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Frequently Asked Questions

What is workers' compensation?
Workers' compensation is insurance that the law requires your employer to carry at no cost to you. It helps you if you are injured on the job or become ill due to your job.
What is a workers' compensation injury or illness?

A workers' compensation injury or illness is one that occurs due to employment. If you are injured you will receive help no matter who was at fault.

Workers' compensation covers various types of events, injuries, and illnesses. An injury could occur by a single event, such as hurting your back in a fall at work. Injuries could also be caused by repeated exposure, such as hurting your wrist at work from doing the same motion over and over.

Is workers' compensation the same as State Disability Insurance?
No. Workers' compensation is only for injuries or illnesses that occur due to employment. State Disability Insurance (SDI) is for injuries or illnesses that are not work-related. SDI is a benefit provided by the Employment Development Department.
How do I file a claim?

First, tell your supervisor or employer as soon as you can that you have been injured on the job.

Except for first-aid injuries, your employer will provide you with a claim form. Use the form to describe your injury, as well as how, when, and where it occurred. Next, return the completed form to your employer, who will send it to us. We will then get in touch with you to explain the benefits to which you may be entitled.

Generally, the law requires you to provide your employer with notice of your injury within 30 days of the date of injury. In addition, should you disagree with any of our actions, in order to protect your rights you must file an Application for Adjudication of Claim with the Workers' Compensation Appeals Board. You must file within one year of the date of injury, or one year from the last furnishing of indemnity or medical treatment benefits by your employer or State Fund. It is very important that you act promptly so as not to risk losing your benefits because you waited too long.

What is State Compensation Insurance Fund?
We are the insurance carrier your employer has chosen to provide its workers' compensation coverage. We have more than 90 years of experience providing workers' compensation throughout California.
How does this coverage affect my own health insurance?
Workers' compensation is separate from personal health-care insurance. Workers' compensation insurance only covers work-related injuries and illnesses. There is no deductible. The insurance carrier pays all approved medical bills. It is important to let the treating doctor know if your injury is work-related.
May I file a workers' compensation claim if an injury occurs outside of work?
Your employer or your employer's carrier may not be liable for the payment of workers' compensation benefits for an injury resulting from your voluntary participation in any off-duty recreational, social, or athletic activity which is not part of your work-related duties.
What are my protections against discrimination for filing a workers' compensation claim?

It is illegal for your employer to punish or fire you for:

  • Having a work injury or illness.
  • Filing a claim.
  • Testifying in another person's workers' compensation case.

If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state. If you believe you have experienced discrimination because of your injury, contact an Information and Assistance Officer at the State Division of Workers' Compensation. You may also consult with an attorney.

What is workers' compensation fraud?

Workers' compensation fraud laws make it a felony for anyone to file a false or fraudulent statement or to submit a false report or any other document for the purpose of obtaining or denying workers' compensation benefits. Anyone caught performing these illegal acts will be prosecuted. If convicted, the person can face up to 5 years in prison and/or up to a $150,000 fine.

How can I return to work as soon as possible?

You should actively communicate with your treating doctor, claims representative, and employer about the kinds of work you can do while recovering. They may coordinate efforts to return you to modified duty or other work that is medically appropriate. This modified or other duty may be temporary or may be extended depending on the nature of your injury or illness.

What if I have not received the benefits I think I should have?

If you have not received the benefits you think you should have, ask for an explanation from your claims representative. Misunderstandings and errors sometimes do occur. You can resolve most of them by talking with your representative.

If you are not satisfied with your claims representative's answers, you have several options:

  • You have the right to consult with and be represented by an attorney.
  • You can consult with an Information and Assistance Officer of the Division of Workers' Compensation.
  • You can file an Application for Adjudication of Claim with the Workers' Compensation Appeals Board (WCAB) to resolve your claim formally.

The Information and Assistance Officer can help you file the Application for Adjudication of Claim.

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