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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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