Like many other states in the country, California requires employers to purchase no-fault insurance for their workers through the workers' compensation system. The insurance coverage provides medical and monetary benefits to employees who sustain work-related injuries, illnesses, or deaths. The worker can claim the financial benefits, and if the worker is deceased, the descendants can file the claim.   

Per the Workers' Compensation Act (WCA), employers have duties or responsibilities to their employees. The Division of Workers’ Compensation (DWC), which is part of the California Department of Industrial Relations, keeps track of and enforces employer compliance to ensure employees enjoy the benefits they deserve. Unfortunately, some employers do not have workers' compensation insurance.

If you have suffered injuries or illness on the job and your employer doesn’t comply with employers’ responsibilities outlined under WCA; You have the right to sue for compensation in a civil court. The Workers Compensation Lawyer Law Firm is here to help you file a claim in Los Angeles, CA, and ensure you get the benefits the program intends you to enjoy.

Benefits Provided Under the Workers Compensation System

Almost every employer in Los Angeles, including those with one employee, must secure or have workers’ compensation insurance. In this case, an employee or worker refers to any person working for an individual or entity who is not an independent contractor. The benefits derived from the program include medical care, rehabilitation, disability, and death benefits. 

When you fall ill or sustain injuries on the job, medical care benefits will cover your hospital bill and other medical expenses that arise due to the illness or injury. The benefits will also cover the cost of surgeries, doctor bills, medication, treatment, therapy, and even counseling. With this benefit provided under the insurance program, you don’t need to worry about paying your medical expenses out of pocket.

If your work-related injuries require physical therapy, rehabilitation benefits will cover therapeutic and medical expenses necessary. Disability benefits will cover lost wages if the disease or injury prevents you from working temporarily or permanently. When you lose your life because of a work-related injury or illness, your descendants will receive your death benefits. These benefits will not bring you back to life, but they will help your surviving family stay comfortable as they try to adapt to the new life of living without you. 

Injuries or Diseases that are Your Employer’s Responsibility

When you develop an illness or suffer injuries when undertaking a task that will benefit your employer, that’s the only time they have a responsibility as per the WCA. The injuries can occur inside the employer’s premises or outside. When they occur outside the workplace, you will need to prove that you were running an errand or attending a function, all intended to benefit your employer. Any other injury that is not work-related won’t be covered under this insurance system. 

The workers’ insurance program covers mishaps like slip and fall, burn injuries, and any other harm or illness that develops on the job. Other aspects the program covers include:

  • Repetitive strain or stress injuries that stem from repeating the same task over and over
  • Illnesses develop due to a poor working environment like exposure to toxic materials like asbestos or chemicals, causing cancer.

Note that it won’t be your employer’s responsibility if you suffer injuries due to your negligence. Suppose you go to work intoxicated by alcohol or drugs, and in the process, you are involved in an accident, sustaining injuries. In that case, your employer won’t be responsible for the harm.

Further, when you start a fight with a colleague and are injured or sustain self-inflict injuries, your employer doesn’t owe you any responsibility. Injuries or illnesses stemming from the violation of safety protocols and policies at the workplace are not the employer’s responsibility.

Sometimes an employer might try to deny you compensation by arguing that your work-related injuries resulted from a violation of safety policies or recklessness. If this is the case, you will need to sue the employer to retrieve medical care and other benefits. However, you will need a workers’ compensation lawyer to investigate the case’s facts and recover the monetary benefits you need to heal or get back on your feet.

Employer Responsibility

As per WCA, almost all employers in Los Angeles are responsible for protecting their employees by securing workers’ compensation insurance coverage. The benefits are provided to all employees working part-time or full-time if they are not independent contractors. 

The first step every new employer should take is to secure workers’ comp coverage. Failure to provide the coverage can result in severe sanctions by the DWC. The penalties include:

  • Criminal prosecution
  • Hefty fines of no more than $10,000
  • The employer is held personally liable for any workers’ comp benefits due to employee injuries or disease.

California protects employees’ welfare whose employer has not secured workers’ compensation coverage through the Unsecured Employers Benefit Fund. This state-administered fund covers injuries or diseases that develop on the job when your employer hasn’t complied with the WCA requirement of purchasing workers’ comp insurance coverage. After you have received treatment, the state will go back to your employer to demand reimbursement for the amount spent on medical care.

Remember that workers’ compensation requirements also apply to temporary workers. Therefore, if you are an employee of a temporary employment agency, employment referral service, labor contractor, or other agencies that employ temporary workers, you are entitled to insurance benefits under the workers’ comp program. 

Your employer has two options when it comes to meeting coverage requirements as per the law. They can either purchase the insurance coverage from a private insurer licensed by the relevant California agencies or apply with the Office of Self Insurance Plan (OSIP) for self-insurance certification. 

Self-Insurance 

When an employer applies for self-insurance coverage with the OSIP, they seek to use their assets to provide the benefits required under the workers’ compensation system instead of securing insurance coverage through a private insurer. The decision by OSIP on whether to authorize self-insurance depends on the employer’s financial muscle, proposed plan to deliver the benefits and loss prevention program. 

The conditions that an employer must meet for self-insurance authorization are:

  • They must have a minimum of $5 million in shareholder equity
  • Have net profits of at least $5,000 for the five years right before the application
  • They must make a minimum deposit of $220,000 based on the employer’s expected future liabilities.
  • They must demonstrate they have outsourced a certified administrator or have an in-house staff who has become OSIP approved to process and handle employee benefit claims.

Additionally, your employer must show the following documents to be eligible for OSIP authorization:

  • Certified, independently-audited financial statements
  • A written proposal for a disease and injury prevention program meets the minimum Cal/OSHA safety and health regulations.

After an employer has been authorized to self-insure, both the DWC and OSIP will conduct periodic audits to ensure the employer provides timely and proper benefit payment. 

It’s worth noting that some employers are authorized to self-insure. These are:

  • Employers that have been previously authorized to self-insure but allowed their coverage to lapse.
  • Any employer in the business of providing workers to other employers
  • Employers who specialize in temporary service provision to other businesses
  • Leasing employers
  • Entities identified as a professional employer

Group Self-Insurance 

Not every employer can meet the requirements by OSIP. If your employer doesn’t qualify for self-insurance, they can apply for group self-insurance. Multiple employers combine their assets to create a group of self-insurance that covers individual liabilities. And just like in self-insurance, the employers must demonstrate that as a group, they have the financial strength to meet all obligations required under WCA to get authorization. The requirements include:

  • That all businesses applying for group self-insurance are in the same industry
  • Together, the businesses must make a deposit equal to 135 percent of their estimated future liabilities.
  • Demonstrate adequate funds to cover losses and administrative expenses for a minimum of eight out of ten years.
  • Obtain an insurance plan to cover insurance claims over $500,000
  • Inform every group member if there is a possibility of a conflict of interest between the group and vendors.

Self-Insurance Annual Reports

All employers under self-insured workers’ comp must submit annual reports to demonstrate continued compliance with all the conditions of self-insurance. The information is further used to evaluate the adequacy of each self-insurance. 

If an employer’s self-insurance is insufficient, they should deposit the additional funds within 60 days of submitting the self-insurance annual report. 

Self-Insured Employers’ Responsibilities When Filing Annual Reports

All self-insured employers must file an annual report concerning claims handled as on the job injuries. One commitment the employer must make is to file annual reports as per the DWC guidelines, demonstrating:

  • The number of claims filed by employees seeking compensation for their illness or injury
  • The number of benefits paid as compensation to these employees that file claims
  • An estimation of future liabilities for claims under federal and state statutes
  • The average number of workers on the payroll and the total wages for each location adjustment
  • The number of funds deposited as security
  • A list of all claims seeking to indemnify employees for their on the job illness or injury

Employers’ Responsibilities

On top of providing employees with workers’ compensation coverage, employers have other responsibilities. These include:

Publish a Notice of Compliance With Workers’ Comp Laws in a Conspicuous Place at the Workplace

All employers subject to WCA provisions must display a notice of compliance with the rules and regulations in a site where it’s easily noticeable and accessible. The notice should inform workers that workers’ compensation coverage is provided. 

Because most employees in many businesses in Los Angeles are Spanish and English speakers, the coverage notice must be bilingual or addressed in a language understandable to the English and Spanish population. The notice should inform you and other workers of your rights and responsibilities under the WCA. 

Failure to display the notice in a conspicuous location at the job site can attract misdemeanor charges. The absence of the notice as per WCA requirement is also proof your employer has not obtained workers’ compensation insurance coverage. The DWC has a model poster that employers can use to ensure their coverage notice meets all the law requirements. 

If your employer fails to post this coverage notice as per WCA guidelines, you have the right to seek medical care for a job-related injury or illness with the doctor or physician of your choice. You also have the freedom to choose where to seek treatment if the employer hasn’t posted a coverage notice.

Posting a coverage notice alone isn’t enough. The employer must provide the same information of the notice to new employees when hiring or at the end of their first day at work. As a new employee, you must get information or instructions regarding:

  • The manner to obtain appropriate medical care for injuries that happen on the job site
  • The role or function of your primary physician in treating job-related injuries
  • To acquire and present the form needed to notify your employer, you would like to use your physician to treat your job-related injury or disease.
  • If your employer carries the workers’ compensation coverage through an outside insurance policy carrier, the insurer must provide the employer with all coverage notice requirements for new workers.

Injury Reporting Requirement

Your employer has a responsibility to report when you and other employees suffer injuries or develop illnesses on the job as per the WCA regulation. The rule applies to on the job injuries that cause:

  • Medical treatment beyond first-aid to tend to the injuries
  • Loss of work time more than what your work shift would have been at the time of the injury.

In this case, first aid refers to a one-time treatment and follow-up visits to a medical practitioner for minor injuries that don’t necessitate a visit to the hospital for further treatment. Note that even if your minor injuries are tended to by a medical professional, the treatment is still deemed first-aid. The damages won’t be covered under workers’ compensation coverage. 

As of 1st January 2017, workers’ comp coverage policy carriers must report all injuries stemming from the job, including the minor injuries that require first-aid and don’t result in lost work time, to the Workers’ Compensation Insurance Rating Bureau (WCIRB). The information is obtained for computing your employer’s insurance premium rates for workers’ comp coverage. 

However, this information that the WCIRB compiles can only be reported by the insurance carrier if your employer reports the injury incident. The WCA regulations require employers to report only injuries that require medical treatment beyond first-aid or those that result in lost work time. 

When you incur medical expenses for first-aid treatment as an employee, the medical provider will send a medical report to the insurance company. This, in turn, triggers the responsibility of the insurer to report the claim to WCIRB. 

The incentive to pay medical bills out of pocket for first-aid treatment by insured employers is reduced. They pay out of pocket instead of allowing their insurer to pay through the workers’ compensation coverage. If the insurer pays for the treatment, they will report it to the WCIRB, which might affect your employer’s insurance premium rates. If many first-aid cases are reported, it might indicate a high-risk workplace, which could result in high insurance premiums for the employer. 

However, footing the first-aid medical bill out of pocket means the medical provider won’t claim payment from your insurer. The insurer will not report the claim to the WCIRB. Thus, your employer’s insurance rates are not affected. 

Employers’ Responsibilities When Receiving Notice of an Injury 

Within a day after you have notified your employer or they first obtain knowledge about your job-related injuries which requires medical treatment beyond first-aid or results in lost work time, your employer has a responsibility to:

  • Provide you with a Form DWC 1
  • Ask you to complete your section of the Form DWC 1 and return it to them
  • Within a working day after you have filled the form and submitted it to the employer, they should fully complete the form and present it to the insurance carrier or DIR if they are self-insured. The employer also has a responsibility to provide you with a copy of the fully completed form.

Additionally, your employer must complete Form DSLR 5020, referred to as the Employer’s Report of Occupational Injury or Illness. They should then submit the completed form to the claims administrator or the employer’s insurer within five days after you have informed them of the injury or obtained knowledge of an injury.

Remember that your injury or illness cannot wait until the insurance policy carrier evaluates the claim. You need early medical intervention as soon as possible. Therefore, once you have filed all the relevant paperwork for a claim, the employer should authorize $10,000 for medical care. Once they have approved the money, they should inform you within 24 hours so that you can seek medical treatment right away as the insurer evaluates the claim to decide whether to award benefits or not. 

Should you become a victim of a crime at the workplace within the work premise, your employer must provide you with a written notice within a day of the crime, advising that you are eligible for benefits stemming from physical or psychiatric injuries. 

Your employer’s responsibility as per WCA doesn’t end when submitting the forms to the insurer for evaluation. Unless your employer is self-insured, they have a minor role to play during claim evaluation. The insurer will keep them up to date on the case progress. However, the person who plays a significant role during compensation is the employee because you shall cooperate with their employer’s insurer throughout the claim evaluation phase.

Employers’ Responsibilities to Injured Employees

If you are injured or develop an illness on the job, you are not entitled to any special treatment. However, this doesn’t mean you should be discriminated against or treated poorly because of registering a workers’ comp claim against your employer. The law protects you from retaliation from the employer. Additionally, if your injuries are classified as a disability, the employer should make unique accommodation for your condition at the workplace.

The rules that prohibit employers from adverse action or discrimination against injured employees for filing a claim include:

  • Employers often appear to frown towards employees who file claims against them, and some might take adverse action. The law prohibits any retaliation against employees seeking workers’ compensation benefits. So, if your employer fires you after a recent claim you have filed, there is suspicion the laying-off is a retaliation. If this happens, you can file a retaliatory tort against the employer. The charges can result in a fine of up to $10,000.
  • Americans With Disability Act (ADA) is a federal statute that prohibits employers from discriminating against workers with disabilities. Therefore, if your work-related injuries cause temporary or permanent disability, your employer should make the reasonable accommodations for you to continue working. Additionally, California’s Fair Employment and Housing Act provides additional responsibilities for employers and protects employees. The employer should make changes to your working conditions so that you can continue working despite the disability.

Find the Right Workers’ Compensation Lawyer Near Me 

If you are injured or fall ill on the job, and your employer doesn’t carry workers’ insurance coverage, you have the right to take civil action by filing a workers’ comp claim. Workers’ comp claims are complex and confusing because they involve several parties. For a non-lawyer, filing a lawsuit in person can be challenging. If you believe your employer has neglected their workers’ comp responsibilities, you need to assert your rights by filing a civil suit.

At The Workers Compensation Lawyer Law Firm, we are here to help you make sense of where you stand and the next move to take when thinking of taking legal action against your employer. Our lawyers are willing to help you seek compensation for the job injury or illness in Los Angeles. Reach out to us today at 424-501-9228 for a free consultation.