Filing a Workers’ Compensation Claim in California

To receive workers’ compensation benefits, you need to follow these steps

If you’re injured in a work-related accident in California, the best (and possibly only) way to receive compensation is to file a workers’ compensation claim. In this regard, there are certain steps you must take to avoid having your claim denied.

If you suffer a work-related injury in California, you might be entitled to workers’ compensation benefits—including medical expenses and lost wages.

In order to obtain these benefits, there are certain steps you need to take. Unfortunately, one misstep could prevent you from collecting any benefits at all.

Here at Enjuris, we want you to receive all the benefits you deserve. With that goal in mind, let’s take a look at what steps you need to take to receive workers’ compensation benefits in California.

Step 1: See a doctor

If your accident results in a health emergency, seeing a doctor is the first thing you should do. However, even if you don’t see a doctor immediately, it’s important that you see a doctor at some point for medical care.

This begs the question, can you see any doctor you want? It depends.

Workers with health care coverage for conditions unrelated to their job are allowed to “predesignate” their physician by informing their employer through a written statement or using DWC Form 9783. This must be done before you suffer an injury.

If you didn’t predesignate a physician before your injury, your employer is allowed to choose the doctor you see. The doctor is usually someone in the employer's medical provider network (MPN) or health care organization (HCO).

Enjuris tip: There are a couple of rare circumstances in which you can select your personal doctor. For example, if your employer failed to post required information about your workers’ compensation rights, failed to offer you treatment, or sends you to a doctor who isn’t qualified. If you really want to see your personal doctor, talk to an attorney to see if there’s an exception that might apply to you.

Your doctor is a critical piece of your workers’ compensation claim. Among other things, your doctor:

Helps determine when (and if) you can return to work
Helps identify kinds of work you can do safely while recovering
Refers you to specialists if necessary
Writes medical reports that will help determine the benefits you receive
Testifyies in cases where the workers’ compensation claim is contested

Step 2: Report your injury to your employer

California law requires that you report your work-related injury to your supervisor or some other person in management as soon as possible. If your employer doesn’t learn about your injury within 30 days, you could lose your right to receive workers’ compensation benefits.

Enjuris tip: Notify your employer in writing and be sure to keep a copy of the notice in case your employer later claims they weren’t notified. One of the easiest ways to obtain proof of receipt is to send your notice via certified mail with return receipt requested.

Step 3: Fill out the proper form

Your employer is required to give you a Workers’ Compensation Claim Form (DWC 1) within 1 day after you report your injury. This is the form you will use to request workers’ compensation benefits.

Enjuris tip: If your employer doesn’t give you a claim form, you can download the form on the forms page of the California Division of Workers’ Compensation (DIR) website or contact the DIR Information and Assistance Unit.

How do I fill out the Workers’ Compensation Claim Form (DWC 1)?

First, be sure to read all the instructions and other information that comes with the form.

Second, fill out and sign the “Employee” section of the form. Be honest when filling out the form (lying on the form is a felony) and be sure to describe your injury completely. Include every single part of your body affected by the injury.

Step 4: File the form

Give the form to your employer (this is referred to as “filing” the form) and keep a copy for yourself. Consider mailing the form to your employer using certified mail with a return receipt requested. Again, the goal is to be able to prove that all necessary notices and forms were submitted timely should this fact be contested later.

Should I consult with an attorney before filing my form?

The majority of workers’ compensation claims don’t involve attorneys. However, having an attorney can increase the chances of your claim being accepted and may also reduce the stress associated with filing a claim. Attorneys are particularly helpful in complex cases or cases involving non-obvious injuries (such as emotional injuries).

In California, your attorney will be paid out of a portion of your workers’ compensation benefits.

If you don’t hire an attorney, others can help you with your claim, including the I&A officer at your local DWC district office.

Once your form is “filed,” your employer will fill out and sign the “Employer” section of the form and give the completed form to the claims administrator. Your employer must also give you a copy of the completed form within 1 day after you file it.

Once the claims administrator receives the form, they are required to inform you within a “reasonable time” whether they have accepted or denied your claim.

Enjuris tip: The claims administrator is required to send you updates about your claim and answer your questions. If you can’t reach the claims administrator, ask to speak with their supervisor (or contact an attorney).

What to do if your claim is denied

There are a number of reasons why your workers’ compensation claim may be denied, including:

Your employer wasn’t required to carry workers’ compensation insurance
You missed a filing deadline
There’s insufficient evidence that your injury is work-related
The injury isn’t covered
There is a discrepancy between your accident report or claims and your medical records

If you disagree with the decision reached concerning your claim, you must fill out a notice of appeal form.

Then, you must mail the form to your local Workers’ Compensation Appeals Board district office within 20 days after the service date of the determination (this date can be found in the lower right-hand corner of the determination letter)

Enjuris tip: If you didn’t have a lawyer help you with your initial claim, you’ll almost certainly want one to help you with your appeal. If you don’t have an attorney, you can call the Information and Assistance Office or attend a workshop for injured workers to get help.

Workers’ compensation benefits are invaluable and can help you get your life back on track after a serious accident. But, workers’ compensation benefits aren’t guaranteed. Be sure to follow all the steps necessary to file a workers’ compensation claim.

If want to hire an attorney to help, you can find one using our free online directory.

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