California Admin/Reporting

First Report of Injury Form Information

State's First Report of Injury form
Employer's Report of Occupational...(show more)
Employer's Report of Occupational Injury or Illness (show less)
Number of the form (if applicable)
DLSR 5020
Revision date of the First Report of Injury form
06-02-11
Which State Agency administers workers' comp claims?
Division of Workers' Compensation

First Report Submission Requirements and Preferences

State's Preferred Method for receiving the First Report
EDI
State accept claims via EDI?
Yes
State accept claims via Email?
No, Discontinued
State accept claims via Online?
No
State accept claims via FAX?
No
State accept claims via US Mail?
No

Reporting Requirements

Types of Injuries/Accidents is the Employer required to report
Death or serious injuries/ Disability...(show more)
Death or serious injuries/ Disability of 1 day or more, other than first aid /Occupational disease or pesticide poisoning (show less)
Injuries/Illnesses not covered?
Injury or Illness not caused by work.
Date the State requires the First Report to be submitted
Within 5 Days
Time Requirement for the Injured Worker to File a Claim
In writing within 30 days; excusable....(show more)
In writing within 30 days; excusable. Within 1 day of receiving notice or having knowledge of injury, employer must provide injured worker with claim form (show less)
Employer Required to Keep Records of Claims?
Yes

Penalties

Monetary Penalties for Failure to Report?
$50 - $200
Imprisonment Penalties for Failure to Report?
Non-specified

Vocational Rehabilitation and Return to Work Policies

Rehab Services are Provided by the State
Physical and Vocational Rehabilitation
Employer/Carrier Responsibilities for Voc Rehab
Section 139.5 Repealed. Cover Voc Reh...(show more)
Section 139.5 Repealed. Cover Voc Rehab costs. During Physical Rehab & Voc Rehab pay TTD & additional living expenses. Mandatory payments generally capped at $16,000. (show less)
Employee's responsibilities regarding Voc Rehab
Employee must request Voc Rehab withi...(show more)
Employee must request Voc Rehab within 5 years of the date of injury. (show less)
Penalties to the Employee for non-compliance
Compensation withheld for refusal to ...(show more)
Compensation withheld for refusal to cooperate (show less)
Employee's benefits during Voc Rehab
Section 139.5 Repealed. TTD or mainte...(show more)
Section 139.5 Repealed. TTD or maintenance allowance at $246 (limited to 52 weeks) and living expenses necessitated by rehabilitation; terminated VR services may be re- stored within 5 years after injury in certain cases. (show less)
Services are provided by the State WC Rehab Unit
Medical
State's Codes/Regulations for Voc Rehab
(Labor Code section 4658.7); Sec. 139...(show more)
(Labor Code section 4658.7); Sec. 139.5 repealed (show less)
Funding source for the rehabilitation of disabled workers
No fund established
Maintenance Allowance Benefits provided during rehabilitation of Disabled Workers?
A new Supplemental Job Displacement B...(show more)
A new Supplemental Job Displacement Benefit (SJDB) program applies to injuries on or after 1/1/04. This is a nontransferable voucher for education-related retraining or skill enhancement, or both, payable to a state-approved or accredited school. To qualify for this benefit, the employee does not return to work within 60 days after temporary disability ends and does not return to modified or alternative work. The maximum voucher amount is $10,000. Under SJDB there is no maintenance allowance. For injuries occurring on or after 1/1/04. (show less)

Fraud Provisions

Does the State have a Fraud Bureau?
Yes
Claim Fraud defined as a specific crime?
Yes
Underwriting Fraud a specific crime
Yes
Insurer Fraud a specific crime?
No
Fraud Plan required?
Yes
SIU required?
Yes
Annual Fraud Reports required?
Yes
Fraud Warning required?
Yes
Fraud provisions for Insurer-to-Insurer fraud?
Yes
Notify the Licensing Board?
Yes

Immunity Provisions

Specific Immunity for Insurer to Insurer?
No
Specific Immunity for reporting to Law Enforcement?
No
Specific Immunity for reporting to the Fraud Bureau?
Yes
Specific Immunity for reporting to the NAIC?
No
Specific Immunity for reporting to the NICB?
No

Subrogation Statutes and Provisions

Carrier sue the Third Party directly?
Yes
Intervention?
Yes
UM/UIM Recovery?
No
State's Subrogation Statutes
Labor Code § 3852

Medical Malpractice Statutes and Provisions

Medical Malpractice as a Third Party?
No
Legal Malpractice as a Third Party?
Undecided
Recovery Limits
Yes
Employer Negligence?
Proportional. Only if Verdict
Future Credit?
Yes
Personal Injury Statute of Limitations
2 Years

Reporting Requirements and Information for Occupational Diseases

Occupational Diseases are covered
All diseases arising out of and in th...(show more)
All diseases arising out of and in the course of employment (show less)
Time limit for filing a claim for Occupational Disease
Within 1 year of date of injury or la...(show more)
Within 1 year of date of injury or last payment. Employee should know relation to employment. Death--within 1 year if death is within 1 year after injury; if not, within 1 year after last medical payment. No claims 240 weeks after injury, except for claims based on asbestos exposure. (show less)
Medical Care Provisions for Occupational Disease claims
Evidenced-based medical treatment
Compensation Provisions for Occupational Diseases
Same as for accidents
Claims settled or resolved
By agreement upon approval of Appeals...(show more)
By agreement upon approval of Appeals Board, which may order hearing. Disputed cases settled by Appeals Board on application (show less)

Administration and Appeals Provisions

Time limit for modifications of award?
No modification after 5 years.
Attorney Fees determined?
Apportionment, if Active
Method for paying Attorney's Fees
Reasonable fee fixed by the WCAB. If ...(show more)
Reasonable fee fixed by the WCAB. If the court finds no reasonable basis for appeal by the employer, insurer or third party administrator, the WCAB may award fees as supplementary award. (show less)
Administrative agency that has purview over appeals provisions
Workers' Compensation Appeals Board
Time requirement to file an appeal
15 Days
Court(s) for Appeals
Workers' Compensation Appeals Boa...(show more)
Workers' Compensation Appeals Board; District Court of Appeals; Supreme Court (show less)
Process and procedure for filing an appeal
Writ of Review
Appeal process by way of a Jury Trial?
No