General information about workers’ compensation
California Department of Industrial Relations job injury informationFrequently Asked Questions about the recent Workers’ Compensation Bill (SB 863), as provided by the Department of Industrial Relations. This bill made some very significant changes to California Workers Compensation law.
The California Department of Industrial Relations website contains a wealth of information for injured workers, claims administrators and others involved in the system plus frequently asked questions (FAQ), like “What are the benefits?”
The DIR website also contains a large number of informational pamphlets and fact sheets for the injured worker. They are updated from time to time. Fact Sheet Topics include: Basic facts on workers’ compensation for injured workers; Answers to your questions about utilization review; Glossary of workers’ compensation terms for injured workers; Answers to your questions about temporary disability, permanent disability, medical evaluations and uninsured employers. They also have Information and Assistance Guides. They include checklists on how to file various forms: Claim forms, Requests for QME Panels, Applications for Adjudication, Declaration of Readiness, Petition for Commutation, Audit Unit complaints, and how to dismiss your attorney, amongst many other topics.
General information for injured workers includes a simplified flow chart of the claims process.
Printable list of district offices of the WCAB.
Find an attorney certified as a specialist in Workers’ Compensation Law by the Board of Legal Specialization of the California State Bar.
Forms
The Claim Form, which starts the process, with instructions:
Forms for claiming medical mileage.
All workers compensation forms are available on the DIR website. They include all the EAMS OCR forms, WCAB forms, DEU forms and a lot of “Legacy” forms (older forms before the EAMS system). There are a lot of forms that are not EAMS forms, like QME panel forms, spinal surgery second opinion forms and complaint forms regarding QMEs and UR.
Reference and research material
The California Labor Code and relevant sections of the California Code of Regulation.
The California Office of Administrative law has links to all California Codes, the Code of Regulations and the California Constitution.
The Permanent Disability Rating Schedule.
The WCAB Policy and Procedure Manual.
There is a Benefit Notice Manual about what benefit notices the carrier should send, but it is created in 2009, so there may have been some changes since then.
The Medical Treatment Utilization Schedule. They describe recommended treatment guidelines for specific body regions (including post-surgical care and chronic pain) and are legally presumed to be correct.
Important workers compensation cases that have been decided by the WCAB “en banc” or which are considered Significant Panel Decisions along with a list of cases that are pending appellate review.
A free searchable database of all California Appeals Court and Supreme Court published opinions. Unpublished opinions and Slip opinions are available here also for a limited time after the decision.
You can search the QME data base by specialty and zip code or for a certain name:
Lis of reference books and where to find them.
Other publications and databases. These include “The Physicians Guide to Medical Practice in the California Workers’ Compensation System”, and “A Guidebook for Injured Workers, 2006,” in English and Spanish.
The California Workers’ Compensation Institute (CWCI) has the Medical Fee Schedule, Research Papers, and more Links.
Social Security Life expectancy table.
Specific case information
If you have, or had, a case under the old numbering system, pre “ADJ” numbers, such as MON 123456, you can find the corresponding ADJ number, such as ADJ123456 at the EAMS and a Legacy case number look up tool, In the old system, the first three letters designated the District Office where the case was filed. Now that information is found on the Public Information search function.
Search function where you can find all public information regarding particular workers’ compensation cases. It appears that anyone willing to identify themselves by name and email address can see who are the parties and information regarding hearing dates and documents filed in a case
Medicare set asides
Information regarding Medicare Set Aside accounts, based on memos from CMS.
Medical provider network information
One important section of the DIR website contains information about Medical Provider Networks (MPN’s.) This includes a link to the regulations pertaining to MPNs; a lot of it is oriented toward how to establish an MPN.
Travelers Insurance MPN search tool.
Zenith claims page to MPN. Note: by going through the “Information for Workers” channel, you will only find industrial doctors and initial medical care providers.
See below to find all specialties.
Zenith MPN , for all specialties, select “Information for Providers> Medical Networks and Providers> California Network” Note: Almost all Orthopedic doctors are listed under “Surgeons, Orthopedic” and not under “Orthopedics.”
Zurich North America MPN, click the “Claims” tab and then click on “Directory” on the right-hand column, then chose “Access the C.A.R.E. directory now” and enter the password “zurichna.”
Employers and insurance carriers
The DIR website also has information oriented toward employers and insurance adjusters or Claims Administrators. Here is a useful quote from the Claims Administrator page, “You are charged with expediting the delivery of workers’ compensation benefits and services to injured workers’ without unnecessary litigation or delays.”
If you want to report a claim against a claims administrator regarding improper benefit processing there is information about that and a claim form to file the complaint.
WCIRB collects insurance coverage information. There is now an on-line portal to search for the insurance carrier
You can find contact information for an insurance carrier through the California Department of Insurance.
Not all Employers have insurance. Some are so big that they insure themselves. Information about Self-Insured Employers and Joint Powers Authorities (Groups of Municipal Employers.)
State Fund provides a list of all Notices Employers are required to give their employees.
Travelers Home page. You can find introductory information.
Blogs, magazines, websites, etc.
Julius Young of the Boxer& Gerson firm in Oakland provides free analysis of key developments in California workers’ compensation law on his blog.
Jon Gelman’s blog, reviews trends and developments in workers’ compensation law throughout the United States.
Lynch Ryan provides a defense perspective on workers’ compensation, risk management and business insurance issues on his blog.
Articles by Robert S. Havens, designed for the layman, explain various topics, like Depositions, Denied Claims, Benefits and Trial Preparation, from an applicant’s attorney’s perspective, are available here:
MedVal an MSA vendor has a blog with Medicare and Workers’ Compensation related articles:
The editor of Work Comp Central is David DePaolo. His blog is not just about California law, but covers workers’ compensation nationwide.
Work Comp Central is the most complete source for news of the workers’ compensation community throughout the USA, but it is really for professionals, since you must subscribe and it is not cheap.
The Med Legal has a lot of information available without a “username” and more is available with one.
CWCR, the California Workers Compensation reporter has a website that contains subscription information and a list of cases published.
The Workers’ Injury Law and Advocacy Group (W.I.L.G.) is a nationwide organization of workers’ compensation attorneys who represent injured workers.
Other Miscellaneous Related Information
To learn more about or to apply for State Disability Benefits or Unemployment Benefits, go to the Employment Development Department (EDD) and chose the appropriate tab at the top of the home page
To become more involved by commenting on potential new regulations, participate in WCAB forums.
The Commission on Health and Safety and Workers’ Compensation (CHSWC) reports.
Cal OSHA, The Division of Occupational Safety and Health.
The U. S. Government has information about the Americans with Disabilities Act. There are PDF guides to the ADA, including a Primer for small business owners.
American College of Occupational and Environmental Medicine (ACOEM)
Remember, call your attorney if you have any questions.
© Robert S. Havens, 2018. This article is for general information, and not meant as specific legal advice. You should always see an attorney for specific legal questions.