Programs and Units
Audit and Enforcement Unit
The Audit and Enforcement Unit audits insurance companies, self-insured employers, and third-party administrators to ensure that they have met their obligations under the Labor Code and the California Code of Regulations under the direction of the DWC Administrative Director. The unit conducts compliance audits for a random selection of claim files, assesses penalties and orders that unpaid compensation be paid.
Disability Evaluation Unit
The Disability Evaluation Unit (DEU) determines permanent disability ratings by evaluating medical descriptions of physical and mental impairment. The determinations are used by workers' compensation administrative law judges, injured workers and insurance claims administrators to determine permanent disability benefits.
Electronic Data Exchange System
The Electronic Data Exchange System (EDEX) allows approved subscribers and their clients to request and receive, via electronic transmissions, summary data of Workers' Compensation Appeals Board (WCAB) cases.
Electronic Adjudication Management System
The Electronic Adjudication Management System (EAMS) is DWC’s computer-based case management system.
Information & Assistance Unit
The Information and Assistance Unit provides information and assistance to employees, employers, labor unions, insurance carriers, physicians, attorneys and other interested parties concerning rights, benefits and obligations under California's workers' compensation laws.
Labor-management (carve-out) Agreements
"Carve-out" programs allow employers and unions to create their own alternatives for workers' compensation benefit delivery and dispute resolution under a collective bargaining agreement.
The Medical Unit performs a variety of services related to delivery of medical benefits in the workers' compensation system. It establishes policy and guidelines for the treatment and evaluation of injured workers. The unit examines and appoints physicians to be qualified medical evaluators (QMEs), who in turn examine injured workers to help determine the level of benefits they receive. It also certifies and oversees groups -- medical provider networks (MPNs) and health care organizations (HCOs) -- that provide care to injured workers. The unit reviews utilization review (UR) plans and handles UR complaints and investigations jointly with the Audit Unit. The unit oversees the independent medical review (IMR) and independent bill review (IBR) programs used to resolve disputes about medical treatment and medical-legal billing. It also assists the DWC administrative director with other issues affecting providers in the workers' compensation system, such as setting medical fee schedules, and undertakes medical care studies.
Return to Work Supplement Program
Employees injured on or after January 1, 2013, who have received a supplemental job displacement benefit voucher (SJDB), may also qualify for an additional one-time $5,000 payment. The Return-to-Work Supplement Program (RTWSP) will mail approved applicants a $5,000 check that can be used to supplement the earnings lost from being injured.
Supplemental job Displacement Benefits
Additional benefits may be available for injured workers who: were injured on or after January 1, 2004; have a permanent partial disability as a result of that injury; and have not been offered other work by their employer. The Supplemental Job Displacement Benefit (SJDB) comes in the form of a non-transferable voucher that can be used to pay for educational retraining or skill enhancement at state-approved or accredited schools.
Subsequent Injuries Benefits Trust Fund
The Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIBTF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least 70 percent.
Uninsured Employers Benefits Trust Fund
Claims are paid from the Uninsured Employers Benefits Trust Fund (UEBTF) when illegally uninsured employers fail to pay workers' compensation benefits awarded to their injured employees by the WCAB. Certain steps must be taken before and after the issuance of an award in order to receive benefits from the UEBTF.
Workers' Compensation Information System
California's Workers' Compensation Information System (WCIS) uses electronic data interchange (EDI) to collect comprehensive information from claims administrators to help the Department of Industrial Relations oversee the state's workers' compensation system. This information helps facilitate evaluation of the system and measure adequacy of benefits for injured workers and their dependents, and also provides statistical data for research.