What Every Employer Should Know About Workers’ Compensation

What Every Employer Should Know About

Workers’ Compensation

I. History of Workers’ Compensation

Boynton Act 1913 Purpose of workers’ compensation

laws Senate Bill 899 (2004) Senate Bill 863 (eff. 2013)

II. Department of Industrial Relations

Division of Occupational Safety and Health

Division of Labor Standards Enforcement

Division of Apprenticeship Division of Statistics and Research State Mediation & Conciliation

Service

Division of Workers’ Compensation (DWC) Workers’ Compensation Judge Information & Assistance Officer Disability Rater Support Staff—hearing reporters,

clerks, calendar clerks, auditors

III. Benefits

Temporary Disability Permanent Disability Return to Work Services Death Benefits Medical Care

III (a) TD Based on 2/3 average weekly earnings. State establishes maximum ($1103.29)

and minimum rates ($165.49). State average weekly wage as compiled

by the U.S. Department of Labor now determines if rates increase.

3 day waiting period. Payments end when RTW or P&S or

reaches 104 weeks within 5 yrs.

III (b) PD Based on Agreed Medical Examiner,

treating doctor, or Qualified Medical Examiner medical-legal report.

Based on objective findings and employee’s age and occupation.

Max ($290) and min ($160) for injuries on/after 1/1/13

More than 70% PD = life pension If 100% PD, rates are based on TD

III (c) RTW

Supplemental Job Displacement Benefits began in Jan. 2004

SJDP if IW has PD and employer won’t offer other work.

SJDP is up to $6k for injuries on/after 1/1/13

III (d) Death Benefits

Burial benefits up to $10K for injuries on/after 1/1/13

Dependency benefits for total or partial dependents

DB for 3 or more total dependents is $320K

III. (e) Medical Care

All necessary medical care. Caps on some services after 4/19/04 American College of Occupational and

Environmental Medicine Guidelines. Utilization Review company to review

treatment requests. Medical provider networks.

IV. Employer Responsibilities

Get insurance Experience Modification Workers’ Compensation Insurance

Rating Bureau (WCIRB) Shop around because of open rating State Compensation Insurance Fund

(SCIF)

IV. Employer Resp. (Cont.) Give DWC 1 within one day when you

have notice or knowledge of industrial injury

Send DWC 1 to insurance carrier within one day of receipt from employee

Post workers’ compensation notice in conspicuous location

Give workers’ compensation pamphlet to new employee

V. Claims Process DWC 1 (claim form) opens a claim. Authorize up to $10,000 in medical care

when DWC 1 filed. 90 days for insurance carrier to investigate

case before accepting or denying claim. If accepted, employees receives all benefits. Most cases go through this informal process

with employee dealing with carrier.

VI. Litigation Process

Application for Adjudication of Claim Conferences Trials Settlements—Stipulations and

Compromise & Release Findings and Award Appeals

VI. Litigation Process (Cont.)

WCAB (Reconsideration Unit) in San Francisco

District Court of Appeals California Supreme Court

VII. Role of the Uninsured Employers Fund

Special fund to step in shoes of insurance carrier

Lack of insurance enables injured worker to sue in civil court and file WC claims

If payments made, will file liens against illegally uninsured employer

VIII. Other Workers’ Compensation Issues

Fraud—Special Investigation Unit, Office of the District Attorney, Department of Insurance

Employer discrimination Serious and Willful petition Electronic Adjudication

Management Systems (EAMS)

VIII. Other WC Issues (Cont.)

Employee vs. Independent Contractor

First-aid claims WCIRB coverage information

IX. Workers’ Compensation Web Sites

www.dir.ca.gov www.statefundca.com www.wcirbonline.org www.insurance.ca.gov www.cwci.org

X. Questions

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