If you get hurt on the job in California, workers' compensation is there to help. It covers medical bills and replaces lost wages so you can focus on healing instead of stressing about money. Employers are legally required to carry workers’ comp insurance, which means you don’t have to prove anyone was at fault to get benefits.
But here’s the catch; workers’ comp doesn’t always kick in right away. There’s a waiting period, eligibility rules, and a process that can sometimes feel frustratingly slow. When you’re counting on those lost wages to pay your bills, knowing when you’ll get paid and how much can make a big difference. Read on to find out if you qualify for wage replacement, when benefits start, how payments are calculated, and what to do if there’s a delay.
Who qualifies for lost wages in California?
To qualify for wage replacement benefits under California’s workers’ compensation system, your injury or illness must be work-related. This means the injury must have occurred while performing job duties or as a direct result of work conditions. Injuries sustained outside of work or due to misconduct typically don't qualify for benefits. However, not all work-related injuries happen suddenly. Conditions that develop over time, such as repetitive stress injuries or occupational illnesses like lung disease from chemical exposure, may also be covered.
In addition to being work-related, the injury must prevent you from performing your job. If you're completely unable to work due to your injury, you may be eligible for temporary disability (TD) benefits. However, if you can return to work with modified duties or restrictions, your benefits may be adjusted based on any reduction in earnings. In cases where you can perform some tasks but at a lower capacity, temporary partial disability benefits may provide supplemental wage replacement.
Finally, a doctor must verify your work restrictions for you to receive benefits. This involves following a treatment plan, attending scheduled medical appointments, and complying with any work restrictions set by your doctor. Your medical report will determine whether you qualify for total or partial disability benefits.
What is the timeline for lost wages in California?
By law, California has a three-day waiting period before TD benefits start. This means that for the first three days you're unable to work, you typically won't receive wage replacement. However, there are important exceptions to this rule that can impact when payments begin. In some cases, benefits start right away. If the injury requires hospitalization for at least one night, the waiting period is waived, and TD benefits begin immediately. Additionally, if your disability lasts more than 14 days, you should receive retroactive payments covering those first three days.
If the claim is approved, payments will continue every two weeks until the worker is cleared to return or reaches maximum medical improvement. However, not all claims are processed immediately. If an insurance company needs more time to investigate, they must notify you in writing and provide an update on your claim’s status. While insurers have up to 90 days to accept or deny a claim, you shouldn't be left without income. In cases where benefits are delayed, you may apply for State Disability Insurance through the Employment Development Department as a temporary solution.
How are lost wages in California calculated?
Workers' compensation wage reimbursement in California is based on the severity of the injury and the worker’s pre-injury earnings. TD benefits pay two-thirds (66.67%) of average weekly wages, with 2025 rates ranging from $252.03 to $2,520.43 per week, depending on the state average weekly wage (SAWW). Temporary partial disability (TPD) benefits supplement income for workers earning reduced wages due to injury. For lasting but non-total impairments, TPD benefits range from $160 to $290 per week, based on disability percentage.
What causes delays in lost wage benefits?
Workers' compensation benefits don’t always arrive smoothly. Delays and disputes often arise due to claim errors, employer challenges, or insurance investigations. One common issue is missing or incomplete paperwork, which can stall payments. Make sure you file any reports on time, provide medical documentation, and follow up with your employer to prevent unnecessary delays.
Additionally, employers or insurance companies may dispute your injury’s work-relatedness, claim a pre-existing condition caused the disability, or argue that you can perform modified duties. In such cases, the insurance company may delay or deny benefits pending further review. You can challenge these decisions by requesting a Qualified Medical Evaluator assessment or filing a dispute with the California Division of Workers' Compensation. To avoid jeopardizing your claim, it's important to get assistance from an experienced workers' compensation lawyer in California.
Plus, if your employer's insurance company unreasonably delays payments, you may seek penalties against the company. Insurance companies must pay a 10% penalty for late payments without justification. In cases of repeated delays or wrongful denials, a workers' compensation lawyer can help get the benefits owed to you.
Don’t let the system take advantage of you
Getting hurt on the job is stressful enough, but you shouldn’t have to fight for the benefits you’re legally entitled to. The reality is that insurance companies often delay, deny, or dispute claims to protect their bottom line. This could leave you without the care and financial support you need. The San Diego workers' compensation lawyers at Robert A. McLaughlin don’t let that happen. Whether you’ve been hurt in a slip and fall, suffered a repetitive motion injury, faced toxic exposure, or experienced a serious workplace accident, our team is here to make sure you get the medical treatment and wage replacement benefits you deserve.
We take care of the legal aspects of your claim and the complicated paperwork, so you can focus on healing. We also protect workers from retaliation, so your job and future remain secure. No matter where you are in San Diego County, we’ve got your back. We offer a free consultation, so you can understand your rights with no upfront costs or obligations. And because we work on a contingency fee basis, you don’t pay a dime unless we win your case. To get started, contact us online or call our law offices in San Diego, Chula Vista, or Temecula.
"I want to thank the office of Robert A Mclaughlin for all his support in successfully resolving my injury case. Especially Alicia Cordova and Denisse Sanchez for answering all my doubts and questions in a very attentive, detailed and professional way ... I totally recommend them." - Jesus C., ⭐⭐⭐⭐⭐