Guides / For employers
Guide · 6 min read

An Employee Filed a Workers’ Comp Claim: California Employer’s Guide

What California employers must do when an employee files a workers’ comp claim: the one-working-day claim form duty, the 90-day decision window, what the claim actually costs in TD and PD dollars, the levers that control cost, and the mistakes that turn a claim into a lawsuit.

An employee just handed you a claim form — or told you they got hurt. What you do in the next one working day is scripted by statute, and what the claim ultimately costs is arithmetic you can check yourself. This is the employer’s side of the system, written plainly.

The first 24 hours

On notice of injury you must provide the DWC-1 claim form within one working day (§5401), get the worker medical care, and report to your carrier. Prompt paper protects you: the claim’s timeline, the treatment path, and the eventual rating all run cleaner when the first day is done right. Change nothing about the worker’s job status because they filed — §132a makes retaliation a separate, uninsurable liability.

The 90-day window

Your claims administrator has 90 days to accept or deny, or the claim is presumed compensable (§5402) — and up to $10,000 of treatment must be authorized while the decision is pending. Denial is a real option for a real dispute; a reflexive denial of a legitimate claim just adds penalty exposure and attorney involvement to everything that follows.

What the claim actually costs

Three streams, all computable. Temporary disability: two-thirds of wages, tax-free, capped at $1,764.11/week for 2026 injuries (a $1,200/week employee draws $800), generally limited to 104 weeks (§4656). Medical: the treatment itself plus any future-medical award. Permanent disability, priced by the schedule at the 2026 maximum:

10% PD · 2026 max
30.25 weeks × $290 = $8,772.50
30% PD
131 weeks × $290 = $37,990
50% PD
271.25 weeks × $290 = $78,662.50

The quieter cost is your experience modification: claim dollars feed your X-Mod and raise premium for the three policy years that follow — which is why a percentage point of PD that was never checked costs more than the check itself.

Your levers

You control more than most employers use. A medical provider network keeps treatment with doctors who know occupational medicine. A written return-to-work offer within 60 days of P&S heads off the §4658.7 job-displacement voucher and shortens the wage-loss tail. And when the rating lands, verify it: a QME’s WPI runs through the 2005 PDRS pipeline — occupation, age, the ×1.4 — and the calculator prices the string in seconds, the same math both sides’ attorneys run. Reserve-setting from day one is its own discipline: how to set PD reserves.

The mistakes that multiply

Skipping insurance is a crime (§3700.5) with stop-work orders and personal exposure — the UEBTF pays the worker and then pursues you. Paying an injury “off the books” to protect the X-Mod backfires the moment care gets expensive. Firing the claimant creates a §132a claim your carrier does not cover — the worker-side view shows exactly how that plays. Late TD checks add automatic 10% penalties on the §4650 clock. Timelines for the whole arc: how long cases take.

Estimates for informational use; not legal advice — coverage and defense questions belong with your carrier and counsel.

Rate your spine right here

Same engine as the tables above — pick your occupation and age, slide the WPI from the report, and carry it into the full calculator when you’re ready.

Loading the engine…

FAQ

What do I do when an employee reports a work injury in California?
Provide the DWC-1 claim form within one working day of notice (§5401), send the employee for treatment, and report the claim to your carrier immediately. The claims administrator then has 90 days to accept or deny (§5402) — and must authorize up to $10,000 in treatment while deciding. The one thing you must not do is treat the worker differently for filing: §132a makes retaliation separately compensable.
How much will a workers’ comp claim cost my business?
Directly, the carrier pays: temporary disability at two-thirds of wages (capped at $1,764.11/week for 2026 injuries), medical care, and permanent disability by percentage — engine-computed at the 2026 maximum, 10% PD totals $8,772.50 and 50% totals $78,662.50. The lasting cost is your experience modification: claim dollars raise your premium for the three policy years that follow.
Can an employer dispute a workers’ comp claim?
Yes — through the process, not self-help. The administrator can investigate and deny within the 90-day window, dispute treatment through utilization review, and contest the level of disability through the QME process and rating review. What an employer cannot do is skip insurance (§3700.5 makes that a crime with stop-work orders) or punish the filer (§132a).
Rate a real case — free
Every step in this guide, computed for you in under a minute.
Open the calculator
Settlement calculatorDeadline calculatorMoney chartString decoderThe 2005 PDRSAll eleven tools
Setting PD reservesAll guidesThe QME exam