In California, workers’ compensation claims are a type of administrative proceeding designed to quickly pay employees who have been injured on their job. This differs from many other types of legal disputes, which are often handled in the form of a civil lawsuit (for example, a personal injury lawsuit).
While there are similarities between a civil lawsuit and a workers’ compensation claim, there are also significant differences. Unlike civil lawsuits, for example, workers’ compensation cases in California are not commenced by filing a complaint in superior court. Instead, a workers’ compensation case begins by filing a claim form with their employer.
California’s workers’ compensation scheme has several additional defining characteristics, including:
- Mandatory Insurance. Employers are required by law to maintain workers’ compensation insurance, which ensures that all employees can recover for their claims.1
- Work-Related Injuries Only. Only workplace injuries that arise in the normal course of business are compensable.2
- Exclusivity of Remedies. The workers’ compensation system is usually the exclusive way employees can legally recover for their workplace injuries.3
- No-Fault Compensation. Except in cases of serious or willful misconduct, eligible employees are entitled to benefits regardless of who was at fault for their injury.4
The primary reason for these differences is that injured workers normally require fast payment and medical treatment. Thus, California’s workers’ compensation system is designed to give injured employees a prompt resolution of their claims, with certain minimum guaranteed benefits.5
This article will take a closer look at the workers’ compensation claim process, and provides a step-by-step explanation of how workers’ compensation cases proceed.
- 1 Notify Your Employer of the Injury or Condition
- 2 Complete the Workers’ Compensation Claim Form
- 3 File the Claim Form with Your Employer
- 4 Participate in Settlement Discussions, If Appropriate
- 5 Follow the Workers’ Compensation Appeals Board’s Procedures
- 6 Review the Decision and Decide Whether to Appeal
Notify Your Employer of the Injury or Condition
The process of making a workers’ compensation claim starts by notifying the employer of a work-related injury or health condition. The notice should be in writing and should be signed by the injured employee or by someone (including an attorney) acting on the employee’s behalf.6
Giving the employer verbal notice of the injury triggers the employer’s obligation to provide the employee with a claim form, and filing a signed claim form with the employer satisfies the obligation to provide written notice of the injury.7
It is important to notify the employer within 30 days of the date of the injury. The failure to provide notice within 30 days may cause an injured employee to lose the right to make a workers’ compensation claim.8
Employer’s Knowledge of the Injury
Despite the requirement to give written notice of an injury to the employer, an employer is deemed to have received notice of the injury when it learns that an injury occurred.9
For example, if a supervisor or foreperson witnesses the work injury, the employee has been given notice and cannot claim to have been prejudiced because the injured employee did not report it.10 Once the employer becomes aware of the injury, the employer must provide the injured employee with the claim form described below.11
As a practical matter, however, employees should not rely on their employer’s knowledge of the injury. Instead, the safest practice is to give the employer a formal written notice as soon as possible after a work injury occurs.
Nevertheless, the failure to give timely and accurate notice of the injury will not bar the injured employee from receiving workers’ compensation benefits if the failure did not mislead or prejudice the employer.12 So, even if the injured employee notifies the employer more than 30 days after the injury, the employee might not lose the right to receive benefits if the delay did not prevent the employer from investigating the circumstances of the accident that caused the injury.13
Giving Notice of Cumulative Injuries
Some injuries occur over time. For example, a repetitive stress injury occurs as the result of making the same motion repeatedly. An occupational illness might develop only after repeated exposures to a toxic substance. Injuries or health conditions that develop over time as the result of repeated actions or exposures are called cumulative injuries.14
Identifying a specific date on which a cumulative injury occurred, and giving notice within 30 days of that date, can be difficult. The California legislature has attempted to simplify that task by defining the date of a cumulative injury as the date:
- The employee first “suffered disability” from the injury, and
- Either knew or should have known that the disability was caused by employment.15
Suffering an injury is not necessarily the same as suffering disability from an injury. Courts have construed the phrase “suffered disability” to mean “suffered a compensable disability.” A disability is not compensable until it causes a wage loss or becomes permanent.16
An employee must therefore give notice of a cumulative injury within 30 days of the date that the employee realizes or should have realized that the injury caused the employee to miss work or has become a permanent condition.
The safest practice is for employees to give prompt notice of a work injury to an employer whenever they suspect that they are missing work because of a work-related condition. In addition, when a doctor tells an employee that a permanent health condition was probably caused by work, the employee should immediately notify the employer of that condition.
Cumulative injury claims can be asserted against every employer whose work contributed to the injury during a period of one year immediately preceding:
- The date of the injury, as determined above; or
- The last date of employment in an occupation that exposed the employee to the cause of the occupational disease or cumulative injury, whichever occurs first.17
When work provided to two or more employers may have contributed to the cumulative injury, the employee can elect to bring a claim against any one or more of the employers.18
Employees bringing workers’ compensation claims for cumulative injuries may benefit from legal advice, since bringing and proving those claims is often complicated.
Employer’s Duty to Provide the Claim Form
Within one day of receiving the employee’s notice, or becoming aware of a work injury, the employer must give a claim form to the injured employee,19 but only if:
- The injury caused the employee to lose time beyond the work shift in which the employee was injured, or
- The employee needs medical treatment beyond first aid.20
The claim form must be accompanied by a written notice of the employee’s potential eligibility for worker’s compensation benefits. The employer can provide the form and notice to the employee in person or by mail.21
The notice that accompanies the claim form must contain the following information:22
- The procedure to be used to begin proceedings for the collection of workers’ compensation,
- A description of the different types of workers’ compensation benefits,
- What happens to the claim form after it is filed,
- From whom the employee can obtain medical care for the injury,
- The role and function of the primary treating physician,
- The rights of an employee to change the treating physician,
- How to get medical care while the claim is pending, and
- The protections against discrimination provided by law.23
The notice must also contain the following written statements:
You have a right to disagree with decisions affecting your claim.
To obtain important information about the workers’ compensation claims process and your rights and obligations, go to [applicable Internet Web site(s)], or contact an information and assistance (I&A) officer of the state Division of Workers’ Compensation. You can also hear recorded information and a list of local I&A offices by calling [applicable information and assistance telephone number(s)].
You can consult an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee will be taken out of some of your benefits. For names of workers’ compensation attorneys, call the State Bar of California at [telephone number of the State Bar of California’s legal specialization program, or its equivalent].
As a practical matter, employees usually learn about work injuries as soon as they occur, and quickly provide the claim form to the injured employee. When the employee completes and returns the claim form to the employer, the claim form acts as a written notice of the injury.24
The 30-day time limit for providing notice of the injury discussed above is not usually an issue because the injured employee usually receives and returns the claim form well before the 30 day period expires.
Complete the Workers’ Compensation Claim Form
To make a workers’ compensation claim, an injured employee must complete the “employee” section of a claim form. If an employer does not provide the claim form to the injured employee as the law requires, the employee can download the Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility from the Division of Workers’ Compensation website.
Claim forms are also available from offices of the Employment Development Department, the Division of Workers’ Compensation, and lawyers who handle workers’ compensation cases.25
The claim form is written in both English and Spanish, as are the accompanying instructions.26 Versions of the form in Chinese, Korean, Vietnamese, and Tagalog can be downloaded from the Division of Workers’ Compensation website.27
As mentioned above, the employee must fill out the “employee” section of the claim form. The employee must provide:
- The employee’s name, address, and social security number;
- An email address if the employee wants to receive notices by email;
- The date and time of the injury;
- The address and description of where the injury occurred;
- A description of the injury and part of the body affected; and
- A signature.28
In most cases, the injured employee will be able to provide that information easily. In some cases, however, the answers may be ambiguous. For example, the exact date of a cumulative injury is not always easy to determine, for the reasons described above. When in doubt about how to fill out the form, the employee should ask a lawyer for advice.
It may not be possible to provide a complete description of the injury before seeing a doctor and obtaining a diagnosis. To minimize the risk of being accused of attributing subsequent injuries to a work accident, however, it is important to write down every body part that seems to have been affected by the work accident.
If the employee’s primary complaint is back pain but the employee also has a sore neck, it is important to write down both “back” and “neck” on the form.
File the Claim Form with Your Employer
Providing a completed claim form to the employer constitutes “filing” a workers’ compensation claim. The form is filed when it is personally delivered to the employer or received by the employer through first-class or certified mail.29
The employer then fills out the “employer” section of the form and submits it to the employer’s workers’ compensation claims administrator (which is usually someone from the employer’s workers’ compensation insurance company). The employer must give the injured employee a dated copy of the completed claim form, either personally or by mail, within one day of receiving the claim form from the employee.30
Injured employees should keep the copy of the completed claim form that their employers provide. A dated claim form can provide evidence that the employee filed a claim properly. The form also contains important information that an attorney will want to have if the employee decides to be represented by counsel while pursuing benefits.
Providing the claim form to the employer is important because, as noted above, a signed form that is submitted within 30 days of the injury complies with the employee’s obligation to give the employer timely written notice of the injury.31
Filing the claim form therefore assures that the injured employee will be entitled to seek workers’ compensation benefits if the employer does not provide them voluntarily. There are several other important reasons to file a claim form with an employer as soon as possible after an employee is injured.
Presumption That Injury Is Compensable
Submitting a claim form to the employer commences a 90-day period during which the claims administrator has the opportunity to deny the claim without being required to overcome a presumption that the injury is compensable.32
If the employer (or its insurer) does not deny liability within 90 days, the Division of Workers’ Compensation will presume that the employee sustained a compensable injury. That presumption is important because it prevents the insurance company from taking the position that the injury is not work-related unless it first discovers evidence in support of that position after the 90 day period has passed.33
Even if the employer does not give a claim form to the employee as the law requires, the 90 day period will not commence unless a claim form is filed. Injured employees who want medical treatment or other benefits should therefore always file a claim form promptly because they may benefit from a presumption that their injuries are compensable if their claims are not denied within 90 days after filing.
Triggering Entitlement to Medical Treatment
Within one working day after the employer receives the claim form, the employer (or its insurance company) must authorize up to $10,000 for reasonable and necessary medical treatment for the injury described on the claim form while the claims administrator is deciding whether to accept or reject the claim.34
If the claims administrator accepts the claim, treatment continues and the dollar limit no longer applies. If the claims administrator rejects the claim, treatment stops unless the employee successfully challenges that decision, but the employer must still pay for allowable treatment expenses (up to $10,000) incurred until the date of denial.35
Additionally, once a claim has been filed, medical providers are prohibited from collecting directly from the injured worker unless they have received notice that the claim has been rejected and have given a copy of that notice to the employee.36
Tolling Time for Commencing a Proceeding
Providing the claim form to the employer is also important because injured employees usually have one year after the date of injury to commence a workers’ compensation proceeding by asking the Workers’ Compensation Division to award benefits.37
Filing the claim form does not commence a workers’ compensation proceeding, but it does toll the one-year time limit.38 This means the time period from the date the claim is filed until the date it is denied does not count in computing the one-year deadline.
Triggering Entitlement to Late Payment Supplements
Claims administrators have a legal obligation to pay temporary and permanent disability benefits within time periods that are set by California law. The first temporary disability benefit payment must be paid no later than 14 days after the employer first learns that the employee is missing work because of a work-related injury.39
Likewise, the first permanent disability benefit payment must be paid not later than 14 days after the last temporary disability benefit payment is made.40
If an injured employee files a claim form, the employee is entitled to collect a penalty in the amount of 10% of the benefit payment if the employer does not pay those benefits on time. But employees have no entitlement to receive that late payment supplement unless they file a claim form.41
Triggering Entitlement to Medical Evaluations
If an injured employee disagrees with a treating physician about whether an injury is compensable,42 about the existence and extent of a permanent disability,43 or about certain other medical issues,44 the employee may request an evaluation from a “Qualified Medical Evaluator” (or “QME” for short).
An employee only has that right, however, if they have filed a claim form.45 This provides yet another incentive for employees to file the claim form with their employer as soon as possible.
Participate in Settlement Discussions, If Appropriate
In most cases after a claim form is filed, medical treatment is provided and temporary disability benefits are paid without involving a workers’ compensation judge.46
Similarly, claim for permanent disability benefits can be settled without a contested hearing. This is often the case when an injured worker is represented by a lawyer. Settlements, however, must be approved by a workers’ compensation judge.47
As a general matter, there are two types of workers’ compensation settlements:
- Stipulation with Request for Reward. The employer and the injured employee agree on the weekly disability benefit that should be paid, and that benefit is ordered by the workers’ compensation judge. The employer continues to be responsible for providing medical treatment for the work injury if treatment is needed.48
- Compromise and Release. The employer pays a lump sum settlement in lieu of paying weekly benefits. The employer provides no further medical treatment for the injury.49
Employers are usually willing negotiate a more favorable settlement for employees who accept a compromise and release because the employer is relieved of the obligation to pay for future medical treatment. Which form of settlement is best will depend on the facts of the case. It is wise to get legal advice before settling a claim for permanent disability benefits.
When a cumulative injury claim is brought against two or more employers, the employee may enter into a compromise and release agreement with one employer regarding the part of the claim for which that employer is responsible, while reserving the right to pursue the rest of the claim against any remaining employers.50
Follow the Workers’ Compensation Appeals Board’s Procedures
When disputes between injured employees and workers’ compensation claims administrators cannot be resolved through negotiation, a workers’ compensation judge can be asked to resolve the dispute. Proceedings to recover workers’ compensation benefits are instituted before the Workers’ Compensation Appeals Board (sometimes referred to as “WCAB” for short).51
File an Application for Adjudication
Filing a claim form with an employer does not bring a case before a workers’ compensation judge. Rather, the injured employee must file an application for adjudication with the Workers’ Compensation Appeals Board.52 The application must usually be filed within one year of:
- The date of injury,
- The date medical treatment ended, or
- The last date on which benefits were paid.53
When an employer voluntarily provides benefits, including medical treatment or temporary disability benefits, the time period in which an application for adjudication must be filed is tolled because the employee might reasonably assume that the employer is not disputing the employee’s entitlement to benefits.54
If, however, the employer denies the claim or otherwise notifies the injured employee that it is rejecting liability for the injury, the one year limitations period is no longer tolled because the employee should no longer assume that the claim is undisputed.55 Keep in mind also that filing the claim form tolls the one year limitations period only until the claim is denied.56
The Workers’ Compensation Appeals Board will add a case number and a date of filing to the application and will return a copy to the injured employee’s attorney or to the employee, if the employee is unrepresented. If the employee is represented, the employee’s attorney serves a copy of the application upon the employer. If the employee is not represented, the application will be served by the Workers’ Compensation Appeals Board.57
The employer may file an answer within 10 days after service of the application.58
The parties may then engage in discovery to prepare for a contested hearing. Discovery must be completed before the mandatory settlement conference discussed below.59
When the injured employee is prepared to proceed to a hearing, the employee must file a document called a “Declaration of Readiness” with the Workers’ Compensation Appeals Board. The employer may also file a Declaration of Readiness.60
The employer and employee must try to settle the case before filing a Declaration of Readiness.61
Engage in Further Settlement Discussions
The Appeals Board will schedule a mandatory Settlement Conference within 30 days after the Declaration of Readiness is filed.62 The workers’ compensation judge or referee who presides at the settlement conference will encourage settlement.
The workers’ compensation judge or referee also has the authority to approve a compromise and release or to issue a stipulated finding and award. If the case does not settle, the judge will determine which facts or issues are in dispute so that those disputes can be resolved in a contested hearing.63
Prepare and File Pretrial Statements
After the settlement conference, the employer and employee must each file pretrial statements that advise the workers’ compensation judge of:
- The specific issues in dispute,
- Each party’s proposed permanent disability rating,
- The exhibits that will be introduced into evidence, and
- The witnesses who will be called to testify.64
Attend the Trial and Present Evidence
If the case does not settle, a hearing must be held within 75 days after the declarations of readiness are filed.65 At the hearing, the workers’ compensation judge considers evidence about disputed issues. Evidence might consist of:66
- Testimony of the injured worker,
- Testimony of other witnesses,
- The P&S report,
- Reports prepared by a qualified medical evaluator (“QME”),
- Reports of other physicians,
- Hospital records,
- Reports of vocational experts, or
- Other documents that meet standards of admissibility.
The Workers’ Compensation Appeals Board may also direct the employee to be examined by a qualified medical evaluator if an examination will help resolve disputes about and lingering medical issues.67
Review the Decision and Decide Whether to Appeal
After the workers’ compensation judge has considered the evidence, the judge will decide the disputed issues, including whether the injured worker sustained a compensable injury and, if so, the benefits the injured worker should receive.68
The decision must be issued within 30 days of the date the trial ends and the case is deemed “submitted” to the Workers’ Compensation Appeals Board.69
In appropriate cases, either party can seek review of the Workers’ Compensation Appeals Board’s decision in an appellate court. The review addresses the “lawfulness” of the Appeals Board’s order—not the correctness of any factual findings.70
Appellate review is limited and does not include a second trial.71
As a general rule, an appellate court will not second-guess the Appeals Board’s view of the facts, although it can determine whether facts relied upon by the Appeals Board are supported by substantial evidence.72 In most appeals, the appellate court is asked to determine whether the Workers’ Compensation Appeals Board misapplied California law when it decided the case.73
Like all legal proceedings, workers’ compensation hearings and appeals are subject to procedural and evidentiary rules and strict time limits. Employees will often be better positioned to prevail if they obtain legal advice well in advance of filing an application for adjudication.
Labor Code, §§ 3700, 3700.5.
Labor Code, § 3202 [“This division . . . shall be liberally construed by the courts with the purpose of extending their benefits for the protection of persons injured in the course of their employment.”], emphasis added; see also Labor Code, § 3208 [defining “injury” to mean “any injury or disease arising out of the employment . . . .”].
Labor Code, § 3601, subd. (a); Cole v. Fair Oaks Fire Protection Dist. (1987) 43 Cal.3d 148, 154 [“Section 3601 provided that where the ‘conditions of compensation exist,’ the right to recover compensation is ‘the exclusive remedy’ for injury or death of an employee against the employer or coemployee acting within the scope of employment except that an employee shall ‘in addition to the right of compensation against the employer, have a right to bring an action at law for damages against such other employee,’ when the injury is proximately caused by the willful and unprovoked ‘physical’ act of aggression of such other employee.”].
Cal. Const., art. XIV § 4 [noting that the system of compensation should exist “irrespective of the fault of any party”].
See Shoemaker v. Myers (1990) 52 Cal.3d 1, 16 [“The employee is afforded relatively swift and certain payment of benefits to cure or relieve the effects of industrial injury without having to prove fault but, in exchange, gives up the wider range of damages potentially available in tort.”].
Labor Code, § 5400 [“Except as provided by sections 5402 and 5403, no claim to recover compensation under this division shall be maintained unless within thirty days after the occurrence of the injury which is claimed to have caused the disability or death, there is served upon the employer notice in writing, signed by the person injured or someone in his behalf, or in case of the death of the person injured, by a dependent or someone in the dependent’s behalf.”].
Labor Code, § 5401, subd. (a) [“Within one working day of receiving notice or knowledge of injury under Section 5400 or 5402, which injury results in lost time beyond the employee’s work shift at the time of injury or which results in medical treatment beyond first aid, the employer shall provide, personally or by first-class mail, a claim form and a notice of potential eligibility for benefits under this division to the injured employee, or in the case of death, to his or her dependents.”].
Cal. Labor Code § 5400.
Labor Code, § 5402, subd. (a) [“Knowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.”].
Labor Code, § 5402.
Honeywell v. Workers’ Comp. Appeals Bd. (2005) 70 Cal.Comp.Cases 97, 99 [“The employer’s knowledge of an injury satisfies the worker’s duty to provide notice within 30 days of the injury and triggers the employer’s duty to provide a claim form within one working day.”], citations omitted.
Labor Code, § 5403 [“The failure to give notice under Section 5400, or any defect or inaccuracy in a notice is not a bar to recovery under this division if it is found as a fact in the proceedings for the collection of the claim that the employer was not in fact misled or prejudiced by such failure.”]; see also Beckstead v. Workers’ Comp. Appeals Bd. (1997) 60 Cal.App.4th 787, 790–791 [stating the wrong date of injury on a claim form does not bar recovery when employer is aware of the nature and cause of the injury that the employee is alleging and had “ample opportunity to investigate the injury and to prepare and defend the case”].
See Labor Code, §§ 5402, subd. (a) [knowledge of a claim that allows an investigation into facts constitutes notice], 5403 [defect in notice does not bar recovery unless employer was misled or prejudiced]; Beckstead v. Workers’ Comp. Appeals Bd. (1997) 60 Cal.App.4th 787, 790–791 [linking prejudice to the employer’s opportunity to investigate the facts surrounding the injury].
Labor Code, § 3208.1 [“cumulative” injury is one that is caused by “repetitive mentally or physically traumatic activities extending over a period of time, the combined effect of which causes any disability or need for medical treatment”].
Cal. Labor Code § 5412 (“The date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that such disability was caused by his present or prior employment.”). See Hamilton v. Asbestos Corp., Ltd., 95 Cal.Rptr.2d 701, 707, 22 Cal. 4th 1127, 998 P. 2d 403 (2000) (construing a similar statute involving claims arising out of asbestos exposure, the California Supreme Court held that the relevant date is “the date the plaintiff first suffered disability and either knew or should have known the disability was caused or contributed to by that exposure.”).
State Comp. Ins. Fund v. Workers’ Comp. Appeals Bd. (2004) 119 Cal.App.4th 998 [“Cases interpreting section 5412 for statute of limitations purposes hold that the date of injury is the date upon which employment activities cause compensable disability, and the statute of limitations does not begin to run until the last day of employment exposure to such activities, or the compensable disability caused by such activities, whichever is later. Although there is no compensable temporary disability until the worker suffers wage loss, wage loss is not required for an injured worker to be entitled to permanent disability compensation.”], citations omitted.
Labor Code, § 5500.5, subd. (a).
Labor Code, § 5500.5, subd. (c); see Denny’s, Inc. v. Workers’ Comp. Appeals Bd. (2003) 104 Cal.App.4th 1433 [“The [Workers’ Compensation Appeals Board (WCAB)] will hold the multiple employers or insurance carriers in the chain of causation jointly and severally liable for the entire award and allow them to apportion their relative liabilities in separate WCAB proceedings.”].
Labor Code, § 5401, subd. (a).
See Labor Code, § 5401, subd. (a) [“As used in this subdivision, ‘first aid’ means any one-time treatment, and any followup visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and followup visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel. ‘Minor industrial injury’ shall not include serious exposure to a hazardous substance as defined in subdivision (i) of Section 6302.”].
Labor Code, § 5401, subd. (a).
Labor Code, § 5401, subd. (b).
Labor Code, § 5401, subd. (b).
See Honeywell v. Workers’ Comp. Appeals Bd. (2005) 35 Cal.4th 24 [“the employer’s . . . knowledge that a claim of injury is being asserted, substitutes for the written notice required by section 5400”].
Labor Code, § 5401, subd. (a) [“Claim forms shall be available at district offices of the Employment Development Department and the division. Claim forms may be made available to the employee from any other source.”].
See Labor Code, § 124, subd. (b) [“Forms and notices required to be given to employees by the division shall be in English and Spanish.”].
See Labor Code, § 124, subd. (c) [“In addition to the requirement in subdivision (b), no later than January 1, 2018, the department and the division shall make at least the following forms, notices, and materials available in Chinese, Korean, Tagalog, and Vietnamese: (1) The workers’ compensation claim form required pursuant to Section 5401.”].
See Labor Code, § 5401, subd. (a) [“The claim form shall request the injured employee’s name and address, social security number, the time and address where the injury occurred, and the nature of and part of the body affected by the injury.”].
Labor Code, § 5401, subd. (c) ([“The completed claim form shall be filed with the employer by the injured employee, or, in the case of death, by a dependent of the injured employee, or by an agent of the employee or dependent. Except as provided in subdivision (d), a claim form is deemed filed when it is personally delivered to the employer or received by the employer by first-class or certified mail. A dated copy of the completed form shall be provided by the employer to the employer’s insurer and to the employee, dependent, or agent who filed the claim form.”].
Labor Code, § 5401, subd. (c) [“A dated copy of the completed form shall be provided by the employer to the employer’s insurer and to the employee, dependent, or agent who filed the claim form.”].
Labor Code, § 5401, subd. (a).
Labor Code, § 5402, subd. (b) [“If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division. The presumption of this subdivision is rebuttable only by evidence discovered subsequent to the 90-day period.”].
Labor Code, § 5402, subd. (b); but see James v. Workers’ Comp. Appeals Bd. (1997) 55 Cal.App.4th 1053, 1055 [noting that subdivision (b) of section 5402 does not apply to “employees claiming psychiatric injuries who have been employed for less than six months where the injury is not caused by a sudden and extraordinary employment incident.”].
Labor Code, § 5402, subd. (c) [“Within one working day after an employee files a claim form under Section 5401, the employer shall authorize the provision of all treatment, consistent with Section 5307.27, for the alleged injury and shall continue to provide the treatment until the date that liability for the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000).”].
See Cal. Code Regs., tit. 8, § 9812, subd. (i)(3) [“For claims reported on or after April 19, 2004, regardless of the date of injury, if the claims administrator sends a notice of delay in its decision whether to accept or deny liability for the claim, the notice shall include an explanation that Labor Code section 5402(c), provides that within one working day after an employee files a claim form, the employer shall authorize the provision of all treatment, consistent with the applicable treatment guidelines, for the alleged injury and shall continue to provide treatment until the date that liability is rejected. The notice shall advise the employee that the employer’s liability for medical treatment under this Labor Code section is limited to ten thousand dollars ($10,000).”].
Labor Code, § 3751, subd. (b) [“If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision shall be liable for three times the amount unlawfully collected, plus reasonable attorney’s fees and costs.”].
Labor Code, §§ 5405, 5406.
Labor Code, § 5401, subd. (d) [“Filing of the claim form with the employer shall toll, for injuries occurring on or after January 1, 1994, the time limitations set forth in Sections 5405 and 5406 until the claim is denied by the employer or the injury becomes presumptively compensable pursuant to Section 5402. For purposes of this subdivision, a claim form is deemed filed when it is personally delivered to the employer or mailed to the employer by first-class or certified mail.”].
Labor Code, § 4650, subd. (a) [“If an injury causes temporary disability, the first payment of temporary disability indemnity shall be made not later than 14 days after knowledge of the injury and disability, on which date all indemnity then due shall be paid, unless liability for the injury is earlier denied.”].
Labor Code § 4650, subd. (b) [“If the injury causes permanent disability, the first payment shall be made within 14 days after the date of last payment of temporary disability indemnity, except as provided in paragraph (2).”].
See Labor Code § 4650, subd. (d) [“If any indemnity payment is not made timely as required by this section, the amount of the late payment shall be increased 10 percent and shall be paid, without application, to the employee, unless the employer continues the employee’s wages under a salary continuation plan, as defined in subdivision (g). No increase shall apply to any payment due prior to or within 14 days after the date the claim form was submitted to the employer under Section 5401.”]; see also Labor Code, § 5401, subd. (d) [“The claim form shall be filed with the employer prior to the injured employee’s entitlement to late payment supplements under subdivision (d) of Section 4650 . . . .”].
See Labor Code, § 4060 [medical evaluations to determine compensability].
See Labor Code, § 4061 [medical evaluations to determine permanent disability].
See Labor Code § 4062 [medical evaluations concerning medical disputes not covered by sections 4060, 4061, or 4610].
See Labor Code, § 4650, subd. (d) [“The claim form shall be filed with the employer . . . prior to the injured employee’s request for a medical evaluation under Section 4060, 4061, or 4062.”].
Labor Code, § 4650, subd. (a); see also Honeywell v. Workers’ Comp. Appeals Bd. (2005) 35 Cal.4th 24.
Labor Code, § 5001 [“No release of liability or compromise agreement is valid unless it is approved by the appeals board or referee.”].
Labor Code, § 5702 [“The parties to a controversy may stipulate the facts relative thereto in writing and file such stipulation with the appeals board. The appeals board may thereupon make its findings and award based upon such stipulation, or may set the matter down for hearing and take further testimony or make the further investigation necessary to enable it to determine the matter in controversy.”].
See Labor Code, §§ 5000–5006.
Labor Code, § 5005.
Labor Code, § 5300 [“All the following proceedings shall be instituted before the appeals board and not elsewhere, except as otherwise provided in Division 4: (a) For the recovery of compensation, or concerning any right or liability arising out of or incidental thereto.”].
See Labor Code, § 5500 [“Notwithstanding Section 5401, except where a claim form has been filed for an injury occurring on or after January 1, 1990, and before January 1, 1994, the filing of an application for adjudication and not the filing of a claim form shall establish the jurisdiction of the appeals board and shall commence proceedings before the appeals board for the collection of benefits.”].
Labor Code § 5405.
Kaiser v. Workers’ Comp. Appeals Bd. (1977) 19 Cal.3d 329, 333.
Kaiser v. Workers’ Comp. Appeals Bd. (1977) 19 Cal.3d 329, 336 [“we hold that the statute of limitations, embodied in section 5405, begins to run against a potential claimant no later than the date on which the claimant is notified of a disclaimer by the employer, or its compensation carrier”].
Labor Code, § 5401, subd. (d).
Labor Code, § 5501 [“The application may be filed with the appeals board by any party in interest, his attorney, or other representative authorized in writing. . . . Upon the filing of the application, the appeals board shall, where the applicant is represented by an attorney or other representative, serve a conformed copy of the application showing the date of filing and the case number upon applicant’s attorney or representative. The applicant’s attorney or representative shall, upon receipt of the conformed copy, forthwith serve a copy of the conformed application upon all other parties to the claim. If the applicant is unrepresented, a copy thereof shall forthwith be served upon all adverse parties by the appeals board.”].
Labor Code, § 5505.
Labor Code, § 5502, subd. (d)(3) [“Discovery shall close on the date of the mandatory settlement conference. Evidence not disclosed or obtained thereafter shall not be admissible unless the proponent of the evidence can demonstrate that it was not available or could not have been discovered by the exercise of due diligence prior to the settlement conference.”].
Cal. Code Regs., tit. 8, § 10414, subd. (a) [“Except when a hearing is set on the Workers’ Compensation Appeals Board’s own motion, no matter shall be placed on calendar unless one of the parties has filed and served a declaration of readiness to proceed in the form prescribed by the Appeals Board.”)”].
Cal. Code Regs., tit. 8, § 10414, subd. (d) [“All declarations of readiness to proceed shall state under penalty of perjury that the moving party has made a genuine, good faith effort to resolve the dispute before filing the declaration of readiness to proceed, and shall state with specificity the same on the declaration of readiness to proceed. Unless a status or priority conference is requested, the declarant shall also state under penalty of perjury that the moving party has completed discovery and is ready to proceed on the issues specified in the declaration of readiness.”].
Labor Code, § 5502, subd. (d)(1) [“In all cases, a mandatory settlement conference, except a lien conference or a mandatory settlement lien conference, shall be conducted not less than 10 days, and not more than 30 days, after the filing of a declaration of readiness to proceed.”].
Labor Code § 5502, subd. (d)(2) [“The settlement conference shall be conducted by a workers’ compensation administrative law judge or by a referee . . . . At the mandatory settlement conference, the referee or workers’ compensation administrative law judge shall have the authority to resolve the dispute, including the authority to approve a compromise and release or issue a stipulated finding and award, and if the dispute cannot be resolved, to frame the issues and stipulations for trial.”].
Labor Code § 5502, subd. (d)(3) [“If the claim is not resolved at the mandatory settlement conference, the parties shall file a pretrial conference statement noting the specific issues in dispute, each party’s proposed permanent disability rating, and listing the exhibits, and disclosing witnesses.”].
Labor Code, § 5502, subd. (d)(1) [“If the dispute is not resolved, the regular hearing, except a lien trial, shall be held within 75 days after the declaration of readiness to proceed is filed.”].
Labor Code, § 5703.
Labor Code, § 5703.5, subd. (a).
Labor Code, § 5801 [“The appeals board in its award may fix and determine the total amount of compensation to be paid and specify the manner of payment, or may fix and determine the weekly disability payment to be made and order payment thereof during the continuance of disability.”].
Labor Code, § 5313 [“The appeals board or the workers’ compensation judge shall, within 30 days after the case is submitted, make and file findings upon all facts involved in the controversy and an award, order, or decision stating the determination as to the rights of the parties. Together with the findings, decision, order or award there shall be served upon all the parties to the proceedings a summary of the evidence received and relied upon and the reasons or grounds upon which the determination was made.”].
Labor Code, § 5950 [“Any person affected by an order, decision, or award of the appeals board may, within the time limit specified in this section, apply to the Supreme Court or to the court of appeal for the appellate district in which he resides, for a writ of review, for the purpose of inquiring into and determining the lawfulness of the original order, decision, or award or of the order, decision, or award following reconsideration. The application for writ of review must be made within 45 days after a petition for reconsideration is denied, or, if a petition is granted or reconsideration is had on the appeal board’s own motion, within 45 days after the filing of the order, decision, or award following reconsideration.”].
Labor Code, § 5952 [“The review by the court shall not be extended further than to determine, based upon the entire record which shall be certified by the appeals board, whether: (a) The appeals board acted without or in excess of its powers. (b) The order, decision, or award was procured by fraud. (c) The order, decision, or award was unreasonable. (d) The order, decision, or award was not supported by substantial evidence. (e) If findings of fact are made, such findings of fact support the order, decision, or award under review. Nothing in this section shall permit the court to hold a trial de novo, to take evidence, or to exercise its independent judgment on the evidence.”].
See LeVesque v. Workmen’s Comp. Appeals Bd. (1970) 1 Cal.3d 627, 636–637 [discussing scope of the “substantial evidence” test].
See Dep’t of Rehabilitation v. Workers’ Comp. Appeals Bd. (2003) 30 Cal.4th 1281 [“While we accord significant respect to the Board’s interpretation of statutes in the area of workers’ compensation, we subject the Board’s conclusions of law to de novo review.”], citations and quotation marks omitted.