California workers’ comp benefits

What the Labor Code provides after a work injury, and the disputes that come up along the way.

  1. Denied or delayed claimsThe 90-day rule, the denial letter, the QME route and the Application for Adjudication at the WCAB.
  2. Treatment denied by utilization reviewThe UR deadlines in Labor Code 4610, the 30-day IMR window in 4610.5 and what comes after the decision.
  3. Temporary disability and lost wagesTwo-thirds of average weekly earnings, the 2026 DWC rates, the 14-day first check and the 104-week cap.
  4. Permanent disability ratings and paymentsP&S, whole person impairment, the 2005 rating schedule, apportionment and the weekly PD rates from the DIR table.
  5. QME and AME medical evaluationsThe panel request, the strike, the AME option and what the medical-legal report addresses.
  6. SJDB voucher and the Return-to-Work SupplementThe $6,000 voucher for injuries since 2013, what it pays for, when it expires, and the $5,000 state supplement.
  7. Medical treatment, the MPN and changing doctorsWho picks the doctor, how the MPN works, predesignation, second opinions and mileage.

How a claim works

Five steps in a California workers’ comp claim

An overview drawn from the Division of Workers’ Compensation. Every case has its own facts and deadlines.

  1. Report the injury

    Written notice to the employer starts the claim. Labor Code 5400 sets 30 days from the injury for that notice. Once the employer knows, it must give or mail you a claim form within one working day.

    Source: DWC: How to file a claim

  2. File the DWC-1 claim form

    You fill out the employee section, sign and date it, return it to your employer and keep a copy. Within one working day, the employer must authorize medical treatment, up to $10,000 while it decides the claim. In most cases, a claim not denied within 90 days is presumed covered.

    Source: DWC 1 claim form (PDF)

  3. Medical treatment and temporary disability

    Treatment follows the state’s medical treatment guidelines, often through your employer’s medical provider network (MPN). If the injury keeps you from your usual job while you recover, temporary disability payments replace part of the lost wages.

    Source: DWC: If my claim was accepted

  4. The QME and disputes

    When you or the claims administrator disagree with your treating doctor’s report, a qualified medical evaluator (QME) from a state panel examines you. Disputes over a specific treatment request go through utilization review and independent medical review.

    Source: DWC: If my claim was denied

  5. Settlement or trial at the WCAB

    A case ends with Stipulations with Request for Award, a Compromise and Release, or a judge’s decision after trial at the local WCAB district office. A workers’ compensation judge reviews every settlement.

    Source: DWC: How my case is resolved

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