Work Injuries

Not every injury does, and if yours does not, we will tell you on the phone. These are the moments when one usually matters.

• Surgery was recommended, or done.

  You are heading toward a permanent disabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week. rating, and after surgery the rating stringRating string The row of numbers encoding your entire permanent disability calculation. Checkable arithmetic. goes wrong regularly. A shoulder’s distal clavicle resection carries a fixed value and is routinely buried in the operative report.

• Treatment is being denied.

  You are inside the utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out. and IMRIMR Independent Medical Review. The appeal from a UR denial. 30 days (10 if the dispute is only over drugs on the MTUS Drug List). machinery, and every step of it has a deadline.

• A QME panel arrived.

  The evaluator’s report is the single most consequential document in a contested claim, and a judge will rarely disturb it. The specialty and timing rules are unforgiving.

• The rating came back lower than you hurt.

  Almaraz/GuzmanAlmaraz/Guzman The doctrine permitting a physician to depart from the strict AMA rating where it does not accurately reflect the impairment, using another method inside the “four corners” of the Guides. is the route to a more accurate rating when the strict AMA Guides number plainly fails to describe your actual impairment.

• Apportionment is being asserted.

  That some of your disability comes from age, a prior injury, arthritis, or something non-industrial. A percentage assigned without reasoning is not substantial evidenceSubstantial evidence The standard a medical opinion must meet to support a finding..

• Your other side started hurting.

  Overusing the uninjured limb is a compensable consequenceCompensable consequence A new problem caused by the original injury or its treatment. Overusing the other side, the joint above or below, a surgical complication. of the original injury, and so is the back you hurt because of the limp. It has to be claimed.

• The injury is catastrophic.

  For nine listed conditions, temporary disabilityTD / TTD / TPD Temporary Disability, Total or Partial. Wage replacement while recovering. Two-thirds of average weekly earnings; 2026 maximum $1,764.11/week. runs 240 weeks instead of 104, and it is routinely missed.

• It built up over years, with no accident.

  Cumulative traumaCT — Cumulative trauma Injury from repeated exposure over time. The largest injury category in California and the least claimed. is a recognized claim, and the date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this. is when you first suffered disability and knew, or should have known, it was work-related.

Call the same day if the claim was denied, you were fired or punished for filing, or more than a year has passed with nothing paid. Those involve deadlines that cannot be fixed once missed.

And when you probably do not need us. If the claim was accepted, treatment is being authorized, payments are arriving every two weeks, and there is no permanent impairment, you probably do not. Every DWCDWC Division of Workers’ Compensation, part of the Department of Industrial Relations. Administers the system. Information Services Center: 1-800-736-7401. district office has an Information & Assistance officer who answers questions and helps with forms at no cost. We will tell you that on the phone, too.

Whatever the body part, the same benefits are on the table, and each one comes with a number you can check. The pages above say how your injury is rated. These are what the rating sits beside, and most of them are owed whether or not there is ever a rating at all.

Four clocks run in the first ninety days. One is yours: telling your employer. The other three run against the insurer, and they start when your employer learns of the injury and you file the claim form, which is why both should happen at once. Your employer has to give you the claim form within one working day of learning of the injury.

The longer clocks run in years, and they have exceptions that save claims. Generally one year from the date of injury, or from the last benefit provided, to open a case at the Appeals Board, and five years from the date of injury to reopen one for new and further disability. Before you assume either has run, call.

Whatever the injury, the claim ends in the same row of numbers. It is called a rating string. It is the entire arithmetic of your permanent disability compressed into one line, and every element is checkable.

And it must be arithmetically self-consistent. In the example above, 8 × 1.4 = 11.2, which rounds to 11. If the impairment and the multiplier do not produce the adjusted figure, something is wrong, and that is checkable with a calculator.

These are the places a rating string goes wrong most often. Each one can be checked against the reports already in your file.

The injury pages above tell you how the number is built. A call tells you whether yours is right. You do not need the paperwork to call: tell us what you remember, and the documents can come later.