What Every Employer Should Know About Workers’ Compensation

I. History of Workers’ Compensation Boynton Act 1913 Purpose of workers’ compensation laws Senate Bill 899 (2004) Senate Bill 863 (eff. 2013)

II. Department of Industrial Relations Division of Occupational Safety and Health Division of Labor Standards Enforcement Division of Apprenticeship Division of Statistics and Research State Mediation & Conciliation Service

Division of Workers’ Compensation (DWC) Workers’ Compensation Judge Information & Assistance Officer Disability Rater Support Staff—hearing reporters, clerks, calendar clerks, auditors

III. Benefits Temporary Disability Permanent Disability Return to Work Services Death Benefits Medical Care

III (a) TD Based on 2/3 average weekly earnings. State establishes maximum ($ ) and minimum rates ($165.49). State average weekly wage as compiled by the U.S. Department of Labor now determines if rates increase. 3 day waiting period. Payments end when RTW or P&S or reaches 104 weeks within 5 yrs.

III (b) PD Based on Agreed Medical Examiner, treating doctor, or Qualified Medical Examiner medical-legal report. Based on objective findings and employee’s age and occupation. Max ($290) and min ($160) for injuries on/after 1/1/13 More than 70% PD = life pension If 100% PD, rates are based on TD

III (c) RTW Supplemental Job Displacement Benefits began in Jan SJDP if IW has PD and employer won’t offer other work. SJDP is up to $6k for injuries on/after 1/1/13

III (d) Death Benefits Burial benefits up to $10K for injuries on/after 1/1/13 Dependency benefits for total or partial dependents DB for 3 or more total dependents is $320K

III. (e) Medical Care All necessary medical care. Caps on some services after 4/19/04 American College of Occupational and Environmental Medicine Guidelines. Utilization Review company to review treatment requests. Medical provider networks.

IV. Employer Responsibilities Get insurance Experience Modification Workers’ Compensation Insurance Rating Bureau (WCIRB) Shop around because of open rating State Compensation Insurance Fund (SCIF)

IV. Employer Resp. (Cont.) Give DWC 1 within one day when you have notice or knowledge of industrial injury Send DWC 1 to insurance carrier within one day of receipt from employee Post workers’ compensation notice in conspicuous location Give workers’ compensation pamphlet to new employee

V. Claims Process DWC 1 (claim form) opens a claim. Authorize up to $10,000 in medical care when DWC 1 filed. 90 days for insurance carrier to investigate case before accepting or denying claim. If accepted, employees receives all benefits. Most cases go through this informal process with employee dealing with carrier.

VI. Litigation Process Application for Adjudication of Claim Conferences Trials Settlements—Stipulations and Compromise & Release Findings and Award Appeals

VI. Litigation Process (Cont.) WCAB (Reconsideration Unit) in San Francisco District Court of Appeals California Supreme Court

VII. Role of the Uninsured Employers Fund Special fund to step in shoes of insurance carrier Lack of insurance enables injured worker to sue in civil court and file WC claims If payments made, will file liens against illegally uninsured employer

VIII. Other Workers’ Compensation Issues Fraud—Special Investigation Unit, Office of the District Attorney, Department of Insurance Employer discrimination Serious and Willful petition Electronic Adjudication Management Systems (EAMS)

VIII. Other WC Issues (Cont.) Employee vs. Independent Contractor First-aid claims WCIRB coverage information

IX. Workers’ Compensation Web Sites

X. Questions ???