First 90 days

The first 90 days after an on the job injury is an extremely critical time in the California workers’ compensation process. In this article, we will be discussing the most common issues that our Sacramento Workers’ Compensation Attorneys are asked about during the first 90 days after an on the job injury in California. In particular, we will cover how to report a California workers’ compensation injury and how to complete the DWC-1 form. We will also discuss the differences in obtaining medical treatment during the first 30 days after the injury and after the first 30 days of workers’ compensation injury. Lastly, we will review the potential issues that commonly occur when benefits become delayed during the 90 day investigation period.

CA WC Case First 90 day
How do you report a California workers' compensation injury?

Some California workers’ compensation injuries are apparent, and issues surrounding the reporting of an injury are not likely to occur. Some injuries, such as cumulative trauma injuries (e.g., carpal tunnel), are unfortunately less obvious. We often see employees make the unfortunate mistake of trying to hide their injuries out of fear of losing their job or retaliation.  

The underlying and critical issue to start a workers’ compensation claim in California is whether the employer was given “notice” that an injury occurred. If the employer has been given notice but has failed to take action, the employee may be entitled to certain penalties or similar rights. On the other hand, if the employer is not put on notice of an injury, then an employee’s claims may potentially be waived, or the burdens of proof may become more complex.

Under California’s workers’ compensation laws, an employer is required to post a notice in a conspicuous location in the workplace that states the name of the employer’s workers compensation insurer or administrator, as well as any other rights an employee may have after an injury. An employer is also required to post information about how to contact the California Workers’ Compensation Appeals Board. Finally, an employer is required to provide a new employee with information on his/her rights after an on the job injury. If you are injured on the job, you will want to look for that information to see where and how a claim is expected to be reported to your employer.  

It is undoubtedly best to follow the employer’s procedures for the giving of notice of a California workers’ compensation injury; however, you may still have rights if your employer was informally or otherwise put on notice of your injury. While a verbal statement to your employer that you are/were injured is technically sufficient, problems can occur when proof of notification is needed. Consequently, it is not the preferred way to report an injury. If your employer’s system is unclear or you don’t have access to the employer’s preferred method of reporting an injury, then submitting a completed DWC-1 form to the owner or human resources manager is also an acceptable way to give formal notice. 

How do you complete the DWC-1 form for a California workers' compensation injury?

Your employer is required to provide you a standardized claim form, commonly known as a DWC-1, within one working day of being formally or informally notified of a potential injury in the workplace. Your employer is also required to provide you with the three-page prefix to the DWC-1, sometimes referred to as the “Notice of Potential Eligibility.”

The actual DWC-1 has two distinct parts: the employee section; and the employer section. The employee section is where you, the injured employee, will fill in basic biographical information about yourself in the first three lines. The next three lines can be a bit complicated, and most employees do not fill it out correctly. For a traumatic injury, the date, time, and place are fairly simple. However, most injured employees fail to list all of the injured body parts and instead only list the most injured one. Employees also often state the description of the date of injury incorrectly for cumulative injuries or aggravation of prior injuries. Without the guidance of a Sacramento Workers’ Compensation Attorney, this information can be prejudicial to the workers’ compensation claim in the long term. 

How do you receive treatment for a California workers' compensation injury DURING the first 30 days? 

When you are injured on the job, your employer or their workers’ compensation insurance company is obligated to pay for reasonable and necessary treatment. As part of that obligation to provide treatment, the insurance company has the right to dictate which medical provider will treat you for the first 30 days. 

As you would imagine, they traditionally utilize the services of insurance or employer-friendly medical providers that often try to minimize the extent of your injuries and return employees to work too soon. One of the ways this occurs is when early treating physicians fill-out the work restrictions with limitations that are too little or incomplete. For many employees, it can, unfortunately, result in further injuries. 

Can you receive treatment AFTER the first 30 days of a California workers' compensation injury? 

The good news for employees that have a California workers’ compensation injury, after the first 30 days after their injury, they have the right to choose their own treating physician. This generally can bring a sigh of relief as they are able to choose a physician who is a little more neutral then the ones typically selected by the employer during the first 30 days.

Unfortunately, you cannot generally choose any physician you want, but in most cases, you have to choose a physician who is listed within the Medical Provider Network. The Medical Provider Network (MPN) is a designated list of approved doctors, and the claims administrator is required to provide you this list upon request. There are some exceptions to the use of the Medical Provider Network requirement with the two most common situations being when you have predesignated a physician prior to the injury, or if the list is insufficient. 

Can a delay during the investigation of the claim affect benefits?

The timely submission of a properly completed DWC-1 form to your employer is extremely critical as it starts a series of time-tables that relate to the acceptance or rejection of your claim. Generally, your employer must authorize medical treatment within one working day of receiving the claim, even if they have not yet determined if it is work-related or not. However, the treatment that they have to provide you while investigating is limited to $10,000 under the Labor Code.

If there is a good-faith basis to believe the claim may not be related to a work injury, the claims adjuster can delay temporary disability payments while they investigate the claim; however, the investigation must be completed within 90 days. If they do not reject the claim within 90 days, it is presumed compensable as a workers’ compensation injury. Generally, it cannot be later refuted by the insurance company based on evidence that could have reasonably been discovered within the first 90 days.

A lot is going on during the first 90 days after an on the job injury and what you do or don’t do during this time can greatly impact the outcome of your California workers’ compensation case. If you have questions about an on-the-job injury, please do not hesitate to call one of the attorneys in our Sacramento Workers’ Compensation firm for a free no-obligation consultation.