This FAQ is written from the perspective of a veteran workers’ compensation case manager/paralegal with decades of experience. It answers the most common—and most confusing—questions injured workers have during a California workers’ compensation case.
Every workers’ compensation case is unique. This FAQ provides general guidance only and does not replace legal advice. Contact an attorney regarding case-specific questions.
Immediately. California law requires employees to report work injuries as soon as possible. Delays can give the insurance company a reason to question or deny the claim.
Cumulative trauma injuries (repetitive stress, overuse, exposure) are common. The date of injury is typically the last day you worked or when you first knew the condition was work-related.
Employers are legally required to provide a DWC-1 claim form within one working day of learning of an injury. Failure to do so may subject them to penalties.
The insurance company has up to 90 days to investigate your claim. During this time, they must still provide up to $10,000 in medical treatment.
A denial does not end your case. Medical evidence can still prove the injury is work-related. Many denied cases are later accepted or resolved through litigation.
Yes, but you should speak with your attorney first. Recorded statements can be used against you if poorly phrased.
A Medical Provider Network (MPN) is a group of doctors approved by the insurance company. Most injured workers must treat within the MPN for accepted claims.
Yes. You are entitled to change doctors within the MPN, subject to specific rules and timeframes.
UR is the insurance company’s process for approving or denying requested treatment based on medical guidelines.
IMR is a state-run process where an independent doctor reviews a denied or modified treatment request.
Decisions are usually issued within 30 days. During this time, treatment generally cannot proceed unless urgent.
TD benefits are two-thirds of your gross wages and are not taxed, making them lower than regular pay.
TD can stop if the doctor releases you to work, declares you P&S, or you reach statutory limits.
Apportionment assigns what percentage of disability is due to non-work-related causes such as prior injuries or conditions.
Yes. Ratings can be disputed through Qualified Medical Evaluations (QME) or Agreed Medical Evaluators (AME).
A QME is a state-certified doctor who evaluates disputed medical issues.
Absolutely. Exaggeration or minimization can damage credibility and case value.
Generally no, unless strategically advised. Early settlement often undervalues future medical needs.
C&R settlements generally cannot be reopened. Stipulated Awards may be reopened within five years under certain conditions.
It is a voucher (up to $6,000) for retraining or education if you cannot return to your old job.
No. Retaliation is illegal and may entitle you to additional remedies.
Workers’ comp does not guarantee job protection, but other laws such as FMLA, CFRA, and FEHA may apply.
If EDD pays benefits while workers’ comp is delayed, they may seek reimbursement from settlement proceeds.
Yes. Attorneys routinely negotiate lien reductions.
We’ll talk through your situation and outline your options.
For informational purposes only. Not legal advice. No attorney-client relationship is formed by reading this page.
