The Workers' Compensation Appeals Board and its Proceedings

If your claim is disputed - a guide to Workers' Compensation claim rights and procedures.

What if my claim is denied?
What is the Workers' Compensation Appeals Board?
How do I file a claim with the WCAB?
May I be represented by an attorney?
Is there a time limit for filing a claim?
What will it cost me to prove my claim?
Who has access to my WCAB file?
What must I do to cooperate?
How does my case come to hearing?
What if I am not satisfied with the Judge's decision?
Can my case be settled “out of court”?

What if my claim is denied, or what if I do not receive all the benefits to which I believe I am entitled?

The State Division of Industrial Accidents (DIA) can help you. Information and Assistance Officers (I&A Officers) are available through each Division of Industrial Accidents Office to answer your questions, and to provide informal impartial assistance to help you and the insurance carrier and/or employer resolve your dispute. Experience shows that many disputes are resolved in this manner. If you desire written information on Workers' Compensation rights or benefits, a copy of the Division of Industrial Accidents' pamphlet, THE INJURED WORKER: RIGHTS TO WORKERS' COMPENSATION BENEFITS AND HOW TO OBTAIN THEM, is available upon request.

If the Information and Assistance Officer is unable to help you, he or she will inform you of your rights, and the procedure to file an Application with a local office of the Workers' Compensation Appeals Board.

What is the Workers' Compensation Appeals Board (WCAB)?

The Workers' Compensation Appeals Board is a special court that hears and decides disputed Workers' Compensation claims. It maintains district offices staffed by Judges in the Division of Industrial Accidents' offices. They act in response to Applications and also appeals from Rehabilitation Bureau orders which they receive.

Hearings held in the local offices of the Workers' Compensation Appeals Board are similar to those held in any court. But, the procedures are less formal.

Evidence is normally presented in the form of medical reports and testimony taken under oath. The Workers' Compensation Judge's decision is legally binding on all parties.

Workers' Compensation Judges decide all disputes arising out of an industrial injury claim covered by state law. They do not hear civil or criminal matters, nor cases involving injuries to federal employees or persons covered under federal laws.

How do I file a claim with the WCAB?

Any person who may have a claim related to an on-the-job injury may file a claim with a local office of the Workers' Compensation Appeals Board by filing a completed Application for Adjudication of Claim form (DIA/WCAB FORM 1).

These forms are available at local offices of the Workers' Compensation Appeals Board. If you need assistance completing the forms, you may request the help of an Information and Assistance Officer, or an attorney, or representative of your choice. There is no fee for filing an Application with the Workers' Compensation Appeals Board.

The application form is filed in the Workers' Compensation Appeals Board local office located in the county where the injured employee lives or where the injury occurred. If there is no office in that county, it is filed at the closest Workers' Compensation Appeals Board office.

May I be represented by an attorney?

You have the right to be represented by an attorney or representative of your choice.

No attorney or representative may charge you a fee for representing you unless and until that fee is approved by a Workers' Compensation Judge. If you receive an award, the attorney's fee, which is normally 9 to 12 percent of the benefits awarded, is deducted from your award. The fee is paid directly to the attorney, or representative, by the employer or its insurance carrier.

Is there a time limit for filing a claim?

The Workers' Compensation laws contain certain time limits for filing a claim with the Workers' Compensation Appeals Board. In general, the Application must be filed within one year from the date of injury or the last date on which benefits were provided. There are other special time limits that apply in certain situations.

If the claim is not filed within the legal time limit, you may lose your right to pursue your claim. If you have any questions or doubts, contact an Information and Assistance Officer or an attorney of your choice immediately.

What will it cost me to prove my claim?

In most cases, if you have to obtain medical reports or medical examinations to help prove your claim, costs are reimbursed by the employer or the insurance carrier whether or not you receive an award for benefits. This also applies to reasonable costs spent by you, or your attorney, for such things as medical records and witnesses. If you have an attorney, he or she will usually schedule whatever medical evaluations are needed.

Who has access to my WCAB file?

Cases filed at the Workers' Compensation Appeals Board are public records, and may be inspected by anyone interested.

Since the parties are required by law to file all medical reports dealing with your claim at certain stages of the proceedings, your file will probably include medical reports that may be read by the public. In some cases, medical information may be sealed from public view. This is up to the Judge, and is not usually done unless it is requested and special circumstances make it necessary. Your case file may also contain documents relating to your employment history, earnings, other injuries and unpaid medical bills, if disputes exist over such issues. All are part of the public record.

What must I do to cooperate?

You must make it your business to attend all conferences, hearings, and depositions set in your case, unless you are excused. You will receive notice by mail of all such proceedings. It is your responsibility to be sure that your attorney, the insurance carrier and the Workers' Compensation Appeals Board have your correct address at all times while your claim is being litigated. Your failure to attend may delay a decision on your claim or even result in its dismissal.

The employer or carrier has the right to send you to physicians for examination at reasonable intervals. If you refuse to attend, without a good reason, your right to benefits may be suspended. You must also be sure to attend all medical examinations scheduled by your own representative or by the Workers' Compensation Appeals Board or other Division of Industrial Accidents Officials. If you fail to attend examinations without good reasons, and the doctor is not notified in advance, a claim may be made to recover the cost of the missed appointment from any award which you may receive. Also, your failure to attend hearings or medical appointments may delay bringing your case to a decision.

How does my case come to hearing?

Your case file remains inactive until any party requests a hearing by filing a Declaration of Readiness to Proceed (DIA/WCAB FORM 9) with the WCAB. The case may then be set on the calendar for a hearing before a Workers' Compensation Judge.

The hearing may be either a pre-trial conference or a trial. The purpose of a conference is to bring the parties together to see whether agreements can be reached, and if not, to see what matters must be decided by the Workers' Compensation Judge and to plan further proceedings. Testimony is not normally taken at a conference.

A trial may include taking of testimony and presentation of written documents in evidence, followed by submission of your case to the Judge for decision. All hearings are recorded by a court reporter. Your case is heard only by the Workers' Compensation Judge; there is no jury. The decision is normally issued by mail within several weeks after the case is heard.

Workers' Compensation trials are generally much shorter than those in civil courts. They last from one hour, in simple cases, to a full day, or more, in complicated cases requiring several witnesses. The time from filing of the Declaration of Readiness to Proceed to the date of hearing may vary depending upon the schedule at the Workers' Compensation Appeals Board office.

The entire length of time your case may take, from beginning to end, will also vary, depending on such factors as the type of injury, speed of your recovery, and complexity of the issues.

What if I am not satisfied with the Judge's decision?

Any party not satisfied with the Workers' Compensation Judge's decision has the right to petition the Workers' Compensation Appeals Board for Reconsideration. This is done by filing a petition at any Workers' Compensation Appeals Board Office within 20 days of the date of the decision (plus an additional five days if the decision was mailed). The Request for Reconsideration is reviewed by a panel of three of the seven Workers' Compensation Appeals Board commissioners.

They may affirm the decision or grant reconsideration. Any party unhappy with the Board's decision may go to the Court of Appeals and finally to the California Supreme Court. Certain time limits apply to seeking review by these courts. If reconsideration is not requested or if the Workers' Compensation Appeals Board and Appellate courts do not change it, the decision of the Workers' Compensation Judge is final and is legally binding on you, the employer and the insurance company.

Can my case be settled “out of court”?

It is the policy of the Division of Industrial Accidents, and the Workers' Compensation Appeals Board, to encourage the voluntary settlement of cases and to reserve trial time for cases which cannot be voluntarily settled.

A case may be settled at any stage in the litigation process. One common type of settlement is a “Compromise and Release”. This means the parties settle their disputes by agreeing to payment of a lump sum of money in return for closing the case. Any benefit may be settled, except the right to Vocational Rehabilitation (This may only be settled in special situations).

It is the responsibility of the parties to attempt negotiations in good faith to resolve cases without trial. Otherwise, the volume of cases filed with the Workers' Compensation Appeals Board could not be handled.

Once a Compromise and Release is approved, the Workers' Compensation Appeals Board loses power to make any further determinations on any of the issues settled.

If you do not want your case closed and wish the protection of an official award (such as further medical care), it may be possible to agree upon a “Stipulations With Request For Award” of benefits.

In either case, documents are prepared on forms available at the Workers' Compensation Appeals Board, and are submitted to a Workers' Compensation Judge. No settlement or stipulation is valid unless reviewed and approved by a Workers' Compensation Judge or the Workers' Compensation Appeals Board.