What is Workers' Compensation?

If there is any doubt that workers’ compensation is applicable to a particular situation, the Division of Workers’ Compensation (DWC) generally rules in favor of coverage. Workers’ compensation coverage benefits employers by making workers’ compensation the “exclusive remedy” for workplace injuries or illnesses. However, there are exceptions to workers’ compensation exclusivity, either created by statute or court decision. For examples, see Covered Employers and Employees and “Exceptions to the Exclusive Remedy of Workers’ Compensation” in Exclusive Remedy for Workplace Injuries.

Workers’ Compensation Benefits and Administration

Workers’ compensation provides:

• No-cost medical care to “cure” or “relieve” the injured employee of the injury’s effects.
• Varying levels of tax-free replacement income during periods of temporary inability to earn income. If the employee returns to modified or alternate work paying a lesser wage than the usual and customary position, workers’ compensation may continue to cover the employee for a time. The amount of time and compensation depends on the disability’s nature, severity and duration.
• Tax-free benefits for those who suffer varying degrees of permanent disabilities.
• Tax-free benefits for an employee’s surviving dependents if the work-related injury is fatal.

The DWC within the Department of Industrial Relations (DIR) administers workers’ compensation programs. The DWC assists employers and employees with workers’ compensation law and specific workers’ compensation claims.

In cases where there is a dispute, the nature and extent of benefits owed will be determined through a process involving a medical evaluation by an independent qualified medical evaluator (QME) chosen from a three-member QME panel requested from the state by either party to the dispute. The QME’s determination is then reviewed by a workers’ compensation judge.

In cases where the employee is represented by an attorney, requests for assignment of a QME can be made only via the DWC Medical Unit’s online submission process.1

Workers’ compensation judges within the DWC approve settlements and resolve disputes about:

• The cause of an illness or injury.
• Occupation type.
• The need for and scope of medical treatment.
• The nature and extent of temporary and permanent disability.

The Workers’ Compensation Appeals Board (WCAB) can adopt, confirm, modify or set aside decisions or findings of workers’ compensation judges.2 The WCAB decisions are subject to review by appellate courts and the state supreme court.3

1. 8 CCR sec. 30(b)