California Workers' Compensation Flowchart: Step‑by‑Step Guide

Key Differences in California's Process

California requires a written injury report within seven days, a medical evaluation by a California‑licensed physician, and mandatory participation in the State Disability Insurance (SDI) program, unlike many states that rely on private insurers alone.

Initial Reporting and Medical Evaluation

1. Employee notifies employer of injury or illness.2. Employer provides the DWC 1‑Form (Employee Claim Form) within seven days.3. Employee seeks medical care from a California‑approved doctor; the physician completes the DWC 2‑Form (Medical Treatment Worksheet).

Claim Filing and Employer Response

4. Employer files the completed DWC 1‑Form with the Workers' Compensation Insurance Rating Bureau of California (WCIRB) within ten days.5. Employer submits the employer's claim notice (Form DWC‑3) to the insurer and the employee.

Insurance Review and Dispute Resolution

6. Insurer reviews the claim and either accepts, offers a settlement, or issues a denial.7. If denied, the employee can request a hearing before the Workers' Compensation Appeals Board (WCAB) within 30 days.

Benefits Determination and Ongoing Management

8. Approved claims receive temporary disability (TD) benefits, medical treatment, and, if applicable, permanent disability (PD) benefits.9. The employer must provide a safe‑return‑to‑work plan and may be required to contribute to SDI reimbursements.

Closure and Post‑Claim Options

10. Claim closes when the employee reaches maximum medical improvement (MMI) or a settlement is reached.11. After closure, the employee may still appeal the benefit determination within 180 days.

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