the injury was reasonably necessary for a work-related injury.^{[3]XResearch source}
- You may be eligible to receive compensation for travel costs to receive medical care.^{[4]XResearch source} If this is necessary, you must use the state’s expense form, available at http://www.dir.ca.gov/dwc/WorkersCompensationBenefits.htm#MileageRates. The mileage rates and claim forms have changed over time, so be sure to use the correct rate and form.
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Part 2

Part 2 of 5:

Filing the Claim

This form is referred to as the “DWC-1” form. Within a day after reporting your injury, your employer should provide you with a copy of this form. If the employer does not do that, you can download a copy from the DWC website at http://www.dir.ca.gov/dwc/DWCForm1.pdf. If you are unable to get the form online, you can call the DWC Information and Assistance Unit at 800-736-7401.
2
Complete the DWC-1 carefully. Complete only the “Employee” section of the form. This form is going to ask you for the following information:^{[5]XResearch source}
- Name
- Address
- Date and time of the injury
- Address and description of the location where the injury occurred. It is good to be descriptive here. If you slipped on a puddle in the bathroom, describe the location as “bathroom floor, puddle of water,” not just “bathroom.”
- Injury you sustained and the body part affected. Again, be descriptive and complete. “Broken left ankle” is a better response than “broken bone.”
- Signature.
3
Submit the DWC-1 to your employer. Make sure that you keep a copy of the form before you turn it in. Your employer is then required to complete the “Employer” section of the form and return a signed copy to you within one working day. If you do not receive the completed Employer’s copy, you should ask about getting it.^{[6]XResearch source}
- You may turn in the copy by hand or by mail. If you are mailing the form, you should use certified mail, return receipt requested, so you have a copy of the date that you sent the form and the date it was received.^{[7]XResearch source}
After the employer completes the form that you have submitted, the form is sent to the employer’s insurance company. The insurance company will review the information and send you a letter about the status of the claim within about two weeks.^{[8]XResearch source}
By law, your employer has 90 days from the date that you submit the claim form to notify you if the claim is “accepted” or “denied.” If the employer does not inform you of anything within 90 days, then the claim is presumed to be accepted.^{[9]XResearch source}
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Part 3

Part 3 of 5:

Collecting Benefits for an Accepted Claim

The first of five basic benefits that you are entitled to is reasonable and necessary medical care for your injury or condition. You should not receive bills for any of this care. If you do, then you should remind the doctor or hospital that this is a workers’ compensation claim and that the bills should go to your employer. You can also notify your employer, so they can help correct the error.^{[10]XResearch source}
These are payments from your employers to cover any lost wages for the time that you were unable to work. This may not apply to all cases, if you did not lose any work time.^{[11]XResearch source}
3
Receive permanent disability (PD) benefits. Permanent disability benefits are payments from your employer if your injury is something that will be permanent. The amount of PD benefits is set by law and is based on a variety of factors:^{[12]XResearch source}
- the date of your injury
- the level of your impairment, that is, how much your injury prevents you from being able to work, as determined by a doctor
- your age and occupation
- A “disability evaluator” will review these factors, using an established formula, and will determine the amount of your PD benefits.
This is in the form of a voucher, up to $6,000, that you can use for any additional education or training, if necessary, to get back to work.^{[13]XResearch source}
If the injury is such that it causes the death of the employee, then the employee’s spouse or dependents are entitled to receive payments. The amount of the payments is determined by the number of dependents and their ages.^{[14]XResearch source}
If you, your employer, or the insurance company disagree about the level of benefits or the duration of care that you need, you are entitled to see a qualified Medical Evaluator for an additional opinion. This is an impartial doctor with training in reviewing workers’ compensation claims.^{[15]XResearch source}
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Part 4

Part 4 of 5:

Dealing with a Disputed or Denied Claim

Your employer has up to 90 days to notify you that your claim is denied. This means that the employer is not going to be providing benefits for your injury. You should review this notification carefully and consider hiring an attorney if you wish to proceed further.^{[16]XResearch source}
As a first step after learning that your claim was denied, you are entitled to see a Qualified Medical Evaluator for an additional opinion. This is an impartial doctor with training in reviewing workers’ compensation claims.^{[17]XResearch source}
3
Complete and submit an Application for Adjudication of Claim form. If, after the independent evaluation, you still believe that you have a valid claim, you may file a case with the DWC. You file a case by completing and submitting the Application for Adjudication of Claim form. This form is available online at http://www.dir.ca.gov/dwc/FORMS/EAMS%20Forms/ADJ/DWC1.pdf. It asks for much of the same information that was on your original DWC-1 Claim form, but with more opportunity to detail the incident and your injuries.
- The completed form must be submitted to the DWC office in the county where you live or in the county where you were injured.
- You must also deliver a copy of the completed Application for Adjudication form to your employer.
After submitting your Application for Adjudication, you will receive a notice in the mail that confirms the filing of your case. This will include a case number, which you will need to use on any further correspondence. You will also receive instructions about proceeding further with the case.^{[18]XResearch source}
At this point, if you have not yet hired an attorney, you should consider doing so. You will be entering a time of preparation for trial, which can get complicated. You are allowed to proceed on your own, and the DWC web site contains all the forms and information you may need, but depending on the seriousness of your claim, you should consider the extra help.
This is a form, available on the DWC web site,^{[19]XResearch source} that tells the office you are ready to go forward with a hearing. Before you file this Declaration, you should be sure that you have spoken to any witnesses and that you are ready to argue your case before a judge.
At the hearing, you and a representative from the employer (usually a claims administrator), and your attorneys, will appear before a judge. This is more of a meeting than a full trial. The judge will discuss the case with both of you and will try to help reach a settlement. If that is not possible, the judge will set a date for a future trial.^{[20]XResearch source}
You will be required to share documents with the employer, prepare witnesses, and define the specific issues that are in dispute.
At the trial, you will present your case to a different judge than you saw at the previous conference. You and your employer will have the opportunity to present your side of the issue, question and cross-examine witnesses, and explain your view regarding the claim. The judge will issue a written, final decision within a few weeks after the trial.^{[21]XResearch source}
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Part 5

Part 5 of 5:

Getting More Educated About Workers Compensation

The California Division of Workers’ Compensation has published “A Guidebook for Injured Workers.” You can download the entire Guidebook online at http://www.dir.ca.gov/InjuredWorkerGuidebook/InjuredWorkerGuidebook.pdf.
2
Attend a free seminar on workers’ compensation. The California DWC offers free, one-hour seminars each month at division offices around the state. You can find links to the division offices on the DWC web site^{[22]XResearch source} or call 800-736-7401 to get more information. At the workshop, you will learn about:^{[23]XResearch source}
- Your right to medical treatment
- Disability payments
- Returning to work after injury
- Resolving a disagreement over a claim
The DWC maintains a very informative web site, with links to current legislation, information about programs, and contacts to various state agencies. If you have been injured on the job, this is a reference you will want to know thoroughly.^{[24]XResearch source}
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Tips

If your work injury has left you disabled, and you are having difficulties with filing the claim, you can seek assistance from the DWC by contacting their main headquarters at 1-800-736-7401.
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Consider hiring an attorney, depending on the seriousness of your claim, and certainly if the case winds up going to trial.
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Warnings

Be sure to pay close attention to the due dates and deadlines. If you fail to provide timely notice, submit your initial claim, or file a case for further adjudication by the established deadlines, you may lose the right to go forward with your claim. If your case proceeds to trial, it becomes even more important to meet deadlines.
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