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Pocket Guide to Workers' Compensation in California
(Public and Private Sectors)

By Juliann Sum
Updated by John Holstedt and Eric Ledger
2nd edition, 2014

$20 each

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The Pocket Guide to Workers’ Compensation in California gives an overview of workers' compensation law and procedure. It provides a brief history of the law and a summary of citations to applicable statutes, regulations, and precedent cases. The guide includes pertinent resources, a glossary, and an index of terms.

The guide covers:

  • Stages of a compensation claim
  • Benefits
  • Rights and obligations
  • Labor-management carve-outs
  • Rights of employees whose employers are illegally uninsured
  • How workers’ compensation law relates to disability rights laws, job-protected leave laws, and public benefits.

The guide is a valuable reference and training tool, and helpful to anyone who needs to understand the workers’ comp process in both the public and private sectors in California.

 

Table of Contents

I. Scope and Operation of the Workers' Compensation System 1
    A. Introduction 1
    B. California workers' compensation laws apply to most injuries
        and illnesses caused by employment
2
    C. Injured workers may not sue the employer in court, and
        benefits are limited
3
    D. Employers are required to have insurance 4
    E. Coverage of post-termination claims is limited 4
    F. Coverage of psychiatric injuries is limited 5
    G. Sleep dysfunction and sexual dysfunction claims also limited 6
    H. Five categories of benefits are paid 6
    I. Administrative law judges adjudicate disputes 7
II. Preliminary Rights and Responsibilities 8
    A. Employers and workers can prevent injuries and illnesses 8
    B. Some workers may predesignate their personal physician 8
    C. Employers and unions may create labor-management carve-outs 10
III. Requesting Benefits After Injury 11
    A. The injured worker should inform the employer and get emergency
        treatment if needed
11
    B. Filing a claim form preserves the injured worker's rights 12
    C. Employees of illegally uninsured employers may sue the employer
        and apply for Uninsured Employers Benefits Trust Fund benefits
14
    D. Presumptions of compensability apply to public safety officers 15
IV. Medical Care 15
    A. Employers and providers may not collect payment from an injured
        worker for medical care
17
    B. Scientifically based medical treatment guidelines govern care 17
    C. Claims administrators must promptly authorize treatment 18
    D. The primary treating physician has a role in determining benefits 19
    E. How the initial primary treating physician is selected depends on
        whether the worker predesignated and whether there is a medical
        provider network (MPN) or health care organization (HCO)
19
    F. The injured worker's rights to switch primary treating
        physiciansdepend on whether the worker is being treated in an
        MPN or HCO and whether the worker predesignated
21
    G. Disputes over out-of network medical treatment 22
V. Resolving Problems with Medical Care and Medical Reports 24
    A. An injured worker may discuss concerns with a treating physician
        or switch physicians
24
    B. Steps to dispute a treating physician's opinion about necessary
        care depend on whether the injured worker is being treated in
        an MPN or HCO
24
    C. Decisions to authorize care are made in a utilization review (UR)
        process, followed by an Independent Medical Review (IMR)
        appeal process
25
    D. The injured worker has the right to challenge a decision denying
        treatment
26
    E. The injured worker and the claims administrator may dispute a
        treating physician's opinion on matters other than treatment
27
    F. A medical evaluation is required to dispute an opinion by a treating
        physician or a decision to deny care
28
VI. Temporary Disability Benefits 30
    A. Temporary disability (TD) benefits are paid to injured workers who
        are disabled while recovering
30
    B. Payment amounts depend on lost wages 31
    C. TD benefits are paid on a schedule 31
    D. Penalties are payable for delays 32
    E. When TD payments end is based on the worker's medical
        condition, return to work, or duration of payments
32
VII. Working After Injury 34
    A. Workers' compensation law prohibits discrimination against
        workers with job injuries
34
    B. The treating physician determines work capacities and restrictions 35
    C. The employer may reduce its liability for certain benefits by offering
        work
35
    D. Actions taken in a workers' compensation claim do not eliminate
        rights and obligations under disability rights laws
37
VIII. Permanent Disability Benefits 40
    A. Permanent disability (PD) benefits are paid to workers who
        will always be limited in their ability to work
40
    B. Benefits depend in part on a medical report 41
    C. The worker's disability is given a permanent disability rating 41
    D. Payment amounts depend on ratings of the disability, date of
        injury, pre-injury wages, and whether the employer offers work
43
    E. PD benefits are paid on a schedule 43
    F. Penalties are payable for delays 44
    G. PD benefits are commonly settled 44
XI. Supplemental Job Displacement Benefits 46
    A. A supplemental job displacement benefit (SJDB) is a voucher
        that promises to pay for educational retraining or skill
        enhancement
46
    B. Benefit amounts depend on the worker's permanent disability
        rating
47
    C. Voucher expiration date 47
X. Sources of Further Information and Help 48
    A. California agencies 48
    B. Reference materials 49
XI. Glossary 50
XII. Index 61

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