Duyệt tất cả câu hỏi

1. Under California Labor Code §3700, which employers are required to carry workers' compensation insurance?

California is the strictest state in the nation on this point: Labor Code §3700 requires every employer with even one employee to either carry a workers' compensation policy from an admitted insurer or obtain approval to self-insure. There is no small-employer exemption based on headcount, industry, or payroll size.

2. Workers' compensation in California is best described as which type of system?

California workers' compensation is a no-fault, statutory exclusive-remedy system. The injured worker does not need to prove the employer was negligent, and in turn the worker generally cannot sue the employer in tort for a work injury. The trade-off is automatic, defined benefits regardless of who was at fault.

3. The standard Workers' Compensation and Employers Liability policy is divided into two main coverage parts. What does each part cover?

Part One — Workers' Compensation pays the statutory benefits required by the state's WC law and has no dollar limit because the obligation is whatever the statute requires. Part Two — Employers Liability protects the employer against employee-related lawsuits that fall outside the WC system, such as dual-capacity, consequential-bodily-injury, third-party-over, and loss-of-consortium suits.

4. What is a possible penalty when a California employer is found operating without required workers' compensation coverage?

Failure to carry workers' compensation in California is a misdemeanor. Under Labor Code §3722, the Director of Industrial Relations may issue a stop-order halting business operations until coverage is in place, plus assess civil penalties (commonly cited at $1,500 per employee under the stop-order, with additional minimums). The employer also remains directly liable for any work injury costs.

5. What is the California minimum limit typically required for Part Two — Employers Liability coverage?

Part Two — Employers Liability is sold with three separate limits: bodily injury by accident (each accident), bodily injury by disease (policy aggregate), and bodily injury by disease (each employee). The California minimum customarily written is $1,000,000 for each of the three categories, often shown as 1M/1M/1M.

6. An injured employee unable to work while recovering from a workplace injury is entitled to temporary disability (TD) benefits. How is the TD rate generally calculated?

Temporary disability replaces a portion of lost wages while the worker recovers and cannot work. It is paid at two-thirds of the average weekly wage, subject to a statutory minimum and a maximum that is adjusted each year by the State Average Weekly Wage. TD is not a full wage replacement and it is not taxable.

7. Permanent disability (PD) benefits in California are paid based on what factor?

Once the worker reaches maximal medical improvement, a physician assigns an impairment rating using the AMA Guides as adopted in California's Permanent Disability Rating Schedule. The rating, adjusted for age and occupation, produces a percentage that determines the number of weeks and the dollar value of permanent disability benefits.

8. Under California law, how soon must an employer provide a DWC-1 claim form to an employee after receiving notice of a workplace injury?

Labor Code §5401 requires the employer to give the injured worker (or personally deliver/mail) the DWC-1 claim form within one working day after the employer learns of the injury. This short deadline is what triggers the formal claim process and the timeline for the insurer's investigation.

9. After a claim is filed, what is the maximum time the insurer has to either accept or deny the claim before the law presumes the injury is compensable?

Labor Code §5402(b) creates a 90-day presumption: if the claim is not denied within 90 days after the claim form is filed with the employer, the injury is presumed compensable, and that presumption is rebuttable only by evidence that could not have been discovered with reasonable diligence within the 90 days. (Initial medical treatment up to $10,000 must also be authorized during the investigation.)

10. Under California's ABC test (Labor Code §2775), a worker is classified as an employee — and therefore must be covered by workers' compensation — unless the hiring entity proves all three of which conditions?

Labor Code §2775 codifies the ABC test from Dynamex / AB 5. To classify a worker as an independent contractor (and thereby avoid the WC obligation), the hiring business must prove ALL THREE prongs: (A) freedom from control and direction, (B) the work is outside the hirer's usual course of business, and (C) the worker is customarily engaged in an independently established trade or business of the same nature.

11. A California corporation has one shareholder who is also its sole officer. Which statement about that owner's workers' compensation coverage is correct?

Labor Code §3351 (with §3352) lets corporate officers who own a sufficient share of the company — including a sole shareholder who is also an officer — sign a written waiver and exclude themselves from coverage. The exemption must be in writing and is filed with the insurer. Regular employees of that corporation still must be covered.

12. A licensed general contractor hires an unlicensed framer who has no workers' compensation insurance, and the framer is injured on the job. Who is most likely responsible for providing workers' compensation benefits?

Labor Code §2750.5 creates a strong presumption that any worker performing services requiring a contractor's license without holding one is the EMPLOYEE of the hiring contractor — not an independent contractor. The general contractor's workers' compensation policy then has to respond, regardless of any side agreement that labeled the framer a 'sub.'

13. What does an employer's Experience Modification Factor (X-Mod) measure for workers' compensation purposes?

The X-Mod is calculated by the Workers' Compensation Insurance Rating Bureau (WCIRB) by comparing the employer's actual losses over a recent multi-year period to the average expected losses for businesses of the same class codes and payroll size. An X-Mod of 1.00 means average; below 1.00 lowers premium; above 1.00 raises premium.

14. An employee is injured at work when a delivery driver from an unrelated company runs a red light and hits him. The WC insurer pays his medical bills and disability. What right does the insurer have against the at-fault driver?

Workers' compensation is the exclusive remedy against the EMPLOYER, not against unrelated third parties. Labor Code §3852 lets the WC insurer subrogate against the third party who caused the injury and recover what it paid in benefits, either by filing its own action, joining the employee's lawsuit, or asserting a lien on the employee's recovery.

15. An employee is injured working for an employer who illegally has no workers' compensation insurance and refuses or is unable to pay benefits. Which California program pays the injured worker?

The Uninsured Employers Benefits Trust Fund, administered by the Division of Workers' Compensation under Labor Code §3716, is a state safety net that pays workers' compensation benefits when an illegally uninsured employer cannot or will not pay. The UEBTF then pursues the uninsured employer to recover what it paid out.

16. An injured worker reaches maximal medical improvement with permanent restrictions and the pre-injury employer cannot offer modified or alternate work. What benefit is the worker generally entitled to?

Under Labor Code §4658.7, a worker with permanent partial disability whose employer cannot offer regular, modified, or alternative work within a set window receives a Supplemental Job Displacement Benefit voucher (currently up to $6,000) that can be used for tuition at California-approved schools, books, tools, certification fees, and other career-retraining costs.