Most states of the United States, including California enacted the social insurance program known as workers compensation during the 1920s, making it the oldest social insurance program in existence. Another unique factor of the workers compensation system is that they are no-fault. This means that a worker receives benefits for an injury or illness that is on the job site or due to environmental factors related to the job without proving that someone else, including the employer is to blame for the debilitating condition.
The California workers compensation system presumes a trade off between employers and employees. Employees agree that workers compensation is the limited relief and benefits provided by the statues regarding workers compensation and the employers agree that the full benefits awarded to the employee will be paid promptly. In theory this system works, in practice, employers sometimes are slow to pay and employees sometimes seek additional benefits or damages, particularly when there is evidence that employer negligence caused the injury or illness.
California's no fault structure was actually fairly successful in eliminating the high level of litigation regarding employer negligence in causing the job site illness or injuries. Most litigation today is over different issues. Questions about whether or not the injury or illness was due to conditions on the job and whether the level of benefits due to an employee who is injured is appropriate.
In California, the workers compensation system is made up of three basic components. The benefit structure describes the entitlements to be received by an injured employee. The benefit delivery system is the method of payment to employees who have claims. The benefit financing system is the method by which employers fund their responsibility for payment to workers when an on the job accident occurs.
Benefit structure
Six basic types of benefits for workers who sustain job related injuries or accidents include: death benefits; supplemental job displacement payments; vocational rehabilitation programs; benefits for permanent disability; benefits for a temporary disability; and medical treatment.
The severity, location and duration of the injury will in large part determine which of the above benefits will be applied to a particular incident. For example, if the employer has a company physician then the employee must use that physician for the first 30 days of treatment, unless the company has received written notice prior to the injury that the employee has a different personal physician. Temporary benefits are intended to replace lost wages and are set at a weekly level of two thirds of the regular wages with a current maximum of $728.
Benefit Delivery
In California and in most other states, delivery of benefits is accomplished either through private insurance carriers approved by the State government or through stable employers who have are self-insured. The employer is expected to begin payments promptly so the injured employee does not suffer from lack of income due to the injury. A significant majority of claims are settled expeditiously and with no litigation. When a dispute does arise, a multi level review and appeal system is in place including workers' compensation referees from the Division of Workers' Compensation, The Workers' Compensation Appeals Board and the appellate courts if necessary.
Benefit Financing
Employers must finance the funding for workers' compensation benefits through one of three methods. Self-insurance, private insurance or through the State Compensation Insurance Fund. Self-insurance approval is granted only to large and stable organizations and governmental organizations and must post a security bond in most instances. Private insurance is obtainable from any of approximately three hundred private insurance companies in California. Pricing for private insurance companies is not regulated except through market competition. The employer may also purchase workers compensation benefits insurance through the State Compensation Insurance Fund.
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