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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. The workers' compensation system is based on a trade-off between employers and employees. Employees are entitled to receive prompt, effective medical treatment for on-the-job injuries or illnesses no matter who is at fault and, in return, are prevented from suing employers over those injuries.
As a result, California employers are required by law to have workers' compensation insurance, even if they have only one employee. And, if your employees get hurt or sick because of work, you are required to pay for workers' compensation benefits. Workers' comp insurance provides six basic benefits: medical care, temporary disability benefits, permanent disability benefits, supplemental job displacement benefits or vocational rehabilitation and death benefits.
The vast majority of workers' compensation claims are resolved without any problems. However, sometimes a disagreement can arise between you and your employee over issues such as whether the injury was sustained on the job or how much in benefits they are entitled to receive.
When a dispute like that arises, the Division of Workers' Compensation can help resolve it through its Information and Assistance Unit or by going before a judge at one of the division's 24 local district offices.
Please be advised that if you are a roofer and don't have any employees, you are still required to carry workers' compensation insurance.
If you are an out-of-state employer you may need workers' compensation coverage if you have any employees regularly working in California, or if you enter into a contract of employment here.
Educational conference - the largest workers' compensation educational event in the state. Normally held in February and March 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.
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 may also be obtained from:
Division of Workers' Compensation
P.O. Box 71010
Oakland, CA 94612-1486
Additionally, you, or the claims administrator representing you, are required to have a program called utilization review (UR), which basically provides a way to double check that the doctor's treatment plan for your employee is sound. Check out our fact sheets and guides page and click on Fact Sheet A for more information on UR.
For injuries on or after Jan. 1, 2013, and as of July 1, 2013 for all dates of injury, if UR has delayed, denied or modified a treating physician’s request for a specific course of treatment and the injured employee disagrees with the UR decision, the dispute can only be resolved through a process called independent medical review (IMR).
If your claims administrator has established a medical provider network (MPN) or a health care organization (HCO), your employees' work injuries and illnesses will be treated by a doctor in the network. These networks of doctors are similar to health maintenance organizations (HMOs). If your employees qualified to pre-designate a personal physician and did so prior to being injured they can go to their regular doctor for their workers' compensation care.
Submitted utilization review plans version
This is a list of the groups that have sent actual utilization review plans to the Division of Workers' Compensation. The list does not contain the names of individual employers that might be covered by these plans. The plans have not been reviewed by DWC staff.
More utilization review topics
More HCO topics
Most workers fully recover from job injuries but some continue to have medical problems. Permanent disability (PD) is any lasting disability your employee experiences, which results in reduced earning capacity after maximum medical improvement is reached. If your 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 PD 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 PD, 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 April 1, 1997
Getting your employees back to work after an injury is one of the most important things you can do for their health and the health of your business. Workers who return to the job as soon as medically possible have the best outcomes: They recover from their injuries faster and suffer less wage loss. You, your employee and your employee's doctor should communicate openly and frequently for the best results.Back to top