1. What employers should know about the system in California CALIFORNIA WORKERS’ COMPENSATION

2.  Insurance Company/Employer/Defendant  Applicant/Applicant’s Attorney  Medical Providers/QME Doctors/Lien Claimants  Administrative Law Judges/I&A Officers/Raters/Support Staff WHO IS INVOLVED IN THE PROCESS?

3.  Up to 90 day delay period for investigation of claim that begins with employer date of knowledge  If accepted, the injured worker can collect benefits and begin treatment  If denied, there are possible appeals for the injured worker  Once the injured workers’ condition stabilizes, settlement discussions can begin BASIC CLAIMS PROCESS

4.  Weekly benefit meant to be partial wage replacement  2/3rds of an Employee’s gross average weekly wage  Subject to maximum and minimum rates, updated annually  In most cases, 104 week limit over a 5 year period from the date of injury  TD ends when injured worker is released to work, reaches permanent and stationary status, or reaches the 104 week cap 5 TYPES OF BENEFITS TEMPORARY DISABILITY (TD)

5.  LC 4600 – Treatment reasonable and necessary to cure or relieve  Medical Provider Networks  Role of the Primary Treating Physician (PTP)  Role of QME/AME and the medical legal process  Medical Treatment Utilization Schedule  Utilization Review and Independent Medical Review 5 TYPES OF BENEFITS MEDICAL

6.  Weekly benefit meant to compensate an injured worker for loss of ability to compete in the open labor market  Benefit begins after the end of TD or when there is evidence of PD when no TD has been paid  Can be withheld until settlement if the employee returns to work for the same employer  Percentage is based upon findings of either the PTP, the QME, or a combination of the two  Based on the AMA guidelines, adjusted for age, occupation, and type of injury 5 TYPES OF BENEFITS PERMANENT DISABILITY (PD)

7.  Supplemental Job Displacement Benefit (SJDB)Voucher  For an employee to be eligible for the voucher, there must be evidence of permanent disability AND no return to work with the employer  Certain elements are required to make a valid offer of work  Amount used to vary, but all injuries after 1/1/13 now grant a $6000 voucher  Return to Work Fund. Tied to eligibility for the voucher 5 TYPES OF BENEFITS RETURN TO WORK

8.  Reduces costs on the claim (TD, SJDB, etc.)  Generally a better recovery result for the injured worker  Compensable consequence injuries are less likely  Supports a healthy culture in the work place  Preserves talent RETURN TO WORK (CONT’D)

9.  Payable to spouse, children, or other dependents if death results from an industrial injury or illness  Up to $10,000 for burial expenses 5 TYPES OF BENEFITS DEATH

10.  Get insurance  Provide DWC 1 Claim Form within one day when you have notice or knowledge of industrial injury  Send completed DWC 1 Claim Form to insurance carrier within one day of receipt from employee  Post DWC-7 notice in a conspicuous location  Provide workers’ compensation pamphlet to new hires, including pre-designation form EMPLOYER’S RESPONSIBILITIES

11.  Conferences, trials, and other proceedings can occur before the Workers’ Compensation Appeals Board (WCAB) throughout the case, but are not required  Two types of settlement: C&R or Stip  Findings and Award/Order may be necessary after litigation if no agreement can be reached LITIGATION AND SETTLEMENT

12.  Uninsured employers are still responsible for work-related injuries  Exclusive Remedy rule does not apply to uninsured employers  Many Statutes of Limitation arguments cannot be utilized by the uninsured employer  It is illegal and may subject employers to non-WCAB penalties as well  UEBTF  Reimbursement/Civil Suit/Writ of Attachment UNINSURED EMPLOYERS

13.  Fraud – Special Investigations Unit, District Attorney, Department of Insurance  Employer Discrimination – Labor Code 132(a)  Serious and Willful Misconduct Petition  Employee versus Independent Contractor arguments OTHER ISSUES

14.  WCAB Information and Assistance: (916) 928-3158 or http://www.dir.ca.gov  Division of Occupational Safety and Health (OSHA)  Insurance Commissioner’s Office  Workers’ Compensation Insurance Rating Bureau (WCIRB.org) RESOURCES

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