California Workers’ Compensation Medical Care and Benefits FAQ

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Review the primary official source.

This FAQ focuses on the medical and benefit record that moves a California workers’ compensation case from initial care through disability evaluation and adjudication.

Can I receive medical care while liability is investigated?

California law can require limited treatment during the investigation period, subject to statutory conditions. Give written notice, keep the DWC-1 and treatment requests, and document authorization or refusal.

How are temporary and permanent disability different?

Temporary disability replaces part of wages during qualifying recovery; permanent disability compensates lasting impairment and diminished earning capacity under the rating system. Medical status and work evidence drive different questions.

What if work restrictions cannot be accommodated?

Preserve every restriction and written offer. Compare actual duties, schedule, location, wages, and duration with the physician’s limits. Modified-work and voucher consequences require the precise offer and dates.

Who decides disputed medical issues?

Treating physicians, utilization review, independent medical review, and QME or AME evaluators have different roles. A party should identify which question—treatment authorization, causation, disability, or apportionment—is actually disputed.

Can a claim cover cumulative trauma?

Potentially. Repetitive work or exposure over time can support a claim, but the injury period, knowledge, disability, employers, carriers, and medical causation must be developed rather than assumed.

What should be ready for a WCAB conference?

Organize the application, answers, medical reports, benefit printout, wage proof, notices, exhibits, witness list, issues, and proposed stipulations. The pretrial statement can limit later issues and evidence.

What should be done immediately after a work injury, and who may qualify?

Report the event or condition, obtain appropriate medical attention, request a DWC-1, and preserve job, witness, wage, and medical records. Coverage generally turns on an employee relationship and injury arising out of and occurring in the course of work, but status and causation can be disputed. The DWC injured-worker FAQ is a starting point, not an individualized eligibility ruling.

Which dates control notice and claim-filing deadlines?

Build a chronology for injury or exposure, first symptoms, disability, knowledge that work may be involved, employer notice, and each filing or denial. Different rules can govern a specific injury, cumulative trauma, death claim, benefit petition, or review request. Act promptly and verify the controlling notice and statute rather than relying on one generic deadline.

How does an MPN affect doctor choice and transfer requests?

Ask whether an approved MPN applies, obtain its notice and directory, and document each selection, transfer request, second or third opinion, and continuity-of-care issue. Predesignation and statutory exceptions may change the analysis. Consult the official DWC MPN questions and answers.

How do wage history and rate caps affect disability benefits?

Temporary and permanent disability use different formulas and statutory limits. For temporary disability, assemble wage statements plus overtime, commissions, tips, bonuses, lodging, and concurrent-job earnings; irregular income should not be reduced to an unsupported estimate. The DWC benefit guidance identifies the framework and current-rate resources.

What should be preserved after a treatment denial?

Keep the request for authorization, supporting report, utilization-review determination, envelopes or electronic service record, IMR application, medical records, and deadline calendar. IMR addresses medical necessity, while QME or AME procedures address other medical-legal disputes. Follow the DWC IMR instructions attached to the actual determination.

What happens when the carrier denies the whole claim?

Request the written denial and stated grounds, compare them with the DWC-1, employer report, medical history, witness evidence, and wage record, and determine whether an adjudication filing or hearing request is needed. A denial does not resolve disputed facts by itself, but missing a governing deadline can limit review.

How should an injured worker evaluate counsel and fees?

Ask who will perform the work, how medical and hearing issues are handled, how often status will be reported, what records are needed, how statutory fee approval operates, and which costs or liens may affect recovery. Avoid any lawyer who guarantees a result before reviewing the complete record.

This page provides general information, not advice for a particular matter. Deadlines and available procedures depend on the governing notice, tribunal, and record.