How to File a Workers' Comp Claim in California

If you're injured or become sick on the job in California, you might be entitled to workers' comp benefits. While workers' comp cases can be lengthy and complex, the steps for initiating a case are relatively straightforward. The only catch is that California, like most other states, has strict deadlines for when you need report your injury, file your claim, and file an appeal. If you don't meet the deadlines, you could lose your right to benefits.

Here's what you need to do—and when you need to do it—to ensure that you receive all the workers' comp benefits to which you're entitled.

When the Clock Starts on Your Workers' Comp Claim

The deadlines in your workers' comp case usually are measured from the date of your injury. If you were injured in a workplace accident, such as by slipping and falling on your back, it's clear when this date is.

Calculating this date is a bit trickier, however, if you have any of the following types of work-related illnesses or injuries:

• Cumulative trauma: These are injuries resulting from repetitive motion or strain, such as carpal tunnel syndrome, tendonitis, or back pain.
• Occupational illness: These are illnesses or diseases resulting from harmful exposure in the workplace, such as asbestosis or conditions caused by chemical exposure.
• Mental health injuries: These are psychological conditions, such as PTSD or major depressive disorder.

In situations like these when your injury or illness develops over time, the date of your injury is considered to be the date when both of the following happen:

• you first missed work or saw a doctor for the injury or illness, and
• you knew or should've known that it was caused by your work—generally because the doctor explained that to you.

Reporting Your Injury to Your Employer

Your first priority, of course, should be getting the medical care you need. As soon as you can, tell your supervisor about your injury and ask for the form to make a written report. You have 30 days after the date of your injury or illness to make a report. You could lose your right to workers' comp benefits if you don't report your injury within that time period.

Even though you technically have a month to report your injury to your employer, it's a good idea to do so as soon as possible, because your employer's insurance company will likely be more skeptical of your claim the longer you wait to report it. Reporting your injury sooner also means you'll start receiving any benefits earlier.

Filing Your Workers' Comp Claim in California

Within one working day after you report your injury or illness, your employer should give you a workers' compensation claim form (known as Form DWC-1). If you don't get the DWC-1 form from your employer, you can download it from the California Division of Workers' Compensation (DWC) website.

Follow the instructions on the form for filling out the employee's portion. Be sure to list each part of your body that was injured. After you're done, either hand the form to your employer in person, or send it to your employer by first-class or certified mail. Your employer then has one working day to fill out its portion, submit the completed form to its insurance company, and give you a copy.

You have one year from the date of your injury to file your claim.

Once you've submitted the claim form, your employer's insurance company must authorize payment for your medical treatment while it's investigating the claim. Until it makes a decision on whether to approve or deny your claim, the insurer is responsible for up to $10,000 in medical bills. Your claim generally is considered approved if the insurer doesn't deny it within 90 days after you've submitted the form.

Filing the Application for Adjudication of Claim if Your Claim is Disputed or Denied

If your claim is disputed or denied, that isn't necessarily the end of the road. You can still open a case with the Workers' Compensation Appeals Board by filing an Application for Adjudication of Claim, known as Form WCAB-1 (also available from the DWC website).

The deadline to file the Application for Adjudication of Claim is generally one year after:

• the date of injury
• the last day when your employer-provided medical benefits, or
• the day when any temporary disability benefits end.

Filing the Form WCAB-1 begins the appeals process. Appealing a workers' comp decision can be complicated and time-consuming. It often involves several legal proceedings, including a hearing on your claim (which is like an informal trial). Although it's possible to get through the process on your own, hiring an experienced workers' comp attorney to represent you during your appeal can greatly improve your odds of success.

Hiring a Workers' Comp Lawyer

A workers' comp attorney can make all the difference in a challenging workers' comp case. An experienced lawyer can gather the evidence needed to support your claim, deal with the insurance company on your behalf, help you navigate your appeal, and prepare you for hearings, among other things.

Hiring a workers' comp lawyer won't cost you anything out of pocket. Workers' comp attorneys in California don't charge a fee unless you win your case.