How does worker’ compensation work in California?

Workers compensation is a state-mandated insurance program. Workers Compensation in California gives your employees benefits when they are acutely injured, develop an injury or contract illnesses at the workplace. It pays for the worker’s medical expenses and rehabilitation costs. Besides, workers’ comp can also provide partial lost wages if the employee is forced to miss work due to the injury. Also, workers comp offers death benefits if an employee is killed while performing a job-related duty.

Do I have to be injured at my
workplace to be covered by workers’ comp?

No. Most injuries that happen in the “course of employment” are covered — as long as your injury is job-related, it’s covered. For example, you will be covered if you are involved in a car accident while driving for business or doing a work-related errand.

What Injuries Are Covered by Workers’ Compensation Insurance?

The simple answer is that generally all injuries and illnesses that occur while you were doing something on behalf of your employer or otherwise in the course of employment. When a work-related injury or illness occurs, California workers’ compensation benefits should help you. Most injuries that classify as work-related are those that occur at the workplace. However, California Workers’ comp insurance also covers off-site work activity or job-related travel

In most situations, injured employees receive California workers’ compensation insurance, no matter who was at fault for the injury. Also, Working Comp in California precludes an employee from suing his or her employer for the injuries covered.

What types of expenses do workers’ compensation insurance cover?

  1. Medical bills including any surgery, clinic visits
  2. Rehabilitation costs to regain muscle function, strength, etc.
  3. Lost wages
  4. Prescription medications
  5. Medical equipment such as ambulatory devices, braces, wheelchair
  6. Income replacement
  7. Certain job replacement benefits

What types of incidents are not covered by workers’ compensation insurance?

Although workers’ compensation covers most job-related injuries, there are a handful of exceptions. This means that there are instances when injuries and illnesses suffered by eligible employees are considered to fall outside the course and scope of employment. Generally, workmans’ comp doesn’t cover Injuries from alcohol intoxication or illegal drug use. Below are a few exceptions of incidents where workman’s comp insurance would not provide coverage.
  1. Off-work injuries
  2. Injuries from criminal activity
  3. Self-inflicted injuries, including suicide
  4. Pre-existing conditions, unless exacerbated by current work
  5. Injuries suffered when an employee’s conduct violated company policy
  6. Injuries that result when a co-worker attacks you for personal reasons
Additionally, workers are not eligible for workers’ compensation benefits for injuries or illnesses resulting from the following situations:
  1. When driving a company vehicle while engaged in non-work activities such as running errands or commuting to and from work.
  2. Voluntary participation in off-duty, employer-sponsored recreational activities such as a company picnic or a softball game.

Can I sue my employer in court over a work-related injury?

Usually, no. California workers compensation laws establish what is known as “employer immunity.” This law provides a trade-off, meaning employers must pay workers’ compensation benefits regardless of fault, but, in exchange, they are immune from most employee personal injury claims.

While employees generally cannot sue their employers for work-related injuries, there are exceptions to employer immunity or situations that would usually allow injured employees to sue their employers outside of the workers’ compensation. So, when can you sue your employer?

  1. Intentional injuries
  2. Injuries caused by employer malice or recklessness
  3. Non-physical injuries such as defamation or discrimination
  4. Bad-faith administration of workers’ compensation claims
  5. Employer retaliation against employees for pursuing workers’ compensation claims such as by firing or demotion
  6. Injuries caused by employer violations of state or federal law such as the Occupational Safety and Health Act (OSHA)
  7. Injuries caused by employers when acting in dual capacities, such as breaches of legal duties in their roles as property owners, landlords, medical providers or work-equipment manufacturers.
Who is not covered by workers’ compensation insurance?
Workers’ compensation does not cover certain types of workers and jobs. That said, states commonly exclude some workers from coverage, such as:
  1. Volunteers
  2. Casual workers
  3. Business owners
  4. Railroad employees
  5. Maritime employees
  6. Farmers and farmhands
  7. Independent contractors
  8. Employees of private homes
What Are the Penalties for Not Providing Workers’ Compensation in California?

California workers comp is designed to provide medical care and income benefits to injured employees. In addition, it protects employers from lawsuits resulting from workplace injuries. California Labor Code Section 3700 mandates all California employers to provide workers’ comp benefits to its employees. Failure to have workers’ compensation insurance means that the employer is open to liability in a regular court of law. However, some employers may not have workman’s compensation insurance.

Not carrying workers’ compensation insurance is a serious matter in California. The injured worker can sue the employer in civil court. If found guilty, the court may penalize the employer by having to pay for the injured worker’s medical bills, lost wages, and pain and suffering. Also, failure to obtain workers comp is punishable by imprisonment of up to one year in the county jail and fines of not less than $10,000 up to $100,000.

What if the Employer Doesn’t Have Workers’ Comp Insurance?
In the case of an employer does not have the funds to pay the injured worker’s benefits, the Uninsured Employers Benefits Trust Fund (UEBTF) will pay the workers’ compensation benefits. An injured worker must request the UEBTF to pay benefits if the employer cannot. These are the requirements needed to send to the UEBTF:
  1. Medical bills related to the work injury
  2. Petition to Join Party Defendant UEBTF
  3. Medical reports documenting the work injury
  4. Special Notice of Lawsuit to notify the employer
  5. Proof of employment such as pay stubs or W-2 during the time of injury
Compare quotes from trusted carriers with Business Insurance California
Complete our secure online application today to compare quotes for workers’ compensation insurance from A+ insurance carriers. Or you can speak with one of your specialists by calling (844) 234-5600.
Send Us A Message
Get a quick, personalized insurance quote today

Start saving on your insurance rate with a free online quote.