A Basic Guide to California Workers’ Compensation Claims

Every state sets its own rules on workers’ compensation. California requires businesses with at least one employee to have a workers’ compensation plan in place. By enrolling in a proper plan, your company will comply with state regulations and be protected from costs that may arise from workplace accidents. Here’s a look at what a business needs to know about workers’ comp in Walnut Creek, CA.

Basics of Workers’ Comp in California

Understanding workers’ comp in Walnut Creek, CA, closely mirrors what the state mandates for companies that hire employees. The coverage pays for accidents on the job, such as when an employee gets injured while operating a machine. The employee is paid for lost wages, medication, and treatment associated with the injury. Workers’ comp essentially functions as liability insurance for the employer.

Businesses can purchase a group program with an insurer licensed to operate in California or tap into the State Compensation Insurance Fund (SCIF). To gain benefits from workers’ comp, the workers must report their injuries or illnesses immediately to their employer and go through a filing process that meets the insurer’s requirements.

The cost of workers’ comp plans is largely based on the size of your company’s payroll. The risks posed by your industry will also factor into monthly premiums. You’ll likely pay about $3 in insurance for every $100 in payroll.

Insurance rates vary among insurers as they all calculate risk in their own way. Factors for lowering rates include decreasing payroll, reducing dangerous tasks, and relocating the business to a zip code with a low crime rate. Your company’s safety records also play a role in the rate reduction. Enrolling in a safety program shows your insurer you are making a conscious effort to lower risks in the workplace.

Be aware that the consequences of failing to comply with California workers’ comp requirements include prison and a fine of up to $100,000. If you are a solo entrepreneur with no employees, you are not required to carry workers’ comp insurance in California. It’s still a good idea to carry certain types of insurance based on what your operation involves.

Common Work-Related Injuries

Most injuries that occur at work are covered by the workers’ comp insurance. Slips and falls are among the most common accidents, along with collisions involving company vehicles. Lifting heavy objects and losing balance is often the cause of warehouse accidents. In addition, workers can get ill from indoor air pollution when a building doesn’t clean filters or use proper ventilation.

Almost all work-related tasks that lead to accidents are covered by the plan. A major concern for employers should be risk management strategies that lower workplace injury rates. It’s important to note that California does not put caps on employee injury claims. That means the insurer must still pay for damages that go beyond the norm.

Filing a California Workers’ Compensation Claim

Except in emergencies, an employee needs to file a workers’ comp claim prior to seeking treatment within 30 days of the injury or learning about the illness. Failing to file the claim within this time frame can lead to a denial of the claim. Be aware that, as an employer, you may refer workers to a specific doctor in the insurance company’s medical network.

Once the employee receives treatment from the doctor, they’ll need to fill out and submit a form. It’s called DWC (Division of Workers’ Compensation) Form I, which you will pass along to the insurer. An additional form for the employee to file within a year to make the claim official is the Application for Adjudication of Claim.

Collecting Workers’ Compensation Benefits in California

All authorized medical expenses are covered by workers’ comp insurance based on state law. These non-taxable benefits include temporary disability income if the employee is unable to return to work right away. This coverage equates to two-thirds of the employee’s regular weekly wage. The weekly maximum is now over $1,215. If the injury leads to long-term disability, the employee may be eligible to collect permanent disability benefits.

Keep in mind that California doctors are required to give evidence-based treatment. A committee within the Division of Workers’ Compensation routinely evaluates medical evidence associated with treatment to strengthen its guidelines.

Denial of Workers’ Compensation Claim

Even though most workers’ comp claims are accepted, there are still various ways in which a claim can be denied. One of the most common reasons for denial is the lack of evidence of the injury. If no other witnesses saw the incident and there is no sign of damage, the claim might not stand. The employer might have disagreements about the claim as well.

Another reason for denial might be that the injury did not occur at work or was not work-related. The claim might also be denied if the employee has no need for medical treatment and can return to work.

Appealing Against the Denial of Claim

When a workers’ comp claim is denied, the employee can go through the appeals process by filing a Declaration of Readiness to Proceed with the Workers’ Compensation Appeals Board (WCAB). The employee must submit this document and a proof of service form to the insurer.

One of the necessary expenses for running a business in California is workers’ comp insurance, which will help you protect your business interests, personal assets, and employees. Contact us at CF&P Insurance Brokers to learn more about workers’ comp in Walnut Creek, CA

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