FAQs

Any injury or illness that is caused by the job is covered by workers’ compensation. The phrase often used is “arising out of or in the course of employment.”

These injuries can fall into two categories:

• Those that occur from a specific event at work that causes the injury. These include but are not limited to incidents such as a back strain from lifting, being burned by a hot surface, or getting a particle in the eye.
• Repeated or cumulative injuries that occur over time. Examples are carpal tunnel syndrome from performing the same motion repeatedly, hearing loss from working in a loud environment and respiratory disorders from breathing a hazardous substance.

Per California law, all work-related injuries including first aid injuries (Learn more about first aid injuries) are to be reported to their insurance carrier as soon as possible. Time restrictions that govern how we may manage the claim are based on the employer's date of knowledge, not Preferred Employers’ date of knowledge.

California’s Labor Code defines first aid as, any physician directed one-time treatment and follow-up visit for the purpose of observation of minor scratches, cuts, burns, and splinters or other minor industrial injuries, which do not ordinarily require medical care.

A Medical Provider Network (referred to as an MPN) is a group of doctors and other health care providers that are established by an insurance company or large self-insured employer to treat workers injured on the job.

Each Medical Provider Network must be approved by the California Division of Workers’ Compensation and must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. These doctors also understand specific reporting and treatment requirements which are specific to occupational injuries.

Preferred Employers is one of the only, if not the only Worker’s Compensation carriers to directly contract their Medical Provider Network (MPN). This benefits injured workers and policyholders by streamlining medical treatment and facilitating direct communication between Preferred Employers, the injured worker and the policy holder driving better outcomes.

Click on the “Find A Doctor” on the Help Injured Workers page of our website.

After the initial appointment, a newly injured employee may choose from any doctor within the Preferred Select MPN network.

An employee may go to a physician outside of the MPN if he/she has pre-designated a personal physician before a work injury occurs.

There are specific criteria that allow an employee to pre-designate a personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or medical group if: Your business must offer employees group health coverage.

• The doctor the employee designates is their regular physician. He or she shall be either a physician who has limited their medical practice to general practice or is a board-certified or board eligible internist, pediatrician, obstetrician, gynecologist, or family practitioner, and has previously directed their medical treatment and retains the employee’s medical records.
• The “personal physician” may be in a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multi-specialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries.
• Prior to the injury, the employee’s doctor must agree to treat the employee for work injuries or illnesses.
• Prior to the injury, the employee must provide the employer the following in writing:
  • Notice that the employee wants their personal doctor to treat a work-related injury or illness, and
  • The personal doctor’s name and business address.

This form can be used by the employee to notify the employer.

Medical Care: On behalf of the employer, Preferred Employers will pay all medical treatment necessary to cure or relieve the effects of a work-related injury or illness. This includes physician services, hospitalization, physical restoration, dental care, prescriptions, X-rays, laboratory services, mileage reimbursement and all other necessary and reasonable care ordered by the treating doctor.

Temporary Disability (TD): When a physician states the injured employee is unable to return to work because of a work- related injury or illness and the employer does not offer the employee modified work that pays or replaces a portion of the employee’s usual wage, then the employee is eligible for TD benefits.

Temporary disability benefits begin after the employee misses 3 days of work. If the employee misses more than 14 days of work, then the employee is entitled to wage replacement for the first 3-day period as well.

Temporary disability benefits are two-thirds of the gross (pre-tax) weekly wages the employee received before the injury. The amount cannot be less than the minimum weekly amount or more than a maximum weekly amount as set by law. For most injuries there is a 104 week cap for temporary disability benefits if the employee is not able to return to work sooner.

Permanent Disability (PD): An employee becomes eligible for PD benefits if an injury or illness results in permanent impairment. Having a permanent disability does not necessarily mean you cannot return to your job. It simply means that the employee’s ability to compete in the open labor market may be reduced, or they have diminished ability to complete daily living activities.

A disability is considered permanent after an employee has reached “maximum medical improvement” or his or her condition has been stationary for a reasonable period. The term you will hear is “permanent and stationary." PD benefit amounts are set by law and paid every two weeks until the benefit is completely paid or when the employee settles the case and receives a lump sum.

Supplemental Job Displacement Benefit: Employees injured on or after Jan. 1, 2004, who are permanently unable to do their usual job, and whose employer does not offer other work, may qualify for this benefit. It is in the form of a voucher that promises to help pay for educational retraining or skill enhancement, or both, at state-approved or state-accredited schools. Making an offer of modified or alternative work can determine worker eligibility.

Employees who do not return to work for their employer within 60 days of the last temporary disability payment may receive a voucher. Employees will not be eligible for the supplemental job displacement benefit if within 30 days of the end of temporary disability payments, the employer makes an offer of modified or alternative work and the employee rejects or fails to accept the offer.

Death Benefits: Benefits are payable to a surviving spouse and dependent(s). Benefits continue for the dependent(s) until they reach 18 years of age. Burial expenses are also included, not to exceed $10,000.

No, you don’t have to, but by providing modified work, claims costs can be contained. There are several other benefits to offering modified work:

• Having the employee come to work even for a shortened workday keeps the employee in a “work routine”.
• Productivity levels don’t drop off from being short a person or having to train a person to perform the injured employee’s job.
• A return to work program reflects well on the company and work environment.
• Studies have shown bringing someone back to modified work improves communication between the employer and injured work, shortens overall recovery time and also mitigates litigation.

If you have questions or valuable information regarding a claim, we encourage you to chat with one of our Customer Service Representatives via our Preferred Digital Assistant www.peiwc.com or email [email protected]. You may also contact our Claims Examiners toll free at 888-472-9001. The Claims Examiner can provide information about claims costs, medical treatment status, eligibility of the injured worker to return to work, any suspicions we have regarding claim legitimacy, and other information.

Under California and Federal law, injured worker medical records are considered protected documents and access to these records is restricted. Preferred is able to share the following information with employers we insure:

• The diagnosis of injury or illness for which workers' compensation is claimed.
• The treatment provided for the claimed injury or illness.
• Medical information that is necessary to allow the employer to modify the employee's work duties.

Investigation reports and statements usually contain sensitive and confidential information that directly impact the outcome of the claim. Because discretion is required with the timely release of the information contained in an investigation report, we do not share these reports. However, upon request, a copy of the statement transcript may be provided to the specific individual interviewed.

Yes, if an injured worker wants to make sure they qualify for all the benefits they may be eligible to receive from a work-related injury or illness. In the case of a fatal injury or illness, the form must be completed by a dependent of the injured employee, or by an agent of the deceased or dependent. If you do not file the claim form within a year of your injury, benefits for which there may be entitlement may be limited.

When the injured worker completes the claim form and returns it to the employer or insurance company, it often is what is used to open the workers’ compensation case. State law also lays out benefits for which the injured worker may qualify once the claim form is returned to the employer or insurance company. Those benefits include, but are not limited to:

• A presumption that the injury or illness was caused by work, if the claim is not accepted or denied within 90 days of giving the completed claim form to the employer or insurance company.
• Up to $10,000 for medical treatment, under medical treatment guidelines, while the claims administrator evaluates claim compensability.
• An increase in disability payments if payments are late.
• A way to resolve any disagreements that might come up between the injured worker and the claims administrator over whether the injury or illness happened on the job, the medical treatment received and whether payments for permanent disability benefits will be made.

The employer must provide, personally or by first class mail, a claim form (DWC-1) and a notice of potential eligibility for benefits (NOPE) to the injured employee, or in the case of death, to his or her dependents within one working day of receiving notice or knowledge of injury or illness which results in medical treatment beyond first aid or results in lost time beyond the date of injury or illness.

If you are a medical provider interested in joining the Preferred Select Medial Provider Network (MPN) please email your request and include your practice locations and specialty to [email protected].

Generally, the employer should be prepared to comply with a subpoena for employee records. When the subpoena is related to a claim for workers' compensation benefits, we recommend that the employer discuss the request with Preferred at the time the subpoena is received. We can guide you through the response process.

Cumulative trauma injuries and repetitive strain injuries and in broad terms used to refer to several distinct conditions that can be associated with repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained/awkward positions. Examples of conditions that may sometimes be attributed to such causes include but are not limited to: edema, tendinitis, carpal tunnel syndrome, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, medial epicondylitis, tennis elbow (lateral epicondylitis), trigger finger, radial tunnel syndrome, and focal dystonia.

As a rule, an injured worker is paid two-thirds of their gross (pre-tax) wages at the time of injury, with minimum and maximum rates set by law. An injured worker’s wages are calculated using all forms of income received from work: wages, food, lodging, tips, commissions, overtime and bonuses. Wages can also include earnings from work completed at other jobs at the time of injury. Proof of earnings must be provided to the claims examiner. The claims examiner will consider all forms of income when calculating Temporary Disability benefits.

Temporary Disability (TD) payments begin when the primary treating physician authorized to treat the work injury states usual work cannot be done for more than three days or someone is hospitalized overnight. Payments must be made by the insurance company every two weeks. Generally, TD stops when one can return to work, or when the doctor releases one to work, or says an injury has improved as much as it can.

There is a specified period from the date of injury that TD payments can be received.

1. If an injury happened between April 19, 2004 and Jan. 1, 2008, the TD payments won’t last more than 104 weeks from the date of the first payment for most injuries.
2. Those injured on or after Jan. 1, 2008 are eligible to receive 104 weeks of disability payments within a five-year period. The five-year period is counted from the date of injury.
3. Payments for a few long-term injuries, such as severe burns or chronic lung disease, can go longer than 104 weeks. TD payments for these injuries can continue for up to 240 weeks of payment within a five- year period.

Generally, Temporary Disability (TD) stops when one can return to work, or when the doctor releases one to work, or says an injury has improved as much as it can.

There is a specified period from the date of injury that TD payments can be received.

1. If an injury happened between April 19, 2004 and Jan. 1, 2008, the TD payments won’t last more than 104 weeks from the date of the first payment for most injuries.
2. Those injured on or after Jan. 1, 2008 are eligible to receive 104 weeks of disability payments within a five-year period. The five-year period is counted from the date of injury.
3. Payments for a few long-term injuries, such as severe burns or chronic lung disease, can go longer than 104 weeks. TD payments for these injuries can continue for up to 240 weeks of payment within a five- year period.

Medical Only/ Minor Temporary Disability Claims:  
Work injuries or illnesses that require only medical treatment or result in temporary disability can be resolved rather easily. Once the medical provider releases the injured worker to return to full work and medical bills are received and paid, the claim can be closed with appropriate benefit notices as required by law are issued.

Permanent Disability Claims :
If the injured worker loses time from work due to an injury or illness that resulted in permanent disability, the case can be resolved when there is an agreement between the injured worker and the claims administrator or a judge issues an order about the injured workers' compensation payments and future medical care that will be provided to the injured worker.

In order to protect the injured worker’s rights, whether or not the worker is represented by an attorney, settlements must be reviewed by a workers’ compensation administrative law judge, to determine whether they are adequate.

There are two different ways to settle a permanent disability case:

• Stipulations with Request for Award (Stips)
  • Payments – the injured worker and the claims administrator agree on the amount of temporary disability (if not already paid) or permanent disability payments you will receive. This is usually paid in bi-weekly payments.
  • Medical care - The claims administrator usually agrees to pay for medical care, if needed for the accepted work injury.
• Compromise and Release (C&R)
  • One payment - The claims administrator agrees on an amount to resolve all aspects of the injury. This is usually paid in a lump sum.
  • Medical care - If the lump sum includes the estimated cost of future medical care, the claims administrator will no longer pay for any additional care.

There a several ways to obtain claim forms and notices. You can do any of the following:

• Access our Online Resource Site or log onto secured Customer Connect website. 
• Chat with one of our Customer Service Representatives.
• Call our customer service hotline at 888-472-9001, then press 2 at the prompt.
• Send an email to [email protected].

Additional information can be located at the Department of Industrial Relations website: 

https://www.dir.ca.gov/dwc/DWC_FAQ.htm.