California Workers’ Compensation — What You Need To Know

A bandaged hand resting on a vice grip

California Workers’ Compensation — What You Need To Know

All California employers must provide workers’ compensation benefits to employees injured on the job. An injury can occur via a single event or through repeated tasks, such as an injury that occurs from doing the same motion over and over. Workers’ compensation also covers some psychological injuries.

What benefits are available?

Benefits include:

  • Medical care. This includes doctor visits, tests, medications, equipment and travel costs that are reasonably necessary to treat your employee’s injury.
  • Temporary disability benefits. Your employee will be paid lost wages if their injury causes them to miss work during recovery.
  • Permanent disability benefits. These kick in if your employee never completely recovers and their injury causes a measurable, permanent loss of physical or mental function.
  • Supplemental job displacement benefit. This helps pay for retraining or skill enhancement if your employee is eligible to receive permanent disability benefits, you do not offer them another position and they do not return to your company.
  • Death benefits. If your employee dies from a job injury or illness, their spouse, children or other dependents will receive this benefit.

Can employees see their regular doctor?

Employees can see their regular doctor if they inform you in writing, pre-injury, of the name and address of their physician or medical group; this is known as predesignation. They must also have health care coverage for medical conditions that are not related to their job.

If you have a contract with a health care organization (HCO) certified by the California Division of Workers’ Compensation, you must provide employees with a predesignation form within 30 days of hire. This form allows employees to predesignate their personal doctor. If your employee fails to predesignate, you can require them to see a doctor within your contracted HCO.

What should employees do if they are injured on the job?

If your employee is injured on the job, they should report the injury to you as soon as possible. If they believe they were injured because of repetitive motions, they should inform you as soon as they believe it was caused by their job duties. If they take more than 30 days to notify you, they may lose their benefits. You should give them a claim form, which they fill out and you provide to your insurance carrier. Within one working day, you can authorize up to $10,000 in necessary medical treatment.

Can employees work while they are recovering?

Once a doctor has examined your employee, they will send a report to your insurance company. If the doctor determines that the employee can work, the doctor should also describe:

  • Limits on the work your employee can perform during their recovery, so they are protected from additional injury
  • Changes to their work schedule, equipment or other conditions

If the doctor says your employee cannot work, you cannot require them to do so.

What happens when employees are recovered and ready to return to work?

Depending on their injury and recovery, you generally have three options:

  • Regular work. Your employee can return to their previous job, receiving the same salary and benefits they had before their injury. The job must be theirs for 12 months, unless there is misconduct.
  • Modified work. Your employee can return to their previous job, with some changes to their duties, schedule or environment if they will never fully recover from the injury. Alternative work must also be available for at least 12 months. They must be paid at least 85% of the previous salary and benefits and be within a reasonable commuting distance of where they lived before the injury.
  • Alternative work. If the doctor determines the employee cannot return to their previous job, you can offer them alternative work. This job must also last at least 12 months, pay at least 85% of their previous salary and benefits and be within reasonable commuting distance.

If you offer modified or alternative work, your employee must accept within 30 days of the offer. Failure to respond to the offer can affect their eligibility for supplemental job displacement benefits.

If you have more questions about workers’ compensation, talk to your benefits adviser or legal counsel. They can help you get appropriate coverage and better understand California’s workers’ compensation law.

This content is for informational purposes only, should not be considered professional, financial, medical or legal advice, and no representations or warranties are made regarding its accuracy, timeliness or currency. With all information, consult with appropriate licensed professionals to determine if implementing any recommendations would be in accordance with applicable laws and regulations or to obtain advice with respect to any particular issue or problem.

Coast General Insurance Brokers