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Carrying worker's compensation insurance in California is mandatory, unlike many other states.  The only instance where "self-insuring" is feasible is if a company can show more than $5 million in net worth and a net income of at least $500,000.  Even at that, a sizable security deposit is required up-front. "Pool" coverage has become available in recent years, making worker's comp more affordable for smaller companies as they group their policies together.  California's workers comp rules are so thorough that even a real estate company has to carry coverage on their agents in the field.  There is no exemption for small numbers of employees (even one or two), and waivers are not permitted unless the company can meet the requirements of net worth and net income (as above).

There are two broad fields into which worker's compensation rules can be divided: worker's compensation and employer liability.  As anywhere else, the worker's compensation end of the insurance is there to cover employees who are injured on the job and to provide for their recovery and loss of income.  Employer liability insurance gives coverage to the employer in cases where an employee is injured on the job but the injury is not compensable under worker's comp.  A "no-fault" system has been adopted to streamline the worker's compensation process in California; in other words, the employee should be taken care of regardless of whether the accident was due to the employee's negligence, the employer's or the involvement of a third party.  

Generally, an employer in California is responsible for:

 Posting a notice of worker's comp coverage and policies, in an area where all employees can see it

Making sure that every injury, even the slightest one, is reported to the proper worker's comp authorities

Drafting a written report to document any lost-time injury

Getting immediate medical care for any employee injured on the job

Seeing to it that the information listed on a claim gets to the proper worker's comp office

Getting medical care to an employee who is unable or unwilling to do it on his own

If an employee lets the employer know early on that he has a personal physician he would prefer to see if injured, it can be his or her right to see that doctor for a worker's comp claim. This also applies if the employer hasn't posted his mandatory notice of worker's comp rights, policies and coverage in the workplace.  California law mandates that as many as seven percent of employees can choose to "pre-designate" their own physician.  In all other cases, it's the employer's choice as to which doctor will see an employee for worker's comp claims (usually a doctor from a network of physicians who handle such cases).  The employee then has the right to see another physician after a 30-day period. 

 

The calculations for premiums on worker's comp insurance are indexed by several factors, including the industry, the nature of the employee's specific job and the company's previous track record of on-the-job injuries and claims. The premiums may also be adjusted according to factors such as a certified health care organization, special group or dividend programs or other underwriting adjustments.   Especially hazardous industries might be hit with a surcharge from worker's comp insurance carriers; the employer can appeal that surcharge or shop around for coverage elsewhere.  Early cancellation of a worker's comp policy will usually result in the employer being assessed with a penalty.

Employees cannot be asked or require to help pay for their premiums; worker's comp insurance premiums in California are considered a part of the cost of doing business.  The state does have a Worker's Compensation Insurance Rating Bureau that makes recommendations on carriers and rates, but the rates themselves are determined by a free market, not the state itself.  As in any other consumer-oriented industry (auto insurance, homeowner's insurance, etc.) the employer has the option and the right to shop for the best rates and coverage for their particular needs.

 Worker's compensation in California covers the following fairly standard set of eventualities:

Medical care from start to finish (which includes hospitalization, X-ray, doctor's bills, surgery, physical therapy, etc. from start to finish)

Temporary disability (a weekly allowance until the employee is recovered and ready to come back to work)

Permanent disability (a stipend if the employee isn't able to return to work again, ever)

Vocational rehabilitation (retraining in cases where the employee is too compromised to return to work in his original field)

Transportation reimbursement (trips to doctor's appointments, hospital or rehab)

Death benefits (paid to surviving family)

Disputed claims are directed to an Information and Assistance Officer; failing that, employees can seek recourse with the state's Worker's Compensation Appeals Board. 

Many other states don't give an employee the right to sue an employer if they can prove negligence, recklessness or other willful safety violations.  In California, employees can seek damages including pain and suffering, bodily injury, emotional suffering, mental anguish and diminished earning power.  Also, firing, threatening to fire, demoting or harassing an employee for filing worker's comp claims is considered retaliation.  Retaliation is a misdemeanor, and should be reported immediately to the local worker's comp office. 

 

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