RISK MANAGEMENT

Workers' Compensation

(213) 738-2159
(213) 252-0404 fax

Mission Statement

  • To respond to County departments’ needs that arise from the costs and risks associated with workers’ compensation claim liabilities.
  • To comply with all legal mandates related to workers’ compensation and to accomplish this at the least possible cost to the County.
  • To assist injured workers in the fair, equitable, and expeditious resolution of workers’ compensation claim issues.

Workers’ Compensation Overview

Workers’ compensation is the oldest social insurance program; it was adopted in most states, including California, during the second decade of the 20th century. It is a no-fault system, meaning that injured employees need not prove the injury was someone else’s fault in order to receive workers’ compensation benefits for an on-the-job injury.

The workers’ compensation system is premised on a trade-off between employees and employers. Employees are supposed receive the prompt delivery of defined statutory workers’ compensation benefits for on-the-job injuries, and in return, the defined workers’ compensation benefits are, for the most part, the exclusive remedy for injured employees against their employer, even when the employer negligently caused the injury.

The Workers’ Compensation Claim Management Unit (WCCMU) operates and monitors a complete permissibly self-insured workers’ compensation program ensuring the full provision of benefits under the law to employees whose injuries arose in the course and scope of employment. This program oversees the administration of approximately 25,000 workers’ compensation claims and is the largest of any local governmental agency in California.

Currently, the County of Los Angeles contracts with private firms charged with the administration of workers’ compensation claims. These firms are called workers’ compensation third party administrators. The WCCMU provides continuous on-site workers’ compensation third party administration contract monitoring. Additionally, the WCCMU provides customer service designed to assist injured workers and departments resolve workers’ compensation claim issues by providing subject matter expertise.

Workers_Compensation_Overview

The CEO Risk Management Branch acknowledges; the California Division of Workers’ Compensation, California Commission on Health and Safety and Workers’ Compensation, Institute of Industrial Relations – University of California at Berkeley, and the Labor Occupational Health Program, School of Public Health – University of California at Berkeley for providing material that has been incorporated into this website.

Report A Work Related Injury / Illness

Injury_Illness_Report

The purpose of the following material is to provide department managers and supervisors a general guide for reporting industrial injuries/illnesses.

Policies and procedures may differ significantly from one department to another. Therefore, it is recommended every manager and supervisor become familiar with their department’s industrial injury/illness reporting practices.

Promptly reporting injuries/illnesses benefits injured workers and helps control the cost of workers’ compensation claims.

What to do when an injury occurs

Medical Care – When an employee reports an industrial injury/illness it is important that medical treatment is provided without unnecessary delay. Supervisory staff should refer the employee to a medical facility listed in the Initial Treatment Center directory applicable to their department. That information can be obtained from the department return-to-work unit.

Two exceptions follow:

  • If the employee’s need for treatment appears urgent – the employee should be referred to the nearest emergency room or call 911.
  • If the employee has predesignated a personal physician to treat an on-the-job injury or illness, and it is not an emergency, the employee should go to this predesignated physician.
Industrial Injury/Illness Reporting Paperwork

An employer must provide an employee a Workers’ Compensation Claim Form (DWC-1) within one working day of receiving notice of an industrial injury/illness. Additional paperwork is required to ensure the full investigation and expeditious delivery of benefits.

* The offer of transitional modified or alternative work is a very important cost saving tool. Departments are encouraged to develop an aggressive early-return-to-work policy that works closely with the injured worker, treating physician, and workers’ compensation third party administrator to return injured employees back to work as soon as practicable. In many cases, the exploration of transitional modified or alternate work should begin upon notification of the industrial injury or illness.

** Use each workers’ compensation injury claim as an opportunity to evaluate your workplace. The Supervisory Investigation Report can be a useful tool in preventing “like type” injuries from occurring in the future. Any ongoing hazard or exposure should be corrected immediately. Reporting supervisors and managers should identify any third party whose actions may have led to the injury/illness. This will assist the County in pursuing subrogation recovery.

Telephonic Reporting

Each and every County department has access to a 24-Hour workers’ compensation injury/illness reporting service. This service is available 24 hours, 7 days per week, and will transmit the information received by the department to the appropriate workers’ compensation third party administrator within one working day.

Work Related Injury/Illness 24-Hour Telephonic Reporting

Department

Telephone Number

Unit 1000 Departments

(888) 419-0585

Unit 2000 Departments

(888) 935-2667

Unit 3000 Departments

(800) 419-0585

Unit 4000/5000 Departments

(866) 291-7121

Workers’ Compensation Benefits

The Benefit Structure

The benefit structure defines what injured workers are entitled to receive when they sustain an injury “arising out of and in the course of” their employment.

There are six basic types of workers’ compensation benefits available, depending on the nature, date, and severity of the worker’s injury:

  1. Medical Care
  2. Temporary Disability Benefits
  3. Permanent Disability Benefits
  4. Vocational Rehabilitation Services
  5. Supplemental Job Displacement Benefits
  6. Death Benefits
Workers_Compensation_Benefits
Medical Care

Injured workers are entitled to receive all medical care reasonably required to cure or relieve the effects of the injury/illness, with no deductible or co-payments by the injured worker. Reasonable medical treatment required to cure or relieve the effects of an industrial injury/illness means treatment that is based upon the guidelines adopted by the administrative director or, prior to the adoption of those guidelines, the update American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines.

Generally, the employer controls the medical treatment for the first 30 days after the injury is reported, and the employee is then free to select any treating physician or facility. However, if the employee has notified the employer in writing prior to the injury that he or she has a “personal physician” — a physician or surgeon who has previously treated the employee — the employee may be treated by that physician from the date of injury. Choice of treating physician differs; however, if the employer has developed a state certified Medical Provider Network.

Temporary Disability Benefits

Those workers unable to return to work within three days are entitled to temporary disability benefits to partially replace wages lost as a result of the injury. The benefits are generally designed to replace two-thirds of the lost wages, up to a maximum of $840 per week.

Temporary disability benefits are payable every two weeks, on a day designated with the first payment, until the employee is able to return to work or until the employee’s condition becomes permanent and stationary.

Many County employees are entitled to salary continuation benefits that are paid in lieu of state rate temporary disability benefits. Certain classes of County employees are entitled to statutorily derived benefits that exceed the state temporary disability rate.

Permanent Disability Benefits

Injured workers who are permanently disabled – those who have a permanent labor market handicap — are entitled to receive permanent disability benefits. A worker who is determined to have a permanent total disability receives the temporary disability benefit – up to $840 per week – for life. A worker determined to have a permanent partial disability receives weekly benefits for a period which increases with the percentage of disability, from four weeks for a one percent permanent disability up to 694.25 weeks for a 99.75 percent disability. Permanent partial disability benefits are also payable at two-thirds of the injured worker’s average weekly wages, but are subject to a much lower maximum. As of Jan. 1, 2004, the rates are $220 per week for disabilities less than 69.75 percent and $270 per week for disabilities rated at 70 to 99.75 percent. Those with a permanent partial disability of 70 percent or more also receive a small life pension – a maximum of $257.69 per week – following the final payment of permanent partial disability benefits.

The percentage of permanent disability is determined by using the Permanent Disability Rating Schedule and an assessment of the injured worker’s permanent impairment and limitations.

The Permanent Disability Rating Schedule specifies standard percentage ratings for permanent impairments and limitations, and provides for the modification of these standard ratings based on the injured worker’s age, occupation, and considers the employee’s diminished future earning capacity. The standard rating is adjusted for age by lowering the rating for younger workers and increasing it for older workers on the theory that it is easier for younger people to adjust to a permanent handicap. The standard rating is adjusted for occupation by increasing the rating if the permanent impairment or limitation will be more of an impediment in performing the worker’s occupation, and lowering the rating if it will have a lesser impact.

Vocational Rehabilitation Services (for injuries before Jan. 1, 2004)

Injured workers who are unable to return to their former type of work are entitled to vocational rehabilitation services if these services can reasonably be expected to return the worker to suitable gainful employment. This includes the development of a suitable plan, the cost of any training, and a maintenance allowance while participating in rehabilitation.

Once an injured worker is determined unable to return to his or her previous type of work, the employer and worker jointly select a rehabilitation counselor who will determine whether vocational rehabilitation is feasible, and if appropriate, develop a suitable rehabilitation plan. The goal of a rehabilitation plan is to return the injured worker to “suitable gainful employment” – employment or self-employment that is reasonably attainable and which offers an opportunity to restore the injured worker as soon as practicable and as near as possible to maximum self-support.

The maintenance allowance payable to an injured worker while in rehabilitation is, like temporary disability benefits, designed to replace two-thirds of lost earnings, but the maximum weekly amount is lower – $246 per week. The worker may, however, supplement the maintenance allowance with advances of permanent disability benefits up to the point where the worker is receiving the same weekly amount as he or she received in temporary disability benefits. Total costs for rehabilitation are now limited to $16,000 for workers injured on or after Jan. 1, 1994.

For dates of injury on or after Jan. 1, 2003, injured workers who have legal representation may settle vocational rehabilitation for a lump sum. Vocational rehabilitation does not apply for dates of injury after Jan. 1, 2004.

Supplemental Job Displacement Benefit (for injuries on or after Jan. 1, 2004)

This is a nontransferable voucher for education-related retraining or skill enhancement, or both, payable to a state approved or accredited school if the worker is injured on or after Jan. 1, 2004. To qualify for this benefit, the injury must result in a permanent disability, the injured employee does not return to work within 60 days after temporary disability ends, and the employer does not offer modified or alternative work. The maximum voucher amount is $10,000.

Death Benefits

In the event a worker is fatally injured, reasonable burial expenses, up to $5,000, are paid. In addition, the worker’s dependents may receive support payments for a period of time. These payments are generally payable in the same manner and amount as temporary disability benefits, but the minimum rate of payment is $224 per week. The total aggregate amount of support payments depends on the number of dependents and the extent of their dependency. Generally, the maximum (where three or more total dependents are eligible) is $160,000, though additional benefits are payable if there continues to be any dependent children after the basic death benefit has been paid.

Class of Benefits

2002

2003

2004

2005

2006

Temporary Disability

Minimum

Actual Wages

$126

$126

$126

$126 *

Maximum

$490

$602

$728

$840

$840 *

Permanent Disability Minimums

<15%

$70

$100

$105

$105

$130

15-24.75

$70

$100

$105

$105

$130

25-69.75

$70

$100

$105

$105

$130

70-99.75

$70

$100

$105

$105

$130

Permanent Disability Maximums

<15%

$140

$185

$200

$220

$230

15-24.75

$160

$185

$200

$220

$230

25-69.75

$170

$185

$200

$220

$230

70-99.75

$230

$230

$250

$270

$270

Death Benefit Maximums
Single total dependent

$125,000

$125,000

$125,000

$125,000

$250,000

No total dependents and one or more partial dependents

$125,000

$125,000

$125,000

$125,000

$250,000

Single total dependent and one or more partial dependents

$145,000

$145,000

$145,000

$145,000

$290,000

Two total dependents

$145,000

$145,000

$145,000

$145,000

$290,000

Three or more total dependents

$160,000

$160,000

$160,000

$160,000

$320,000

Life Pension
Weekly Wage to determine maximum life pension benefits

$257.69

$257.69

$257.69

$257.69

$515.38

* Increased thereafter by the percentage increase in the State Average Weekly Wage [LC 4453 (a) (10)]

Return-to-Work

The purpose of the Return-to-Work Unit (RTW) is to provide a standardized procedure to aid RTW coordinators, supervisors and managers in implementing RTW principles in their efforts to assist injured/ill employees to return to work and manage their cases.

Visit Return-to-Work Unit (RTW)

Los Angeles County Contacts

Alex Rossi
(213) 738-2154
arossi@ceo.lacounty.gov

Tony Taras
(213) 351-6405
ataras@ceo.lacounty.gov

Joe Carrillo
(714) 480-4422
jcarrillo@ceo.lacounty.gov

Rose Bloom
(626) 463-6182
rbloom@ceo.lacounty.gov

Toni Vu
(714) 543-0700 ext. 1161
tvu@ceo.lacounty.gov

Pam Kennedy
(626) 463-6183
pkennedy@ceo.lacounty.gov

Paige Patterson
(714) 480-4421
epatterson@ceo.lacounty.gov

Third Party Contacts

Frequently Asked Questions

No. You do not need to provide the claim form (DWC-1) and complete the employer’s report (5020) unless the injury results in lost time or the employee requires medical treatment. Departments may require supervisors to complete incident reports documenting when, how, and what occurred. You should contact your department management to find out if they have an incident reporting policy.
Yes. You must provide the claim form (DWC-1) and complete the employer’s report (5020). Document your concerns to the workers’ compensation third party administrator. It is their job to investigate the claim and determine if it is work related. Filing the paperwork promptly expedites the compensability determination and benefits all parties.
If you have this concern, contact your workers’ compensation third party administrator claims examiner. The claims examiner will assist you in obtaining clarification regarding the employee’s ability to return to normal duties.
The workers’ compensation third party administrators are contracted to process industrial injury cases in accordance with County standards, state statute, and all applicable workers’ compensation laws. This includes investigating workers’ compensation claims, determining entitlements, issuing notices, and delivering benefits within with statutory timeframes.
Contractual requirements include: program development, claims management, monitoring medical treatment, assisting injured workers resolve workers’ compensation issues, supporting County department return-to-work efforts, attending claim status reviews, and identifying and investigating potentially fraudulent workers’ compensation claims.
You should contact the County Quality Assurance Evaluator, often called a County Monitor, which is headquartered at the workers’ compensation third party administrator or contact the County Contract Administrator at (213) 738-2154.
All employers must post and keep posted in a conspicuous location a notice to employees that provide employees with useful and important workers’ compensation information. This notice must be posted in English and Spanish where there are Spanish speaking employees. These notices must be posted at all County of Los Angeles locations frequented by employees during the hours of the workday.
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