What Does California Workers' Comp Cover?

Workers’ compensation is an insurance program that covers employees when they get injured or sick on the job. Most employers in California have it, so most workers have access to payments that cover lost wages and medical treatment paid by their company’s insurance.

If you have a work injury and are considering filing for workers’ comp in California, this guide will explain who qualifies and the types of benefits you can get.

Who does workers’ comp cover?

Generally, full-time, part-time, seasonal, and temporary workers can get workers’ comp benefits through their California employer. You don’t have to be a legal resident of the state or a documented worker to qualify. In most cases, as long as you get a W-2 form for your taxes, you can apply.

Meanwhile, independent contractors and freelancers who get a Form 1099 don’t qualify for workers’ comp through their employer. However, if you’re an independent contractor with similar duties to an official employee, you could be misclassified. This guide from the Department of Labor clears up some myths about employee misclassification, and where you might fall.

Learn more about the types of workers who can qualify.

Injuries that qualify for California workers’ comp

Just about any injury or illness related to your work can qualify for workers’ comp coverage in California. Some examples include:

• Bodily injuries from accidents or contact with work equipment

• Overexertion-related injuries, like from lifting heavy weights

• Repetitive motion injuries that develop over time

• Illness from exposure to harmful substances

• Transportation-related accidents

• Violence from humans or animals on the job

5 types of California workers’ comp benefits

The benefits available to you through workers’ compensation fall into five categories:

1. Medical coverage

2. Temporary benefits to cover lost wages

3. Permanent benefit checks for long-term conditions

4. Death benefits

5. Work training benefits

1. Medical coverage

As you receive workers’ comp benefits, your employer’s workers’ comp insurance company will pay for all medical care related to your injury. Your medical benefits start right away because your employer must cover up to $10,000 of immediate medical care, even as their insurance investigates your claim. The insurance company has 14 days to send a letter accepting or denying medical coverage for your injury.

Usually, you’ll see a doctor chosen by your employer or their insurer for these treatments after you initially get hurt. But, you may be able to predesignate a doctor using Form 9783.

Workers’ comp covers treatments that the state program’s treatment guidelines consider reasonable for your condition, but there are some limits. For example, you can get up to 24 chiropractic, physical therapy, and occupational therapy visits.

You can also get reimbursed for the travel costs for going to appointments.

2. Temporary disability benefits

If your injury or illness causes you to miss work for at least three days, you’ll qualify for workers’ comp payments to cover your lost wages. These payments are known as temporary disability benefits.

Payments are sent by your claims adjuster, they start within two weeks of reporting your injury, and then you’ll get a check every two weeks. Your payments are usually equal to two-thirds of your typical pay. If you can still do some work while injured, you’ll get reduced workers’ comp payments.

In most cases, you can get these payments for up to 104 weeks (two years), but workers with severe cases could qualify for up to 240 weeks (about four and a half years) of benefits.

Read more about how much workers’ comp pays.

3. Permanent disability benefits

If you never fully recover from your injury, you could qualify for permanent disability benefits. These are payments that replace your temporary benefit payments once you reach MMI. That’s the point where you’ve recovered as much as possible even though it isn’t the same as your pre-injury condition. At this point, it’s also common to get a settlement offer from insurance.

There are two types of payments:

• Permanent partial disability: If you can still work after reaching MMI but not to the extent that you could before, you might qualify for permanent partial disability. This benefit pays two-thirds of your wages and usually lasts weeks or months, but could last up to 1,596 weeks (about 30 and a half years) in severe cases.

• Permanent total disability: In the situation that you can’t work at all even after reaching MMI, you could get permanent total disability checks. These payments are uncommon because California has strict requirements for who qualifies as permanently and totally disabled. If you do qualify, checks are worth two-thirds of your wages before your injury and can last the rest of your life.

4. Death benefits

If you die in a work-related accident, your family members will also receive benefits through workers’ comp.

Depending on the number of dependents you have, your family could get up to $320,000. California pays this benefit at the same rate as temporary disability benefits — two-thirds of the worker’s average weekly wage — but it pays every week. You can get a better idea of the possible total payout in our guide to California settlement charts.

Your family will also receive a payment to cover burial expenses. If the incident leading to death happened after 2013, the family payment is $10,000. Incidents before 2013 come with a $5,000 payment.

5. Work training benefits

California’s workers’ comp program helps you train for a new job if you have a permanent condition and can’t go back to your old job. Officially known as supplemental job displacement benefits, these work training benefits offer a voucher for job training at an eligible school to workers injured after 2004.

If you got sick or injured in 2013 or later, you receive a voucher covering up to $6,000. Meanwhile, if your accident happened between 2004 and 2012, you could get a voucher covering anywhere between $4,000 and $10,000 of education depending on your degree of disability.

When do workers’ comp benefits end?

California workers’ comp benefits end when you return to work, agree to a settlement, or reach the maximum length of benefits (usually two years).

If you reach maximum medical improvement (MMI) and transition to permanent benefits, you will continue to receive medical coverage for as long as your payments last.

How settlements work

In most cases, insurance will offer you a settlement around the time you reach MMI. Insurers generally don’t want to manage or pay for ongoing care. A settlement is usually a lump-sum payment that’s meant to cover workers’ comp checks, medical care, and any other costs related to your injury.

There are multiple types of settlement in California and estimating a fair payout isn’t easy so we recommend consulting a workers’ comp lawyer anytime you get a settlement offer. Learn more about how a lawyer can help you.

How to file a workers’ comp claim

Applying for workers’ compensation in California takes three steps:

1. Let your employer know about your work injury.

2. Get Form DWC-1 from your employer, fill it out, and return it.

3. Get the treatment you need to recover.

As you go through this process, our guide to California workers’ comp will help you understand what to expect. You can also get professional guidance from a lawyer. Workers’ comp lawyers are trained in state and local laws, so they’ll know how to get you the full benefit you deserve. They can help with everything from filing paperwork to attending a court hearing for denied benefits. Lawyers are especially helpful if your employer, claims adjuster, or insurance aren’t cooperating.

A reputable worker’s comp lawyer will also give you a free consultation so you can decide whether you want to work with them. If you do, you’ll pay nothing upfront and you’ll only pay the lawyer after they help you get a settlement.

Atticus is a law firm that’s based in Los Angeles and has local lawyers across the state. To get a free consultation and answer your questions today, start with our quick workers’ comp quiz or call us at the number below.

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Related resources:

California Workers' Comp: Everything You Need to Know

By Victoria Muñoz

Your Guide to California Workers’ Comp Settlements

By Victoria Muñoz