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WORKERS PENSION - PAGE 2

Q. Who decides where an injured employee receives medical treatment?

A. The employer is responsible for arranging medical treatment for the first 30 days from the date of injury. If, prior to an injury or illness, an employee gives written notice to the employer selecting a personal physician, then the employee may go to this physician for treatment immediately after an injury.

Q. Where can employees or employers get more information concerning workers’ compensation benefits?

A. Questions about the workers’ compensation laws, claims process and/or benefits should be directed to an Information and Assistance Officer at one of the district offices of the Division of Industrial Accidents, Department of Industrial Relations. (See Exhibit I for a list of the district offices).

Q. What happens if an employee disagrees with the insurance company on a workers’ compensation claim denial?

A. The employee may request assistance from an Information and Assistance Officer who will attempt to help resolve the dispute informally. If that effort fails, the employee can file an application for adjudication with the Workers’ Compensation Appeals Board,
(WCAB). The Information and Assistance Officer may be able to assist with this filing unless the injured worker has retained a private attorney. The WCAB has exclusive jurisdiction for resolution of the dispute.

Q. As a sole employer or the sole owner/employee of a business, can I obtain workers’ compensation insurance to cover myself?

A. Individual employers may be included for workers’ compensation at the option of the insurance company. The inclusion must be clearly stated in the policy, or by an endorsement to the policy. If an individual employer is included, the remuneration earned by such a person during the policy period will be used as the basis of premium development, subject to a specified minimum and maximum. The California Workers’ Compensation Uniform Statistical Reporting Plan-1995, published by the Workers’ Compensation Insurance Rating Bureau (WCIRB) effective January 1, 1995, establishes minimum remuneration of $22,100 and a maximum of $62,400 for this situation (Note: with Open Rating each insurer can establish its own minimum and maximum remuneration and file same with the CDI).

Q. What is my status as an active partner in a business described as a partnership? Does the policy provide coverage for me in this situation?

A. The definition of employee includes all working members of a partnership receiving wages irrespective of the profits from the partnership. The California Labor Code has a special provision for partners. You should refer to the policy provisions and/or consult
with your agent or broker and insurer for the further details.

Q. Are executive officers covered under the workers’ compensation policy?

A. The inclusion of all corporate officers or directors is mandatory unless the corporation is solely owned by the directors and executive officers. In the latter case, the officers and directors may elect to be excluded from coverage. Again, because of special provisions in the Labor Code for executive officers of solely owned corporations, consult with the agent, broker and insurer for further details.

Q. What happens if my employer does not carry Workers’ Compensation Insurance?

A. You may be able to file a claim with the Uninsured Employers Fund, (U.I.F.). This Fund is located within the Department of Industrial Relations. You should contact Information and Assistance Officer for help in pursuing a claim with U.I.F.

Q. As an employer, where can I obtain workers’ compensation insurance?

A. You can secure workers’ compensation insurance from any licensed insurance company that writes this coverage in California. You may also obtain the required coverage from the State Compensation Insurance Fund. Consult your local Yellow Pages under Insurance for names of companies, agents or brokers offering coverage.

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