Workers' compensation is the nation's oldest social insurance program: It was adopted in most states, including California, during the second decade of the 20th century. Unlike most social insurance programs, workers' compensation benefits are not administered by a government agency. They are administered primarily by insurance companies and those employers secure enough to self-insure their workers' compensation liability.
When an employer becomes aware of a work-related injury or illness, it is expected to begin providing benefits to the injured worker. Sometimes a dispute may arise between the claims administrator and the injured worker over benefits. That's where you come in.
Whether you represent employees (applicants), employers/ insurance carriers or lien claimants, there is useful information on this Web site to help you do your job efficiently and knowledgably. You can find provisions of the Labor Code, California Code of Regulations and pending or proposed rules that will help guide you through the litigation process. You will also be able to easily find the address of any of our 23 district offices plus satellites in cities from Eureka to San Diego, along with a map and directions to each location. Important en banc and significant panel decisions issued by the Workers' Compensation Appeals Board can be accessed here to help you find relevant case law authority. Finally, you can also locate Division of Workers' Compensation Newsline articles covering a wide variety of topics to keep you informed about current and proposed policies affecting your practice, including our EAMS paperless case management system.
Educational conference - the largest workers' compensation educational event in the state. It is held in February in both Northern and Southern California, speakers from the Division of Workers’ Compensation and the private sector will address the most current topics and issues confronting claims administrators, medical providers, attorneys, rehabilitation counselors and others involved in workers’ compensation.
Workers' compensation benefits - Overview of benefits, including currents rates, available for injured workers.
ZIP code locator tool will help you locate the DWC district office serving your ZIP code
Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body regions guidelines adopted from the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain, and therapy after surgery. The Division of Workers' Compensation also has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
Copies of the ACOEM guidelines are available for review at your local DWC office. Other guidelines not adopted from ACOEM can be reviewed and downloaded from the DWC Web site: http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS_Regulations/MTUS_Regulations.htm.
Copies may also be obtained from:
Division of Workers' Compensation
P.O. Box 71010
Oakland, CA 94612-1486
Additionally, employers are required to have a program called utilization review (UR). UR was implemented as a way to confirm the treating physician's plan for the injured worker is medically sound. To ensure prompt and effective medical treatment is provided to injured workers, UR must be completed within strict timelines. Claims administrators who don't meet the timelines or the criteria for a proper UR program are subject to audits and penalties. Injured workers, attorneys, medical providers or others who find that UR is not being done according to the regulations can file a complaint with the DWC.
More UR topics
Many employees now have their workers' comp injuries cared for by a doctor in a medical provider network (MPN) or a health care organization (HCO). These networks of doctors are similar to health maintenance organizations (HMOs).
Your client and/or the claims administrator might disagree with what the treating doctor says about a work injury or treatment. There could be other disagreements over medical issues in the claim. A doctor has to address those disagreements. In that case you and the defense attorney may agree on a medical evaluator (AME) or, if you can't agree, your client will see a qualified medical evaluator (QME).
Most workers fully recover from job injuries but some continue to have medical problems. Permanent disability (PD) is any lasting disability an injured employee experiences, which results in reduced earning capacity after maximum medical improvement is reached. If an injured employee’s injury or illness results in PD they are entitled to PD benefits. Check out our fact sheets and guides page and click on fact sheet D for more information on PD.
For injuries occurring on or after Jan. 1, 2013, there will be a new method for calculating an injured employee’s PD rating. A QME or treating physician can no longer increase an injured employee’s PD by adding impairment in the form of sleep disorder or sexual impairment unless such impairments were a direct result of the injury. In addition, no increase in an injured employee’s PD on account of a psychiatric injury is allowed unless the physical injury was catastrophic or the injured employee was the victim of or a witness to a violent crime
Permanent disability rating schedule - 2005
This schedule is effective for dates of injury on or after Jan. 1, 2005. This schedule will also be used to rate permanent disability in injuries that occurred before Jan. 1, 2005 when there has been either no comprehensive medical-legal report, or no report by a treating physician indicating the existence of permanent disability, or when the employer is not required to provide a notice to the injured worker under Labor Code section 4061.
Permanent disability rating schedule - 1997
This schedule is effective for dates of injury on or after Apr. 1, 1997
Medical report reference materials
For cases rated under the 1997 or earlier rating schedules
Commutation templates and instructions .zip file
Templates and instructions to facilitate the calculation of life pension and permanent disability benefit commutations. When properly used, the templates assure that calculations are done in accordance with commutation calculation methods and tables that went into effect Jan. 17, 2001. The regulations and tables can be found in section 10169 and 10169.1 of Title 8, California Code of Regulations.
More disability rating topics
Evaluation protocols - for injuries rated under 1997 permanent disability rating schedule and prior