New Workers Comp Laws In California

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Governor Jerry Brown had until September 30, 2018 to sign or veto any bill passed by the California Legislature. Governor Brown signed the following workers’ comp-related bills signed into law:

PEACE OFFICERS: Assembly Bill 1749

This bill provides that a California employer may accept liability for an injury sustained by a peace officer not acting under the immediate direction of his or her employer while apprehending suspected law violators, protecting life or property, or preserving the peace outside of California. This bill specifically includes any claims for injuries sustained by peace officers during the Oct. 1, 2017 mass shooting in Las Vegas, Nev. if the employer determines providing compensation serves public purposes.

FRAUD ASSESSMENT COMMISSION FUNDS: Assembly Bill 2046

This bill authorizes, instead of requires, Fraud Assessment Commission funds appropriated but not expended in the fiscal year that have not been allocated to the district attorneys, to be applied to satisfy the immediately following fiscal year minimum total amount required or to augment funding in the immediately following fiscal year.

The bill also requires an authorized government agency that is provided with workers’ comp insurance fraud-related information to release or provide that information to an authorized government agency, upon request, unless it would violate federal law or otherwise compromise an investigation. The bill also requires an authorized government agency that seeks to disclose information obtained from the Employment Development Department to any other governmental agency that is not authorized to receive that information to obtain EDD approval prior to disclosure.

LICENSED CONTRACTORS: Assembly Bill 2705

Licensed contractors are required to have a current and valid Certificate of Workers’ Compensation Insurance or Certification of Self-Insurance on file with the Contractors’ State License Board and violation of this law is a misdemeanor that must be prosecuted within 2 years. This bill makes it a misdemeanor violation for an unlicensed contractor to fail to comply with workers’ compensation insurance requirements and makes that violation subject to the two-year statute of limitations.

DISABILITY INDEMNITY PAYMENTS: Senate Bill 880

This bill authorizes an employer, with the written consent of the employee, to deposit disability indemnity payments for the employee in a prepaid card account until Jan. 1, 2023. The bill imposes certain conditions, such as allowing the employee reasonable access to in network ATMs and allowing for withdrawal and purchases without incurring fees. The bill also requires employers to provide aggregated data on their prepaid account programs to the Commission on Health and Safety and Workers’ Compensation upon request and requires CHSWC to issue a report to the Legislature on or before Dec. 1, 2022 regarding payments made to those prepaid card accounts.

PEACE OFFICERS & ACTIVE FIREFIGHTING MEMBERS: Senate Bill 1086

With respect to peace officers and active firefighting members, existing law extends the time period for commencing workers’ comp proceedings to collect death benefits from 240 weeks from the date of injury to no later than 420 weeks from the date of injury, not to exceed one year after the date of death. Pursuant to existing law, this extension of time pertains to injuries, including but not limited to cancer, tuberculosis, or blood-borne infectious diseases and is only operative until January 1, 2019. This bill removes the Jan. 1, 2019 date of repeal.

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Work Injury Claim Was Denied

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My Work Injury Claim Was Denied

My Work Injury Claim Was Denied.  Now What?  When a claim is denied, it means the claims administrator believes your injury is not covered by workers’ compensation. If the claims administrator sends you a letter denying your claim, you have a right to challenge the decision. Don’t delay, because there are deadlines for filing the necessary papers. If you need help with your workers’ compensation claim, you can contact the Information and Assistance Unit. You may represent yourself or hire an attorney. If you contest the denial of your claim, your case will be heard by a workers’ compensation administrative law judge (WCJ) at one of the division’s 23 local offices plus satellites.

What if I have a disagreement about my benefits?

At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury or treatment. When there is a disagreement about whether your claim is covered by workers’ compensation, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).

For injuries on or after Jan. 1, 2013, and as of July 1, 2013 for all dates of injury, disagreements about a specific course of medical treatment recommended by the treating physician can only be resolved through a process called independent medical review (IMR).

My Work Injury Claim Was Denied – I want to object to the denial of my claim

If you want to object to the denial of your claim, you will need to file a case at one the division’s 24 offices located around the state. Each DWC office is a trial court where disputes that arise from workers’ compensation claims are decided by a judge without a jury.

How do I file a case?

In order to have your case heard by a judge, you must first file an Application for Adjudication of Claim. The application must be filed at the DWC office in the county where you live or in the county where you were injured. You must serve the application on all other parties, which is generally the claims administrator.

What happens next?

The DWC office where you filed the application will send you a notice confirming that it has been filed. The notice will include your assigned case number, which will begin with the letters “ADJ” followed by a sequence of numbers. Keep the notice and use the assigned case number on all documents and correspondence relating to your case.

How do I get a hearing before a judge?

You must file a Declaration of Readiness to Proceed to request a hearing. Your case will be scheduled for a hearing called a mandatory settlement conference (MSC).

What happens at the hearing?

You and your claims administrator or their attorney will appear before a judge. The judge will discuss the case with both of you and try to assist in reaching a settlement. If your case is not settled at the MSC, you will need to prepare documents that outline the dispute, identify the items each party will present at trial and the names of the witnesses that each party will ask to testify. The judge will then schedule a date for trial.

The trial will be held before another judge. You must attend the trial. The judge will issue a written decision after the trial and send it to you by mail, which usually occurs between 30 and 90 days after the trial. If either you or the claims adjustor disagrees with the judge’s decision, you can file a Petition for Reconsideration.

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How To File A Workers’ Compensation Claim?

WORKERS’ COMPENSATION CLAIM FORM (DWC 1)

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File a claim form (DWC-1)

File a claim form (DWC-1) to protect your rights and start the workers’ compensation process. Your employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn’t give you the claim form you can download it from the forms page of the DWC website.

How to fill out a claim form

Complete only the “employee” section of the form and send it to your employer right away. Be sure to sign and date the claim form and keep a copy for your records. Return the claim form to your employer in person or by mail. If you mail the claim form, use certified mail — return receipt requested — so you have a record of the date it was mailed and the date it was received. If you don’t return the completed form to your employer you may risk your right to benefits.

What happens next?

Your employer should fill out the “employer” section and forward the completed claim form to the insurance company. You should receive a copy of the completed claim form from your employer. If you don’t, request a copy and keep it for your records.

Generally, the insurance company has 14 days to mail you a letter telling you the status of your claim. If you don’t receive this letter, call the insurance company to find out the status of your claim.

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Workers’ Compensation Claim Was Accepted

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If my workers’ compensation claim was accepted

If my workers’ compensation claim was accepted …   You should hear whether your claim is accepted or denied from your employer or its claims administrator within 90 days from the date the claim form is given to your employer. If you do not, your injury will be presumed to be covered.

What benefits am I entitled to?

Workers’ compensation insurance provides five basic benefits:

What if I have a disagreement about my benefits?

At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury. When there is a disagreement, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).

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I was injured at work

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I was injured at work…

I was injured at work. Now What? Workers’ compensation benefits are designed to provide you with the medical treatment you need to recover from your work related injury or illness, partially replace the wages you lose while you are recovering, and help you return to work. Workers’ compensation benefits do not include damages for pain and suffering or punitive damages. Benefits include:  medical care, temporary disability payments, permanent disability payments, Supplemental Job Displacement Vouchers and return to work benefits.

Report the injury or illness to your employer

Make sure your supervisor is notified of your injury as soon as possible. If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps avoid problems and delays in receiving benefits, including medical care. If you don’t report your injury within 30 days, you could lose your right to receive workers’ compensation benefits.  Some injuries are obvious and some are not.  Any physical or psychological injury as a result of your work duties may an industrial injury.  Consult with an attorney who is a workers’ compensation specialist.

Get emergency treatment if needed

If it’s an emergency, call 911 or go to an emergency room right away. Tell the medical staff that your injury or illness is job-related. If you can safely do so, contact your employer for further instructions.

If you don’t need emergency treatment, make sure you get first aid and see a doctor if necessary.

What’s next?

Once you file a claim, your employer is required to provide you with medical care.

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