California Workers’ Compensation FAQ
Lloyd Lee Law in Valencia answers common questions after a California job injury. Lloyd Lee is a California attorney, licensed in 2011, State Bar #276453. General information, not legal advice, not a results promise. Deadlines depend on the date of injury and the file. The site chat is advertising, not a lawyer.
What should I do first after a work injury in California?
Get emergency care if you need it and tell the provider it is a job injury. Report to a supervisor promptly, follow up in writing, and keep a copy. Ask for the claim form (DWC-1). The employer generally must give or mail it within one working day of learning of the injury (Labor Code § 5401). If they do not, get the current DWC form, complete the employee section, list body parts, sign, date, return it, and keep a copy. Reporting is not filing. The form starts the insurer’s clocks. Do not skip care while you wait. See Hurt at work in California.
How long do I have to report a work injury and file a California workers’ compensation claim?
California uses more than one deadline. It is not always exactly one year from the accident. Notice to the employer is generally 30 days (Labor Code § 5400). For a gradual or cumulative injury, the date of injury is often measured from when you first had disability and knew, or should have known, the job was involved (Labor Code § 5412). That date can affect notice and filing clocks. Missing 30 days does not automatically end every claim, but delay is a common denial reason. WCAB proceedings are often due within one year from the injury or from the last date medical or wage benefits were furnished, whichever is later (Labor Code § 5405). Other rules can apply, including some “new and further disability” situations (Labor Code § 5410). Death-benefit timing is different. An open insurance file does not replace those clocks.
What benefits can California workers’ compensation provide?
Five basic benefits: medical care reasonably required to cure or relieve the injury; temporary disability (partial wage replacement while you cannot do usual work); permanent disability if lasting impairment remains after the condition stabilizes; a supplemental job-displacement voucher if you cannot return to the employer and no qualifying offer is made (amount set by statute); and death benefits for dependents, plus burial expense, if the injury causes death. Workers’ compensation generally does not pay pain and suffering against the employer. Rates change. This page does not freeze a dollar chart.
Can I choose my own doctor after a California work injury?
It depends. Many employers use a Medical Provider Network. Treatment is generally inside that network unless a valid written predesignation, with the physician’s agreement, was on file before the injury. A QME is not your treating doctor. Utilization review / independent medical review is about a requested treatment, not a QME exam. This page does not say you can always pick any doctor, or never pick your doctor.
How long does the insurance company have to accept or deny my claim — and can I get treatment in the meantime?
After the completed claim form is filed with the employer, the claims administrator generally has 90 days to deny (Labor Code § 5402(b)). If liability is not rejected in that period, the injury is presumed compensable. That is not an automatic lifetime award. During investigation, up to $10,000 in medical treatment must generally be authorized (Labor Code § 5402(c)). That cap is not unlimited care. DWC describes a status letter, generally within 14 days.
What if my California workers’ compensation claim is denied?
A denial letter is a claims-administrator decision, not a court judgment. File an Application for Adjudication of Claim at DWC/WCAB for the county of residence or injury, serve the claims administrator, and keep the case number. A case on file does not get a hearing until someone files a Declaration of Readiness. Next is often a mandatory settlement conference. Compensability and disability disputes may go to a QME or AME. Treatment disputes after utilization review generally go to independent medical review, not a QME. Deadlines still run. Do not wait a denial out. Santa Clarita and Valencia workers often appear at the Van Nuys office, but venue depends on residence or injury — not always Van Nuys.
What is a QME in a California workers’ compensation case? How is an AME different?
A QME is a DWC Medical Unit–certified physician who writes a medical-legal report on work-relatedness, restrictions, permanent disability, or future care. A QME is not your treating doctor and does not decide a utilization-review treatment request. Unrepresented workers generally request a three-doctor panel and pick from it. Those steps have short deadlines; missing them can let the claims administrator choose. Represented parties may agree on an Agreed Medical Evaluator or use a panel and strike process. This page does not describe how to shop a panel.
How do temporary disability payments work in California?
Temporary disability is generally two-thirds of lost gross wages, subject to the current DWC benefits chart — not a number frozen on this page. There is generally no temporary disability for the first three days unless you are hospitalized overnight or off work more than 14 days. For many injuries on or after January 1, 2008, there is a 104-week cap within five years of the date of injury; some severe conditions can last longer. Temporary disability usually stops when you return to usual work, are released to usual work, or the doctor finds the condition permanent and stationary. It does not last until you are “fully healed.”
What is permanent disability, and what does “maximum medical improvement” mean?
When the treating doctor or a QME/AME finds the condition permanent and stationary, or at maximum medical improvement, remaining impairment can be rated as permanent disability. Stabilized does not mean pain-free. Rating uses the doctor’s impairment analysis, occupation, age, and date of injury. Apportionment can subtract other causes and must rest on medical evidence. Settlements are often stipulations (payments over time, sometimes with future medical left open) or a compromise and release (a lump sum that typically closes future medical). A workers’ compensation judge must approve. This page does not publish sample dollar amounts.
Can I have a workers’ compensation claim and a third-party injury case at the same time?
Workers’ compensation is generally the exclusive remedy against the employer. Filing a claim is a request for benefits, not a lawsuit against the boss. Labor Code § 3852 preserves a possible civil claim against someone other than the employer — another driver on a work errand, a subcontractor, a property owner, a product maker. I-5 and SR-14 work crashes and job sites with outside contractors are common here. That path is fact-dependent. It is not “you can always sue.” Compensation covers medical care and partial wages on a no-fault basis, without pain-and-suffering against the employer. The carrier may assert a lien or credit against a third-party recovery. This page does not promise a lien reduction. Two clocks can run: the compensation deadlines above, and a civil deadline that is often about two years for negligence. Public-entity claims can be shorter. See California Personal Injury FAQand California government injury claims.
If you want this office to look at the facts, start a confidential review at lloydleelaw.com or call (661) 480-2420. Meetings are by appointment at 25050 Ave Kearny #107, Valencia. Workers’ compensation attorney fees are generally paid from the recovery and must be approved by a judge as reasonable. This page does not publish a fee percentage.
General information about California law. Not legal advice. Not about any one case. No attorney-client relationship until a written agreement is signed. This page is attorney advertising.
Lloyd Lee Law · 25050 Ave Kearny #107, Valencia, CA · (661) 480-2420 · lloydleelaw.com