A workplace injury can create immediate questions about medical care, income, paperwork, and whether an employee can safely continue working. California has an established workers’ compensation system for addressing qualifying job-related injuries and illnesses, but the process may be unfamiliar to someone experiencing it for the first time.
Understanding the basic steps that usually follow a workplace injury can help workers keep track of important documents, communicate with their employer, and locate reliable information about available benefits.
Get Medical Attention When Necessary
The first concern after a workplace injury should be health and safety. An employee who needs emergency treatment should obtain appropriate medical attention rather than waiting for workers’ compensation paperwork to be completed.
Workers should tell the healthcare provider that the injury or illness occurred because of work. This helps establish that treatment is connected with an occupational injury.
In less urgent situations, an employer may provide information about where the worker should receive initial medical treatment. The rules can depend on factors such as whether the employer uses a Medical Provider Network or whether the employee properly predesignated a personal physician before the injury.
Report the Workplace Injury Promptly
California workers should generally notify their employer about a workplace injury or occupational illness as soon as possible.
Reporting the incident allows the employer to begin the workers’ compensation process and arrange appropriate medical care. Delayed reporting can also create practical problems when an employer or claims administrator tries to determine how and when an injury occurred.
Not Every Injury Happens in One Accident
Some occupational injuries are obvious immediately. Examples can include a fall, machinery incident, vehicle collision, burn, or lifting accident.
Other work-related conditions may develop gradually. Repetitive movements, prolonged lifting, noise exposure, physically demanding work, or other occupational conditions can contribute to symptoms over time.
Workers should report these conditions when they reasonably believe their work may be contributing to the problem.
Complete the DWC 1 Claim Form
After an employer learns about a workplace injury or illness, California’s Division of Workers’ Compensation states that the employer must generally provide or mail the employee a workers’ compensation claim form within one working day.
The employee completes the employee portion of the DWC 1 form, signs and dates it, and returns it to the employer.
Workers should keep a copy of the completed form for their records.
California DWC provides additional instructions through its official workers’ compensation claim guide.
What Happens After the Form Is Returned?
The employer completes its section and forwards the claim to the workers’ compensation insurance carrier or claims administrator.
The employee should receive a completed copy. DWC guidance states that the claims administrator generally has 14 days to mail the worker a notice describing the status of the claim.
Workers should save this correspondence along with the claim form, medical reports, work-status notes, and other documents connected with the injury.
Medical Treatment May Begin While the Claim Is Reviewed
A worker does not necessarily have to wait until the insurance company makes its final claim decision before receiving treatment.
According to California DWC guidance, once the employee files the claim form, the employer generally must authorize appropriate medical treatment within one working day. While the employer or insurer is deciding whether to accept or deny the claim, qualifying treatment may be provided up to the limit established by California law.
Medical treatment may include physician appointments, diagnostic testing, medication, physical therapy, specialist visits, or other appropriate services.
For more detail, see our guide to Medical Treatment After a Work Injury.
The Claims Administrator Investigates the Claim
After receiving the claim, the claims administrator may review information about the accident, employment, medical condition, and other circumstances.
A claim may eventually be accepted, denied, or remain under investigation while additional information is collected.
California DWC states that workers generally should learn whether a claim has been accepted or denied within 90 days after the claim form is provided to the employer. Under DWC guidance, if the employer does not deny the filed claim within that period, the injury is generally presumed to be covered.
What Happens If the Claim Is Accepted?
An accepted workers’ compensation claim may involve several different types of benefits depending on the circumstances.
California workers’ compensation recognizes five basic benefit categories:
- Medical care
- Temporary disability benefits
- Permanent disability benefits
- Supplemental job displacement benefits
- Death benefits for qualifying dependents
Not every claim involves every benefit. The benefits available depend on the worker’s injury, recovery, work status, and other factors.
Read How California Workers’ Compensation Works for a broader explanation of the system.
What Happens If You Cannot Work?
A treating physician may determine that an employee cannot perform their usual job while recovering.
Temporary disability benefits may provide partial wage replacement when an eligible worker loses wages because the injury prevents them from performing their usual work.
California DWC generally describes temporary disability as two-thirds of qualifying gross wages lost during recovery, subject to statutory minimum and maximum amounts.
Temporary Work Restrictions
Some employees can continue working but cannot perform every part of their regular job.
A physician may establish restrictions involving lifting, standing, reaching, driving, repetitive activity, working at heights, or other job duties.
An employer may be able to provide modified work that fits within those restrictions.
What If the Injury Causes Lasting Limitations?
Some workers recover completely, while others continue to experience lasting impairment after their medical condition becomes permanent and stationary or reaches maximum medical improvement.
Permanent disability benefits may be available when a qualifying occupational injury causes lasting disability affecting the worker’s ability to earn a living.
Our guide to Temporary vs. Permanent Disability Benefits explains how these two benefit categories differ.
What If the Claim Is Denied?
A denied claim does not necessarily mean the workers’ compensation process is automatically over.
California provides procedures for resolving disputes about whether an injury is work-related, medical findings, disability, or benefits.
Depending on the dispute, a Qualified Medical Evaluator, workers’ compensation judge, or another part of the DWC system may become involved.
The Division of Workers’ Compensation also operates an Information and Assistance Unit that provides educational help to injured workers.
Keep Important Records
Workers’ compensation claims can generate paperwork over many months. Keeping organized records may make the process easier to follow.
Consider retaining copies of:
- The DWC 1 claim form
- Medical reports
- Work-status notes
- Benefit notices
- Letters from the claims administrator
- Medical appointment information
- Mileage records
- Modified-work offers
Recovery and Returning to Work
Returning to employment may happen gradually. Some workers resume their regular jobs, while others temporarily perform modified duties.
Employees should understand their medical restrictions and avoid performing tasks that conflict with the treating physician’s instructions.
Workplace conditions also remain important after an injury. Our guide to Workplace Safety in California’s Central Valley discusses heat, machinery, falls, transportation, and other occupational hazards.
Understanding What Comes Next
There is no single recovery timeline for every workplace injury. Some claims involve a short period of treatment, while others involve extensive medical care, disability benefits, or long-term work restrictions.
Understanding the basic steps can make it easier to recognize important notices and know where to locate current information.
For an overview of the system historically covered by Central Valley Injury, visit our Workers’ Compensation System page.
Central Valley Injury provides general educational information only and does not provide legal advice or legal representation.