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1. What benefits am I entitled to?

Workers’ Comp insurance provides five basic benefits:
  • Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
  • Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering
  • Permanent disability benefits: Payments if you don’t recover completely
  • Supplemental job displacement benefits (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer
  • Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.

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2. What type of medical care am I entitled to?

You are entitled to reasonable medical treatment to cure or relieve work-related injuries and illnesses. The doctors who treat you must follow treatment guidelines referred to as the medical treatment utilization schedule (MTUS). Only the treatment that meets the guidelines must be approved.

All employers or claims administrators handling their workers’ compensation claims are required by law to have a program called utilization review (UR). This program is used to decide whether or not to approve medical treatment recommended by your doctor.

A utilization review is the process an employer or claims administrator uses to determine whether the proposed treatment for a worker’s job-related injury or illness is medically necessary. If the treatment isn’t found to be medically necessary, the workers’ compensation claim may be denied.

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3. Can I be treated by my regular doctor?

If you pre-designated your personal physician or medical group before you were injured, you can have your regular doctor treat you for your work-related injuries immediately after you are injured.


If you do not have a pre-designated doctor, you have to go to a MPN doctor designated by your employer. An MPN is a group of physicians selected by the employer or insurer to treat injured workers. MPNs must be approved by the state Division of Workers’ Compensation (DWC). Each MPN includes a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. The claims administrator is required to give you a list of MPN doctors near you. After the first appointment you are free to select another doctor within the MPN.

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4. If I haven’t pre-designated doctor and my employer doesn’t have an MPN, who will be my doctor?

The claims administrator has the right to select your treating doctor for the first 30 days after your employer knows that you were injured. After the first 30 days, you may be treated by a physician of your choice or at a facility of your choice within a reasonable geographic area.

Additionally, if you gave your employer the name and business address of a personal chiropractor or acupuncturist in writing prior to your injury or illness, after 30 days you may be able to transfer care to your personal chiropractor or acupuncturist.

After you have received 24 chiropractic visits, a chiropractor cannot be your personal physician.

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5. What if I have a disagreement about my medical benefits?

At some point during your claim, you or the claims administrator might disagree with what your treating physician reports about your injury or treatment. When there is a disagreement, depending on the type of injury, you may be evaluated by a qualified medical evaluator (QME). To qualify as a QME, a physician must meet additional educational and licensing requirements. They must also pass a test and participate in ongoing education on the workers’ compensation evaluation process. If you have an attorney, your attorney and your claims administrator might agree on a doctor to resolve medical disputes. This doctor is called an agreed medical evaluator (AME).

  • You can email to for any questions on workers’ compensation or contact us for free  information and assistance .
  • Medical care must be paid for by your employer if you get hurt on the job — whether or not you miss time from work
  • You may be eligible to receive benefits even if you are a temporary or part-time worker
  • You don’t have to be a legal resident of the United States to receive most workers’ compensation benefits
  • It’s illegal for your employer to punish or fire you for having a job injury or for requesting workers’ compensation benefits when you believe your injury was caused by your job

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6. How do I know if I really am an independent contractor?

There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor. Some employers misclassify employees as an independent contractor to avoid workers’ compensation and other payroll responsibilities. Just because an employer says you are an independent contractor and doesn’t need to cover you under a workers’ compensation policy, doesn’t make it true. A true independent contractor has control over how their work is done. You probably are not an independent contractor when the person paying you:

  • Controls the details or manner of your work
  • Has the right to terminate you
  • Pays you an hourly wage or salary
  • Makes deductions for unemployment or social security
  • Supplies materials or tools
  • Requires you to work specific days or hours

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7. I just want to get back to work. How can I make that happen?

Soon after your injury, the treating doctor examines you and sends a report to the claims administrator about your medical condition. If the treating doctor says you are able to work, he or she should describe:

  • Clear and specific limits, if any, on your job tasks while recovering. These are called work restrictions. They are intended to protect you from further injury (example: no work that requires repetitive bending or stooping)
  • Changes needed, if any, in your schedule, assignments, equipment or other working conditions while recovering (example: provide headset to avoid awkward positions of the head and neck)
  • If the treating doctor reports that you cannot work at all while recovering you cannot be required to work.

Injured 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. Your decision about returning to work will be influenced by your doctor, your employer and the claims administrator. Communicate honestly and frequently with them for the best results.

If your doctor decides you cannot return to work while recovering from your injuries you cannot be required to go back to your job.

Sometimes you can go back to your job with work restrictions if your employer is willing and able to make accommodations. For example, your employer may change certain parts of your job or provide you with new equipment.

If your doctor says you can go back to work with restrictions but your employer is unwilling or unable to accommodate your injuries, you are not required to return to work.

Meanwhile, depending on your injuries, you may be eligible for TD, supplemental job displacement benefits or PD benefits.

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8. What if my employer does not offer me work?

If you were injured between Jan. 1, 2004 and Dec. 31, 2012, and your employer has 50 or more workers, and you are not offered regular, modified or alternative work, your weekly PD benefits will be increased by 15 percent once that offer is made.

If you were injured between Jan. 1, 2004 and Dec. 31, 2012, and your employer has fewer than 50 workers, and you are not offered regular, modified or alternative work, your PD benefits will not change.

If you were injured on or after Jan. 1, 2013, your permanent disability benefits will not change if you are not offered regular, modified or alternative work, regardless of the size of the employer. Depending on your date of injury, you may still be entitled SJDB if the job does not last for 12 months or your disability prevents you from performing the tasks involved in the job. If you have concerns, talk to your employer or the claims administrator. If it doesn’t help ….

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9. I disagree with my treating doctor’s opinion about the work I can handle. What can I do?

Different doctors may have different opinions about a worker’s ability to do tasks safely. You have a right to question or disagree with a report written by your treating doctor. To dispute the doctor’s report about your ability to work:

  • If you do not have an attorney, you must send a letter to the claims administrator stating that you disagree with the report. You must send the letter within 30 days of receiving the report
  • If you have an attorney, contact your attorney right away. The deadline for stating your disagreement is 20 days
  • If your employer assigns or offers you work that does not meet the work restrictions required by your treating doctor, you don’t have to accept it. Contact a DWC I&A officer for more details on how to proceed.
  • It is illegal for an employer to discriminate against you because you requested workers’ compensation benefits or because you have a work-related disability. This is prohibited by California Labor Code section 132a, the federal Americans with Disabilities Act (ADA) and the California Fair Employment and Housing Act (FEHA).
  • However, an employer is not always required to offer you a job or offer a job that you may want. For example, there may not be any jobs you can do that meet the doctor’s work restrictions.

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10. What resources are available to me?

Your local I&A officers are a great resource and their services are free. They are not there to act on your behalf as an attorney would, but they’ll help you understand how to act on your own behalf. Attend a free seminar for injured workers at a local DWC district office for a full explanation of workers’ comp benefits, your rights and responsibilities. You can also make an appointment with an I&A officer and speak to them privately at your convenience.

In addition, there is a lot of information on the I&A page of the DWC’s website. Check out the fact sheets and guides for injured workers. The fact sheets provide answers to frequently asked questions about issues affecting your benefits. The guides will help you fill out forms you may need to get a problem with your claim resolved at the local DWC district office.

If you do not have time for all of that, please do not hesitate to call us inmediatly…

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