take charge of your workers' compensation claim

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4th edition
Ta ke Charge
of Your Workers’
Compensation
Claim
An A to Z Guide
for Injured Employees
by Attorney Christopher A. Ball
edited by Bethany K. Laurence
Fourth Edition FEBRUARY 2003

Editor BETHANY K. LAURENCE
Illustrations MARI STEIN
Production SUSAN PUTNEY
Book Design TERRI HEARSH
Cover Design TONI IHARA
Index THÉRÈSE SHERE
Proofreading ROBERT WELLS
Printing CONSOLIDATED PRINTERS, INC.
Ball, Christopher A.
Take charge of your workers’ compensation claim : an A to Z guide for injured employees
/ by Christopher A. Ball ; edited by Beth Laurence 4th ed.
p. cm.
Includes index.
ISBN 0-87337-909-8
1. Workers’ compensation Law and legislation California Popular works. I.
Laurence, Bethany K., 1968- II. Title.
KFC592.Z9 B35 2003
344.794'021 dc21
2002043244
Copyright © 1995, 1998, 2000, 2002 and 2003 by Christopher A. Ball. ALL RIGHTS RESERVED. Printed in the U.S.A.
No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise without prior written permission.
For information on bulk purchases or corporate premium sales, please contact the Special Sales Department. For
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Street, Berkeley, CA 94710.
Acknowledgments
The Law Offices of Rose, Klein & Marias, my employer, without whose encouragement this
book would never have been written. I am proud to be associated with a firm that has always
fought for and put the needs of injured workers first and foremost.
Robert I. Vines, my mentor and dear friend, for his unselfish willingness to share his vast

knowledge and experience in workers’ compensation with anyone who asks (and I asked
plenty!). If it were not for his faith and support, I would not have been in a position to write
this book.
Linda Foley and Kathryn Phillips, two extremely competent paralegals, whose expertise in
the area of vocational rehabilitation was greatly utilized by this author, and whose review of
the vocational rehabilitation chapter is gratefully acknowledged and appreciated.
Ralph “Jake” Warner, founder and owner of Nolo, who took an unwieldy and seemingly
unmanageable subject matter and somehow managed to put it in a format that makes sense.
Lisa Goldoftas, editor extrordinaire at Nolo, who in my humble opinion deserves all the
credit for making this book readable. Her expert guidance and suggestions were always right
on target and appreciated.
Judge Kenneth Peterson and Judge David Hettick (Oakland Workers’ Compensation
Appeals Board), for their exemplary reading of the manuscript and excellent suggestions for
improvement.
Applicants’ attorney Jeffrey E. Friedman (Jones, Clifford, McDevitt, Naekel & Johnson law
firm, San Francisco), whose expertise greatly enhanced the book.
Attorney Moiece Palladino (State Compensation Insurance Fund), for her careful reading
of the manuscript and outstanding suggestions.
John Hopper, Information & Assistance Officer (Van Nuys), for his review and excellent
comments.
Robert S. Lichtenstein, M.D. (Mountain View, California), Board Certified Neurosurgeon,
for his fine and compassionate reading of the medical chapters; Mike Mansel (insurance
broker), for his excellent critique of the book; and Bill Nickoloff, for his helpful suggestions.
Stephanie Harolde, for her careful and patient treatment of so many drafts of the manuscript;
and Terri Hearsh, for her beautiful design and artful handling of a complicated manuscript.
Dedications
To Mom—You gave me what money can’t buy, and I’m forever indebted.
To my children, Jennifer and Christopher—I’m certain I neglected you while writing this
book, but you understood and accepted my commitment. You are both responsible and
caring young adults and I’m very proud of you. Thank you both for your help.

To my loving wife, Marian—Without your support and understanding, this book would
never have been completed. Thanks for putting up with me when the long hours made
me irritable, and for the encouragement you gave when it seemed as though this book
would never be finished. You are truly my inspiration.
Table of Contents
Part I: All About Workers’ Compensation
1
Introduction to Workers’ Compensation
A. What Is Workers’ Compensation? 1/2
B. What an Injured Worker Is Entitled To 1/3
C. Where to Get Additional Information and Help 1/5
D. How to Use This Book 1/5
E. What This Book Does Not Cover 1/6
2
Overview of a Workers’ Compensation Claim
Step 1. Notify Your Employer of the Injury 2/2
Step 2. Get Medical Treatment If Needed 2/2
Step 3. Paying for Medical Treatment If Employer Refuses Authorization 2/3
Step 4. What to Tell the Doctor 2/3
Step 5. The Doctor Decides If You Need Time Off 2/3
Step 6. Complete Workers’ Compensation Claim Form and Application for
Adjudication of Claim Form 2/4
Step 7. Secure Control of Your Medical Care 2/4
Step 8. Receive Temporary Disability Benefits If You’re Eligible 2/4
Step 9. Handling a Denial of Your Claim or Benefits 2/5
Step 10. Taking Problems to the Appeals Board 2/5
Step 11. After You Are Determined to Be Permanent and Stationary (P&S) 2/6
Step 12. If You Recover Completely and Return to Work 2/6
Step 13. If You Are Entitled to Vocational Rehabilitation Benefits 2/6
Step 14. If You Are Permanently Disabled—Negotiate a Final Settlement 2/7

Step 15. Go to Trial If There Is No Settlement 2/7
Step 16. Judgment Is Paid or the Matter Is Appealed 2/7
3
Is Your Injury Covered by Workers’ Compensation?
A. Is Your Job Covered by Workers’ Compensation? 3/2
B. Do You Have a Compensable Injury? 3/5
C. Injuries Not Covered by Workers’ Compensation 3/9
4
Cumulative Trauma Disorders
A. What Is a CTD? 4/3
B. Becoming Aware of Your Injury 4/5
C. Diagnosis and Treatment 4/7
D. Recovery and Permanent Injuries 4/10
E. Returning to the Workforce 4/11
F. Further Medical Treatment 4/14
Part II: Protecting Your Rights
5
What to Do If You’re Injured
A. Request Medical Treatment 5/2
B. Report the Injury Within 30 Days 5/3
C. File Your Workers’ Compensation Claim 5/4
D. The Insurance Company’s Answer 5/15
E. Take Steps to Protect Your Rights 5/15
6
Keep Good Records to Protect Your Claim
A. Set Up a Good Recordkeeping System 6/2
B. Read and Understand What You Receive in the Mail 6/2
C. Gather Important Records Pertaining to Your Claim 6/2
D. Request Copies of Documents and Evidence 6/7
E. Keep Your Address Current 6/7

7
The Insurance Company’s Role
A. Self-Insured Employers 7/2
B. The Insurance Company’s Responsibilities 7/3
C. Your Responsibilities As an Injured Worker 7/3
D. Who’s Who in the Insurance Company 7/3
E. How to Deal With the Insurance Company 7/5
F. Tactics Insurance Companies Use to Deny or Minimize Claims 7/8
G. Settling Your Case 7/10
8
Dealing With Your Employer
A. Self-Insured Employers 8/2
B. The Employer/Insurance Company Relationship 8/2
C. The Employer’s Responsibilities 8/4
D. If You’re Out of Work Due to the Injury 8/5
E. Bankruptcy or Other Employer Financial Problems 8/7
9
Taking Charge of Your Medical Case
A. Important Role of the Treating Doctor 9/2
B. Choose Your Treating Doctor (Get Medical Control in Your Case) 9/6
C. Changing Treating Doctors 9/10
D. Be Sure You Receive Excellent Medical Care 9/14
E. When Your Condition Becomes Permanent and Stationary (P&S) 9/17
10
Medical-Legal Evaluations
A. Rules for Medical-Legal Evaluations 10/2
B. Compensability of Injury (Labor Code § 4060) 10/4
C. Nature and Extent of Permanent Disability or Need for Future Medical Treatment
(Labor Code § 4061) 10/6
D. Other Issues to Be Resolved by Medical-Legal Evaluations (Labor Code § 4062) 10/9

E. Picking a Qualified Medical Examiner (QME) 10/10
Part III: Workers’ Compensation Benefits
11
Payment of Medical Benefits
A. Payment for Current Medical Treatment and Evaluations 11/2
B. Future Medical Care Costs 11/4
12
Temporary Disability Benefits
A. Types of Temporary Disability 12/2
B. Amount of Temporary Disability Payments 12/3
C. How Payments Are Made 12/5
13
Permanent Disability (and Life Pension)
A. How Permanent Disability Payments Compensate You 13/2
B. Kinds of Permanent Disability Awards 13/3
C. Establishing Your Permanent Disability Status 13/3
D. How Permanent Disability Benefits Are Paid 13/5
E. Amount of Permanent Partial Disability Benefits 13/6
F. Life Pension Benefits 13/8
G. Permanent Total Disability Benefits 13/9
14
Vocational Rehabilitational Benefits
A. What Is Vocational Rehabilitation? 14/2
B. Six Steps in a Vocational Rehabilitation Plan 14/4
C. Eligibility for Vocational Rehabilitation (QIW Status) 14/6
D. How to Start Vocational Rehabilitation 14/9
E. Delays and Failure to Provide Rehabilitation Services 14/10
F. Preparing a Vocational Rehabilitation Plan 14/11
G. Completing a Vocational Rehabilitation Plan 14/16
H. Where to Get Help With Vocational Rehabilitation 14/16

15
Death Benefits
A. Who May Receive Death Benefits 15/2
B. Death Benefit Amount 15/3
C. Additional Payments for Dependent Minor Children 15/4
D. Burial Expense for Deceased Worker 15/5
E. Unpaid Temporary or Permanent Disability Payments 15/5
F. How Death Benefits Are Distributed 15/6
16
Extraordinary Workers’ Compensation
Benefits and Remedies
A. Subsequent Injuries Fund Benefits 16/2
B. The Uninsured Employers’ Fund 16/3
C. Discrimination Benefits (Labor Code § 132(a)) 16/3
D. Employer’s Serious and Willful Misconduct 16/4
17
Benefits and Remedies Outside the
Workers’ Compensation System
A. State Disability (SDI) 17/2
B. Social Security Benefits 17/3
C. Claims or Lawsuits for Personal Injuries 17/4
D. Claims or Lawsuits Based on Discrimination 17/5
Part IV: Settling Your Case
18
Rating Your Permanent Disability
A. Overview of the Rating Process 18/3
B. What Is Involved in the Rating Process? 18/5
C. Step-by-Step Example of How to Rate a Disability 18/6
D. Other Considerations in Rating a Permanent Disability 18/22
E. How to Use the Old Rating Manual for Injuries That Occurred Before 4/1/97 18/23

19
Figure Out a Starting Settlement Amount
A. What You May Receive in a Settlement 19/2
B. Two Kinds of Settlements 19/2
C. Determine the Value of Your Claim Using the Settlement Worksheet 19/5
D. What to Do Next 19/14
20
Negotiating a Settlement
A. Deciding Whether to Negotiate Your Own Settlement 20/2
B. The Concept of Compromising 20/3
C. How to Negotiate a Settlement 20/3
D. Review and Sign Settlement Documents 20/8
E. Attend an Adequacy Hearing 20/23
Part V: The Workers’ Compensation Appeals Board
21
Preparing Your Case
A. Identify Possible Issues in Dispute 21/2
B. How to Prove (or Disprove) Disputed Issues 21/5
C. Depositions 21/7
D. Subpoenaing Witnesses and Documents 21/12
E. Preparing for a Pre-Trial Hearing 21/15
F. Preparing for a Trial 21/17
22
Arranging for a Hearing or Trial
A. Kinds of Hearings 22/2
B. Trial on Preliminary Issues (Case Not Ready to Settle) 22/4
C. Trial on Entire Case (the Case-in-Chief) 22/6
D. Complete Documents to Set Your Case for Hearing 22/7
E. Copy, Serve and File Documents 22/11
F. Receiving Notice of a Hearing 22/13

23
How to File and Serve Documents
A. What Is Service of Documents? 23/2
B. How to Serve Documents by Mail 23/3
C. How to Serve Documents Personally 23/4
D. How to Serve Documents by Fax 23/4
E. How to File Documents With the Workers’ Compensation Appeals Board 23/6
24
Going to a Hearing or Trial
A. Finding Your Way Around the Appeals Board 24/2
B. Pre-Trial Conference (Mandatory Settlement Conference) 24/4
C. Trial 24/15
D. Findings and Award 24/21
25
Appealing a Workers’ Compensation Decision
A. The Three-Step Appeal Process 25/2
B. Petition for Reconsideration 25/2
C. Writ of Review With the Appellate Court 25/4
D. Writ of Appeal to the California Supreme Court 25/5
Part VI: Beyond This Book
26
Lawyers and Other Sources of Assistance
A. Information and Assistance Officers 26/2
B. Hiring a Lawyer 26/2
27
Legal Research
A. Find a Law Library 27/2
B. The Basics of Legal Research 27/2
28
Case Law Review

CHAPTER 3—IS YOUR INJURY COVERED BY WORKERS’ COMPENSATION? 28/3
CHAPTER 5—WHAT TO DO IF YOU’RE INJURED 28/4
CHAPTER 9—TAKING CHARGE OF YOUR MEDICAL CASE 28/5
CHAPTER 10—MEDICAL-LEGAL EVALUATIONS 28/6
CHAPTER 11—PAYMENT OF MEDICAL BENEFITS 28/7
CHAPTER 12—TEMPORARY DISABILITY BENEFITS 28/8
CHAPTER 13—PERMANENT DISABILITY (AND LIFE PENSION) 28/9
CHAPTER 14—VOCATIONAL REHABILITATION BENEFITS 28/12
CHAPTER 15—DEATH BENEFITS 28/13
CHAPTER 16—EXTRAORDINARY WORKERS’ COMPENSATION BENEFITS
AND REMEDIES 28/14
CHAPTER 18—RATING YOUR PERMANENT DISABILITY 28/15
CHAPTER 19—FIGURE OUT A STARTING SETTLEMENT AMOUNT 28/16
CHAPTER 20—NEGOTIATING A SETTLEMENT 28/18
CHAPTER 21—PREPARING YOUR CASE 28/19
CHAPTER 22—ARRANGING FOR A HEARING OR TRIAL 28/20
CHAPTER 24—GOING TO A HEARING OR TRIAL 28/20
Appendices
A1
Summary of Important Workers’ Compensation Laws for
Injuries Between 1/1/90 and 12/31/93
A2
Temporary Disability Benefits Compensation Chart
A3
Permanent Disability Indemnity Chart
A4
Maximum Life Pension Weekly Payments for Injuries
Between 7/1/96 and 12/31/02
A5
Workers’ Compensation Forms

A6
Workers’ Compensation—District Offices
Part I: All About Workers’ Compensation

CHAPTER
1
Introduction to Workers’ Compensation
A. What Is Workers’ Compensation? 1/2
B. What an Injured Worker Is Entitled To 1/3
1. Take an Active Role in Obtaining Benefits 1/3
2. Workers’ Compensation Benefits 1/3
3. Other Benefits and Remedies 1/4
C. Where to Get Additional Information and Help 1/5
1. Information and Assistance Officers 1/5
2. Workers’ Compensation Insurance Rating Bureau (WCIRB) 1/5
3. Division of Workers’ Compensation Website 1/5
D. How to Use This Book 1/5
E. What This Book Does Not Cover 1/6
1 / 2 TAKE CHARGE OF YOUR WORKERS’ COMPENSATION CLAIM
A
s a workers’ compensation attorney, I advise in-
jured workers about how the law applies to their
particular workers’ compensation claim. I have yet
to talk to an injured worker who felt that the workers’
compensation laws were fair or adequate. There is good
reason for this. Legal limitations and restrictions as to how
much an injured worker may recover result in many
workers’ receiving inadequate benefits. Unfortunately, the
workers’ compensation system was not designed primarily
to benefit the injured worker. Instead, it was created to

protect employers and workers’ compensation insurance
companies by limiting their legal liability and obligations.
Despite these negatives, workers’ compensation has
evolved over the years to include some fairly decent worker
protections. Although many of these are buried in hard-to-
understand rules and procedures, informed workers who
understand how the system works and are willing to assert
their rights have a good chance of being treated fairly.
Sadly, most workers have little, if any, knowledge about
their workers’ compensation rights. This book aims to
change that.
This book can help you if you’re handling your own
workers’ compensation case or filing a claim on someone
else’s behalf, such as a minor. (In legal terms, this is referred
to as acting in the capacity of a Guardian ad Litem, where
you file a workers’ compensation claim on behalf of a
minor or someone who is incompetent.) If you’re repre-
sented by an attorney, she will be better able to guide you
through the process if you’re well-informed about workers’
compensation procedures and understand the important
decisions you’ll need to make.
If you were injured on or after January 1, 1994, this
book will provide up-to-date information on California
workers’ compensation laws. Due to changes in the law, this
book cannot be relied on for injuries occurring prior to
1994, although it should still be very helpful.
INJURIES BETWEEN 1/1/90 AND 12/31/93
If you were injured before 1994 and your case hasn’t
settled yet, you will need to go beyond this book to find
information that applies to your date of injury. Appendix 1

provides a summary of the important laws for injuries that
occurred between 1/1/90 and 12/31/93. In addition, the
Workers’ Compensation Information and Assistance Unit
provides free help, as discussed in Section C1, below.
LEGAL CITATIONS
Throughout this book, you’ll see references to laws
that govern the California workers’ compensation
system. If you want more information, you can look
up these legal citations, as discussed in Chapter 27.
Labor Code (LC). The vast majority of workers’
compensation laws are contained in the California
Labor Code, the basic state laws that regulate employ-
ment matters.
California Code of Regulations (CCR). These rules
and regulations expand upon, interpret and explain
procedures for implementing and enforcing the
California Labor Code.
United States Code (USC). Many laws that apply to
people not covered by California workers’ compensa-
tion laws can be found in the United States Code.
A. What Is Workers’ Compensation?
Workers’ compensation is a system of benefits set up to
help employees who are injured on the job. If a worker dies
as a result of work injuries, the employee’s dependents are
entitled to receive workers’ compensation death benefits.
Work-related injuries (which broadly include injuries,
occupational illnesses and diseases) are also referred to as
“industrial injuries.” For workers’ compensation purposes,
an industrial injury is any injury—in any occupation—that
occurs as a result of your employment. Put another way,

“industrial” is synonymous with “work.” You may also hear
the term “compensable injury,” another term that refers to
an injury that’s covered by workers’ compensation.
The workers’ compensation system is sometimes
described as a “no-fault” system of give and take. The
injured employee gives up the right to sue an employer in
court. In return, the employee receives compensation
without having to prove that the employer caused the
injury. In exchange for providing compensation regardless
of fault, the employer’s liability is limited to benefits
specified in the California Labor Code. Not surprisingly,
these amounts are almost always significantly less than what
might be available if employees could sue in court. For the
vast majority of cases, the rule that all work-related injuries
must go through the workers’ compensation system is a fact
INTRODUCTION TO WORKERS’ COMPENSATION 1 / 3
of life. (There are a few situations where an injured em-
ployee is not covered by workers’ compensation and may
sue an employer in the regular (municipal or superior)
court system; see Chapter 17 for a discussion.)
At first glance, a no fault system sounds like a fair
deal—workers who are hurt are taken care of without having
to go through a costly process of assigning blame. Unfortu-
nately, the existing system is complicated and hard to
understand. It has evolved into what too often becomes a
bureaucratic nightmare that commonly intimidates and
hinders people with valid claims. But perhaps the worst
aspect of the California workers’ compensation system is that
it doesn’t deliver on its fundamental promise to cover all
injured workers on a no-fault basis. The employer and its

workers’ compensation insurance company will often fight
an employee’s perfectly legitimate claim every step of the way.
WORKERS’ COMPENSATION FRAUD
Over the last several years, alleged workers’ compensa-
tion fraud (the filing of false claims) has been a major
concern of employers and workers’ compensation
insurance companies alike. In response to these
concerns, California passed major revisions to its
workers’ compensation laws, which are incorporated
in this book. It is now a felony for anyone to knowingly
file a false or fraudulent workers’ compensation claim.
The laws that make it harder to commit fraud unfor-
tunately also make it much more complicated for
injured workers to file and receive compensation for
legitimate claims.
B. What an Injured Worker Is Entitled To
Enough about the problems with workers’ compensation
laws. If you’ve been injured on the job, you probably want
to know how you’ll be compensated. California workers’
compensation laws provide a limited number of benefits
(mostly money payments). Workers’ compensation benefits
are tax exempt; in other words, they are not considered
income for income tax purposes.
1. Take an Active Role in Obtaining Benefits
It’s a fact of life that you’re the one who must see to it that
the insurance company provides you with benefits. If you
(or your attorney, if you have one) don’t go after all the
benefits to which you are entitled, you will likely be
shortchanged. In the workers’ compensation system of
limited benefits, you cannot afford to be complacent.

Lest you let your pride get in the way, clearly under-
stand that workers’ compensation benefits should not be
considered charity. Whether you like it or not, the existence
of the workers’ compensation system means that you have
given up valuable legal rights. For example, you cannot sue
your employer, you are not entitled to payments to cover
lost wages (past, present or future) and you cannot receive
compensation for your pain and suffering.
Accept workers’ compensation benefits for what they
are: part of a system set up to get you medical treatment for
your injury, provide minimum income while you are off
work and help you get back to work in some capacity as soon
as possible.
WORKERS’ COMPENSATION JARGON
In few places on earth will you find a system that uses
more confusing, contradictory and just plain batty
terminology. Unfortunately, you will simply have to
master a number of confusing terms and acronyms
used in the workers’ compensation system or you
won’t understand how to handle your claim. When-
ever you hit a mind-boggling term, take a moment to
learn what it means. In no time at all, you’ll be talking
with ease about your TTD, VRMA, QME, P&S and
QRR.
2. Workers’ Compensation Benefits
The following summary discusses what is available and
refers you to the chapters that explain how to obtain and
make the best use of available benefits:
1 / 4 TAKE CHARGE OF YOUR WORKERS’ COMPENSATION CLAIM
• Medical Treatment and Related Costs. You are entitled to

medical treatment, at no cost to you, to cure and relieve
the effects of your industrial injury. You are also
entitled to be reimbursed for costs of mileage going to
and from your medical appointments. You are not,
however, entitled to mileage reimbursement for
attending court hearings or traveling to the insurance
company’s office. (Chapters 9, 10 and 11 cover all
aspects of medical benefits.)
• Temporary Disability. You are entitled to receive mon-
etary payments while you are off work and temporarily
disabled due to your injury. The amount of temporary
disability is based upon two-thirds of your average
weekly wage, with established maximums, depending
upon the date of your injury. In short, don’t expect to
receive as much money as when you were on the job.
(See Chapter 12.)
• Permanent Disability. If your injury affects your ability to
participate in the open job market in the future, you
may receive a set dollar amount as compensation. How
much you’ll receive is determined by the part of your
body that is injured, your age, your occupation and any
work restrictions as determined by various doctors.
These factors are plugged into a standard rating
schedule to determine how much you can recover. If
you’re 70% to 99.75% disabled, you may additionally
receive a small pension for the rest of your life. If you’re
100% (totally) disabled, the amount you are entitled to
receive increases substantially. (See Chapter 13.)
• Vocational Rehabilitation Benefits. If you cannot return to
your former job because of limitations caused by your

industrial injury, you are entitled to assistance in
finding other employment. Vocational rehabilitation is
a program designed to assist you in returning to the
labor market. To this end, vocational rehabilitation
employs a number of means, including possibly a
retraining program, designed to help you acquire the
skills necessary to return to suitable gainful employ-
ment. (See Chapter 14.)
• Death Benefits. If you were a total or partial dependent
(one who relied upon another for support) of an
employee who died as a result of an industrial injury,
you may have the right to recover certain benefits,
including burial expenses and a sum of money. (See
Chapter 15.)
OTHER WORKERS’ COMPENSATION BENEFITS
In unusual circumstances, you may be entitled to
benefits that are not available in a typical workers’
compensation claim. Turn to Chapter 16 if any of the
following remedies may apply to your situation:
• Subsequent Injuries Fund Benefits. You may be
eligible if you had a prior injury or illness before
your present workers’ compensation injury,
regardless of whether or not the prior injury
happened at work.
• Uninsured Employer’s Fund. This fund is available if
your employer does not have workers’ compensa-
tion insurance and is not self-insured.
• Discrimination Benefits Under LC § 132(a). You may
be eligible to file a separate claim if your employer
discriminated against you because you asserted

your right to file a workers’ compensation claim.
• Employer’s Serious and Willful Misconduct. You may
qualify for increased benefits if your employer’s
seriously improper action or inaction—such as the
failure to remedy an obvious safety violation—
contributed to or caused your work injury.
3. Other Benefits and Remedies
You may qualify for benefits and remedies outside the
workers’ compensation system, including:
• State Disability (“SDI”). Most workers have a small
amount deducted from each check for “SDI.” In the
event of disability for any reason (work or otherwise),
you may be entitled to disability payments. SDI is
usually paid where workers’ compensation temporary
disability is not being paid. (See Chapter 17, Section A.)
• Social Security Benefits. If your injury is severe enough,
you may qualify for Social Security disability, which is
paid by the federal government. (See Chapter 17,
Section B.)
• Claims or Lawsuits for Personal Injuries. If your work
injury was caused, entirely or in part, by an outside
third party (someone not working for your employer),
you may be able to sue that person or entity in civil
court for damages. (See Chapter 17, Section C.)
INTRODUCTION TO WORKERS’ COMPENSATION 1 / 5
• Claims or Lawsuits Based on Discrimination. In some
instances where you have been discriminated against,
you may be able to file a claim under the Americans
with Disabilities Act, the California Fair Employment
Housing Act or other legal avenues. (See Chapter 17,

Section D.)
C. Where to Get Additional Information
and Help
While this book may answer most of your questions, it’s
quite possible that you’ll need further assistance. You may
contact any of the agencies listed below for help. In addi-
tion, Chapter 27 provides information on how to utilize the
law library and the Internet to do legal research. If you
decide that you want to be represented by an attorney, you
may also find Chapter 26 on lawyers helpful. Be aware,
however, that it may be difficult to find a workers’ compen-
sation attorney willing to take your case, as lawyer fees are
relatively low and most workers’ compensation attorneys
have many more possible cases than they can handle.
1. Information and Assistance Officers
The Workers’ Compensation Appeals Board is the place
where your matter is heard by a workers’ compensation
judge, and where documents in your case are filed. Despite
its name, all workers’ compensation matters (not just
appeals) are handled by the Workers’ Compensation
Appeals Board, also known as the “Appeals Board” or the
“WCAB.” There are approximately 18 Appeals Boards in
the State of California.
Each Workers’ Compensation Appeals Board has at
least one Information and Assistance officer (also called an
I&A officer). The Information and Assistance officer’s role
is to assist injured workers in navigating their way through
the workers’ compensation system. Some Information and
Assistance officers can be your best source of information
and help in resolving problems you encounter.

Information and Assistance officers are there to give
you free help in pursuing your workers’ compensation
claim. See Appendix 6 for the number of your local work-
ers’ compensation office. You may get helpful general
information from the automated Workers’ Compensation
Information and Assistance Unit line at 800-736-7401,
which provides prerecorded information about workers’
compensation.
In addition, “Injured Worker Workshops” are held
the first Tuesday of every month at every district office.
These free one-hour workshops consist of a presentation by
an Information and Assistance officer followed by a
question and answer session. Call your district office for
more information. (See Appendix 6 for the phone number.)
2. Workers’ Compensation Insurance Rating Bureau
(WCIRB)
The Workers’ Compensation Insurance Rating Bureau
(WCIRB) is helpful in finding out who your employer’s
workers’ compensation company was at the time of your
injury. Here’s where to reach the WCIRB:
Workers’ Compensation Insurance Rating Bureau
525 Market Street
Suite 800
San Francisco, CA 95105
Telephone 415-777-0777
3. Division of Workers' Compensation Website
The Workers’ Compensation Division has developed a
helpful website at www.dir.ca.gov/DWC/dwc_home_page.
htm. Here you can find an overview of workers’ comp laws
and rules, an FAQ (frequently asked questions) area and

guides for injured workers on topics such as how to object
to a summary rating, how to file an appeal and how to fire
your attorney. This site also provides workers’ compensa-
tion forms and the manual for rating permanent disabilities
in PDF format (readable by Adobe Acrobat Reader).
D. How to Use This Book
No two injuries are alike, and no two injuries are ever
handled the same way by the same insurance company, let
alone by different companies. How much of this book
you’ll choose to read will depend on your individual
circumstances.
1 / 6 TAKE CHARGE OF YOUR WORKERS’ COMPENSATION CLAIM
I suggest that you read Chapter 2 (Overview of a
Workers’ Compensation Claim) to get a good understand-
ing of the workers’ compensation system, and to determine
where your claim is in the system. Read Chapter 21 (Pre-
paring Your Case) in conjunction with Chapter 2, as trial
preparation should begin on day one of your claim and
continue until the day of trial.
If you have a cumulative trauma, or repetitive stress
injury, read Chapter 4 (Cumulative Trauma Disorders).
A thorough reading of Chapter 6 (Keep Good Records
to Protect Your Claim) will assure that you properly prepare
and maintain the information you will need for trial.
At least glance through Chapter 5 (What to Do If
You’re Injured) to make certain that you have done every-
thing you should following your injury. Feel free to turn to
relevant chapters as the need arises and skip any chapters
that do not apply to your situation. For example, if the
employer’s workers’ compensation insurance company has

already accepted your case and begun providing benefits,
you may want to skip Chapter 3 (Is Your Injury Covered by
Workers’ Compensation?). Likewise, if the insurance
company has proposed a settlement, you’ll want to turn to
Chapter 19 (Figure Out a Starting Settlement Amount).
While great care has been taken to provide you with a
comprehensive and informative book on your workers’
compensation benefits, this book cannot cover each and
every aspect of workers’ compensation law in detail.
Particularly if your claim has been denied or delayed, you’ll
need to go beyond this book. (See Chapters 26 and 27 on
hiring a lawyer and doing your own legal research.)
Finally, to avoid using the cumbersome “he or she,” I
have randomly alternately used masculine and feminine
pronouns throughout the book.
E. What This Book Does Not Cover
Workers’ compensation laws have changed tremendously
over the last few years. This has inevitably resulted in
uncertainty, as three different sets of laws are on the books
—laws that apply to years prior to 1994, to 1994–1997, to
1998–2002 and after 2002. Many of the new or revised laws
are subject to various interpretations, and will continue to
be interpreted for many years to come as workers’ compen-
sation cases are brought to trial and legal decisions are
appealed. I have given my best effort to provide you with
accurate explanations of the law for injuries on or after
January 1, 1994. However, this book is not a legal opinion
on any issue or law and should not be relied on as such. If
you have questions or concerns regarding a workers’
compensation issue or law, you should attempt to consult

with a workers’ compensation attorney, get help from an
Information and Assistance officer or do your own research.
If you face any of the following issues, you should seek help
beyond the book:
• You were injured before January 1, 1994. Appendix 1 gives
an overview of workers’ compensation laws between
1/1/90 and 12/31/93 and gives some suggestions for
where to find additional information.
•
Your employer was not insured.
By law, your employer
must carry workers’ compensation insurance or be
permissibly self-insured. If, however, your employer
does not have workers’ compensation insurance, you’ll
probably need to seek compensation from the Uninsured
Employers Fund, discussed in Chapter 16, Section B.
• An injured worker died. If an employee’s death was due to
a work injury, at least in part, the worker’s dependents
may file a claim for death benefits. The worker’s estate
may be entitled to any accrued workers’ compensation
benefits as of the date of death. (See Chapter 15 for
more information.) If you feel the death was due to the
work injury and the insurance company denies cover-
age, seek help from an Information and Assistance
officer or see a lawyer.
• You have a stress-related (psychological) injury. Insurance
companies almost always deny these claims and will
fight you every step of the way. If at all possible, find a
workers’ compensation attorney to represent you or
seek help from an Information and Assistance officer.

(See Chapter 3, Section B4, for more information.)
INTRODUCTION TO WORKERS’ COMPENSATION 1 / 7
• If the statute of limitations has run. If the insurance
company has denied your claim because it asserts that
you failed to file your claim in a timely manner, you’ll
need help beyond the book. Contact an Information
and Assistance officer or see a lawyer. (See Chapter 5,
Section C1, for more information.)
• Apportionment. Insurance companies sometimes claim
that all or part of a permanent disability is due to
preexisting or subsequent factors, such as a non-work-
related auto accident. If so, seek help from an Informa-
tion and Assistance officer or see a lawyer. (See Chapter
3, Section B7, for more information.)
• Post-termination claim. Sometimes an insurance com-
pany will deny a claim if you were terminated or laid
off. If this happens, seek help from an Information and
Assistance officer or see a lawyer.
ICONS USED IN THIS BOOK
Look for these icons to alert you to certain kinds of
information.
Caution: Alerts you to potential problems you may
encounter in your workers’ compensation case
.
Tip: Gives practical suggestions for handling a
legal or procedural issue that may come up.
Fast Track: Lets you know when you may skip
reading some material that is not relevant to
your situation.
Resources: Refers you to additional books or

resources.
See a Lawyer: Advises you to see a workers’
compensation attorney or other source of
assistance.
Case Law: Lets you know there is an important
court decision or case on this legal area,
discussed in Chapter 28, Case Law Review.
■