Frequently Asked Questions

  • What is workers’ compensation?

    Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries and illnesses. In general, an employee with a work-related injury or illness can get workers’ compensation benefits regardless of who was at fault — the employee, the employer, a coworker, a customer, or some other third party. If you have a work-related injury or illness, your employer is required by law to provide workers’ compensation benefits.

    You could get hurt by:

    • A single work-related event, such as hurting your back in a fall, getting burned by a chemical that splashes on your skin or getting hurt in a car accident while making deliveries.
      — or —
    • Repeated exposures at work, such as hurting your wrist from doing the same motion over and over or losing your hearing because of constant loud noise.

    To determine if your particular situation qualifies for coverage under the workers’ compensation program, you should consult with a qualified attorney.

  • Do I have to be injured at my workplace to be covered by workers’ compensation?

    No. As long as your injury is job-related, it should be covered. While each case is different, workers’ compensation should cover injuries sustained while traveling on business, doing a work-related errand, attending a training session, or even attending a required business-related social function.

    To determine if your particular situation qualifies for coverage under the workers’ compensation program, you should consult with a qualified attorney.

  • Are all on-the-job injuries covered by workers’ compensation?

    Workers’ compensation covers most, but not all, on-the-job injuries. The workers’ compensation system is designed to provide benefits to injured workers, even if an injury is caused by the employer’s or employee’s carelessness. But there are limits. For example, injuries that happen because an employee is intoxicated / using illegal drugs or injuries sustained during “horseplay” are typically not covered by workers’ compensation. Coverage may also be denied in situations involving:

    • Self-inflicted injuries (including those caused by a person who starts a fight)
    • Injuries suffered while a worker was committing a serious crime
    • Injuries suffered while an employee was not on the job, and
    • Injuries suffered when an employee’s conduct violated company policy.

    To determine if your particular situation qualifies (or may be disqualified) for coverage under the workers’ compensation program, you should consult with a qualified attorney.

  • What should I do if I have a job injury?

    Report the injury to your employer by telling your supervisor right away. If your injury or illness developed over time, report it as soon as you learn or believe it was caused by your job.

    Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need. If your employer does not learn about your injury within 30 days and this prevents your employer from fully investigating the injury and how you were injured, you could lose your right to receive workers’ compensation benefits.

    Get emergency treatment if you need it. Your employer may tell you where to go for treatment. Tell the healthcare provider who treats you that your injury or illness is job-related.

    Fill out a claim form (DWC-1) and give it to your employer. Your employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn’t give you the claim form you can download it from the forms page of the DWC website.

  • After I file a claim, do I have to go to my employer’s doctor?

    Usually, yes. In some cases, you can pre-designate a treating doctor. Pre-designation must be done before you are injured. In most cases your employer controls your medical treatment for the first 30 days, which means you have to go to the doctor you are assigned for the first 30 days. After the first 30 days you can change doctors. However, if your employer has a Medical Provider Network (“MPN”), in most cases, you must choose a doctor that is within your employer’s MPN.

  • Do I need to fill out the claim form (DWC-1) my employer gave me?

    Yes. Giving the completed form to your employer opens your workers’ compensation case. It starts the process for finding all benefits you may qualify for under state law. Those benefits include, but are not limited to:

    • A presumption that your injury or illness was caused by work if your claim is not accepted or denied within 90 days of giving the completed claim form to your employer
    • Up to $10,000 in treatment under medical treatment guidelines while the claims administrator considers your claim
    • An increase in your disability payments if they’re late
    • A way to resolve any disagreements between you and the claims administrator over whether your injury or illness happened on the job, the medical treatment you receive and whether you will receive permanent disability benefits.
  • What does my employer do after I file a claim?

    Your employer contacts its insurance carrier and reports the claim to them. That insurance carrier will send you letters, including a medical release, and may contact you to take your statement. The medical release, if you sign and return it, allows the insurance carrier to obtain your medical records from your doctors. It is generally best to consult with a qualified attorney before you sign a medical release or give a statement.

  • Once I file a claim, how long before my employer provides me benefits?

    That depends on many factors. First, your employer has 90 days to accept or deny your claim. Your employer does not have to pay you anything, including temporary disability, until it accepts your claim. However, during the first 90 days after you file a claim, until your employer denies your claim, it must pay for reasonable medical treatment for your injury, up to $10,000. If your employer denies your claim, it will not pay any benefits. You should always consult with a qualified attorney if your claim is denied.

  • Can I be terminated from my job if I have filed a workers’ compensation claim?

    While filing a workers’ compensation claim does not create a shield against being fired or laid off, the reason for your termination cannot be related to your injury or because you filed or requested to file a workers’ compensation claim.

    If you believe you have been fired because you filed a claim, you should consult an attorney. You can take action in the workers’ compensation court system to obtain back pay, benefits, and penalties against your employer. However, you must file a petition in the workers’ compensation court system within one year of your employer’s bad conduct, or your claim will be barred.

  • Does workers’ compensation cover just my medical bills?

    Workers’ compensation does pay hospital and medical expenses that are necessary to diagnose and treat your injury. But it also provides disability payments while you are unable to work (typically, about two-thirds of your regular salary), and may pay for rehabilitation, retraining, and other benefits as well.

    To determine if your situation qualifies for such additional benefits, it’s best to consult an attorney.

  • How long after I file a claim can I get medical treatment?

    In most cases, you should see a doctor the same day. If your employer does not refer you to a doctor, you can go to one and submit the bill to your employer. However, if your employer does refer you to a doctor, then you cannot bill your employer for seeing your own doctor. If your claim is accepted, then you have to go to the doctor that your employer sends you to for 30 days. After 30 days you can change doctors. However, in most cases, while you can choose a doctor after 30 days, you have to choose a doctor that is within your employer’s MPN. If your claim is neither accepted nor denied, you can get up to $10,000 in medical treatment, paid for by your employer. After 90 days, if your employer has not denied your claim, it is deemed accepted by law.

  • What benefits am I entitled to?

    Workers’ compensation provides five basic benefits:

    • Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
    • Temporary disability benefits / 4850 Pay: Payments if you lose wages because your injury prevents you from doing your usual job while recovering (but no longer than two years regardless of whether you’ve recovered).
      If you are a safety officer (firefighter, law enforcement officer, correctional officer), 4850 pay is equivalent to your regular pay — up to a maximum of 52 weeks.
    • Permanent disability benefits: Payments if you don’t recover completely
    • Supplemental job displacement benefits (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer
    • Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.

    To determine which benefits may apply to your particular situation, it’s best to consult an attorney.

  • How do I pick a doctor within the MPN?

    If you are represented by an attorney, your attorney can help you to find a doctor. If you are not represented, you can contact your claims adjuster and ask him/her to send you a list of doctors that are in the MPN. You can then choose one of those doctors. However, not every doctor listed in your employer’s MPN will be seeing new patients or new workers’ compensation cases. You need to call the doctor and make sure that they will treat you before contacting the carrier again and informing them of the change of doctor.

  • Can I get medical treatment for a work injury even if I have a prior injury to the same body part?

    Yes. If medical treatment is needed for a job-related injury, your employer is required to provide for that medical treatment — even if you had previously injured the same body part in an accident at home, away from work, or in a work injury for another employer.

  • Can my employer refuse to authorize medical treatment that my doctor is recommending?

    In 2004, the California Legislature passed a law that allows your employer or its insurance carrier to deny medical treatment that it does not think is necessary. The system created is called Utilization Review (“UR”). This system allows your employer to deny treatment that your doctor recommends. Even if your employer sent you to a doctor after a job-related injury, it can deny treatment recommended by that doctor.

  • What can I do if my employer denies medical treatment that my doctor is recommending?

    You can object to the denial and request that your injury and the recommended treatment for your injury be evaluated by another doctor — a Qualified Medical Evaluator (“QME”). Upon request, your employer or its insurance carrier will obtain a panel QME list of three doctors. You can choose one of the three doctors to re-examine you to determine if your doctor’s treatment recommendations are reasonable. It may be advisable to consult with an experienced workers’ compensation attorney to help choose from that list of doctors provided.

  • What is temporary disability / 4850 pay / IDL?

    There are two types of temporary disability. One is temporary total disability (“TTD”) and the other is total partial disability (“TPD”). TTD is paid when you are unable to work for a temporary period, due to your injury. TPD is paid when you can work part-time, but not full-time, due to your injury.

    4850 Pay and IDL are a special benefit available to firefighters, police and some other safety officers only. The rules of inclusion are quite complex. To determine if your particular situation qualifies, you should consult with a qualified attorney specializing in these types of cases.

  • If I am injured at work, how do I get TTD or TPD / 4850 pay / IDL?

    You must first report your injury to your employer and then see a doctor. If that doctor takes you off work for a period of more than three days, you are entitled to TTD if you cannot work at all or TPD if you can only work part-time. However, your claim must be accepted by your employer before you can get either TTD or TPD. Your employer may take up to 90 days to decide whether to accept or deny your claim. During this 90-day period, you will not receive either TTD or TPD. Your employer may accept your claim before the 90 days are up, at which time you can get TTD or TPD as long as your doctor says that you should.

    If you are not receiving TTD/4850/IDL, you may qualify for state disability benefits (EDD) if your employer pays into the system. And if you have private disability insurance, they may pay you while you’re waiting for your employer to accept your claim.

    All of these benefits require a doctor’s written certification that you are completely unable to perform your job for more than three consecutive days.

  • When does temporary disability end?

    Temporary disability ends either when you are released to return to work or when you are found to have reached maximum medical improvement (“MMI”), which means you have healed up about as much as you are going to. At that point, you may be entitled to permanent disability if you are not 100% better after you have reached MMI. It may also end if your employer has modified duty available to you.

  • What is permanent disability?

    As with temporary disability, there are two types of permanent disability. One is permanent total disability (“PTD”). This is very rare and is paid to injured workers that can never compete for any job in the future. This person is determined to be totally unable to work. More common is permanent partial disability (“PPD”). This is paid to injured workers that can work, but still have some residual effects from their injury.

  • How is permanent disability determined?

    First, a doctor evaluates you to determine whether you have completely healed from your injury. If you have not completely healed, your doctor will state what physical impairment you have and phrase that as a percentage, between 0 and 100% whole person impairment (“WPI”). Then, a schedule that is issued by the State of California is used to determine a permanent disability rating. This rating is again, phrased as a percentage, between 0 and 100%. Once the number is determined, another chart is used to tell you how much money you will receive for the residual effects of your injury.

  • Can I work and receive permanent disability checks?

    Yes. Permanent disability checks are very different from temporary disability checks. You can be working, full-time and still receive permanent disability checks. These checks are not to supplement lost pay; they are to pay you because of the residual effects of your work injury. Even if you return to work, doing the same job with the same employer, you may be entitled to receive permanent disability checks.

  • How is permanent disability paid?

    Generally, it is paid in checks sent to you every two weeks. As an example, if you are injured in 2005 and your permanent disability is 15%, you will receive approximately $11,110, paid out at a rate of $220 per week or $440 every two weeks, until your award of $11,110 is fully paid out. You can work full-time during this period and you will still get this money. If you completely settle your case, including your right to get medical treatment paid for by your employer to the injured body parts, you can have your permanent disability award paid to you in a lump sum.

    To determine how this may apply in your particular situation, you should consult with a qualified attorney.

  • Am I suing my employer when I file a workers’ compensation claim?

    No. Filing a workers’ compensation claim is not a lawsuit. Your employer is required by law to be insured against work injuries. The claim you are making is against that insurance. Even if your employer is a public entity or is self-insured, your claim is against the workers’ compensation insurance, not your employer.

  • I don’t have any money. Will the Law Offices of Whiting, Cotter & Hurlimann, LLP still represent me?

    Absolutely. Workers’ compensation attorneys generally charge their clients on a contingency fee basis. That means you do not pay any out-of-pocket money upfront and your attorney is paid a percentage of the total award for your claim. This happens only after the successful resolution of your claim and is subject to approval by a workers’ compensation judge. When you first contact Whiting, Cotter & Hurlimann, LLP to discuss your case, you can learn the specifics of how this fee arrangement works.

  • So just what does the “IOD” in IODLaw stand for?

    Injured ODuty.

  • My question isn't here; what should I do?

    The Law Offices of Whiting, Cotter & Hurlimann, LLP want to do everything we can to make sure your questions are answered. So if your question isn’t answered by this list, you should call us at 714-866-0714, email us at or write to us at 1851 E First St, Ste 430, Santa Ana, CA 92705.