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What Types of Injuries are Compensable Under Workers' Compensation?

Workers' compensation insurance provides employees with valuable coverage in the event of an injury on duty. When you are injured while at work, or elsewhere - but doing a work-related activity - and require medical care, workers' compensation should provide coverage. Additionally, it provides protections if your injury renders you unable to work for a period of time. However, it is important to understand your rights and know which injuries are compensable.

California state law requires that most employees in Orange County carry workers' compensation insurance. This provides injured employees the ability to recover lost wages.

What Types of Injuries are Compensable Under Workers' Compensation?

The first requirement for an injury to be compensable, is that it is work-related. Injuries that occur in your free time do not qualify for workers' compensation. However, if the injury occured while you were working, it should be compensable, especially if it could somehow be connected to an employment condition or requirement.

Secondly, compensable injuries do not have to be caused by work accidents such as heavy falling objects or slips-and-falls. Repetitive motion injuries that develop over months or years of doing your job also qualify. The same applies to illnesses (such as carpal tunnel syndrome caused by excessive hours working at a computer, asbestos toxicity or lung cancer caused by second-hand smoke at a restaurant) and emotional trauma due to violence at work.

Work-related injuries, in layman's terms, happen while you do something for your employer, or as part of your employment. It could range from an accident in a company-owned truck, or an incident that occured at a work-related social event (not on work premises).

If your injury occurred during lunch time, it may be compensable if it happened on company-owned property. Mental distress, such as anxiety or depression may also be compensable if the condition occurred or worsened during the course of your employment.

When you are injured at work, you should immediately report the incident, even if it seems insignificant. Your employer is obliged to provide you with immediate medical attention. Be sure to ask whether you are covered by workers' compensation, and obtain a claims form.

If you file for compensation benefits, the claims administrator will consider the medical care provided as well as the circumstances surrounding the injury.

Workers' Compensation: Types of Compensable Injuries

Defining a workplace injury under California workers' compensation law is not exactly straightforward. Here are some examples of distinct injury types that may be compensable:

  • Physical trauma - A purely physical injury that resulted from an identifiable event or accident is the easiest to prove. These claims are relatively straight-forward, because it can be tracked down to a specific incident. Even if you were somewhat negligent, you are still covered by workers' compensation.
  • Occupational illness - Long term exposure to airborne contaminants, excessive noise or chemicals can result in cancer, respiratory illness or hearing loss. Examples of occupational exposure can range from rashes to stomach issues and migraines.
  • Physical-mental injuries - Anxiety and depression are sometimes side effects of a physical injury on the job. If it is possible to show a link based on reliable medical evidence, the worker may receive compensation. Psychiatric injuries that are caused by physical work injures are known as "compensable consequences" of physical injuries. The law changed in 2013, which means that you may not receive additional permanent disability compensation for physical mental injuries, but you will be compensated for the psychiatric injury, and if need be, receive treatment for sexual dysfunction or sleep disorders.
  • Mental-physical injuries - It can be difficult to prove a mental-physical injury, but if you are able to support the fact that the job was to blame for the injury, it may be compensable. An example of a mental-physical injury would be job-stress that leads to a cardiovascular incident or heart attack.
  • Mental injuries - When a worker is exposed to abnormal work-related stress, violence, or a traumatic event in the workplace, it can cause mental injuries that may be compensable. In order for a psychiatric injury claim to be filed, you must have been employed by the same employer for more than six months, and you must show that your employment is at least 51% to blame for the condition. Work-stress must be the predominant cause of the injury, or that you were a witness or victim to a violent act.
  • Repetitive stress or cumulative trauma injuries - These injuries don't occur at a specific time or date and are not caused by a specific event. Instead, they develop slowly over time until the sufferer's abilities are compromised. Typically, the worker, assuming that he or she is simply tired from a long day at work, will pop a pill for the pain. Examples of repetitive stress injuries include orthopedic conditions, such as tendinitis and carpal tunnel syndrome.
  • New injuries as a result of pre-existing conditions or prior work injury - If you are injured at work because of a pre-existing injury or condition, you may be able to claim workers' compensation, provided the injury is an aggravation of a preexisting condition. It may also be shown to be a different injury that was caused by a previous work injury.

Workers' Compensation and Compensable Consequences

Compensation law makers in California recognize the fact that work injuries tend to have a domino effect, which is why they made provision for compensable consequence. What is compensable consequence? It is a new physical issue or complication that results from the original workplace injury. An injured worker who suffers from a compensable consequence is entitled to the same disability benefits and medical coverage that applied to the original injury.

Compensable consequences might include:

  • painkiller addiction that stemmed from a work-induced injury;
  • clinical depression resulting from an injury that is not healing;
  • carpal tunnel syndrome that leads to another overuse syndrome;
  • nerve damage caused by a complication stemming from surgery for a workplace injury.

Employers and workers' compensation insurers tend to routinely deny compensable consequence claims, which is why you need the skills of a workers' compensation attorney who is skilled at demonstrating causal relationship between the secondary condition and the original work injury.

California workers' compensation law automatically sees certain injuries as work-related, specifically in law enforcement personnel who develop hernias, cancer and heart trouble. Unless another explanation is offered, these injuries are presumed to be work-related and therefore compensable.

In some cases, insurance companies may claim only a portion of the responsibility for a legitimate on-the-job injury that leads to a permanent disability. For instance, if you hurt your knee playing football previously, and then hurt the same knee in a work-related accident and claim workers' compensation, a doctor may determine that only a percentage of the injury is work-related. The doctor will attribute a percentage of the injury to the football injury and you will only receive compensation for the work-related portion.

Workers' Compensation and Psychiatric Injuries

Purely psychological work injuries are usually referred to as stress claims. these claims result when workers suffer emotional or mental injuries as a result of stressful conditions at work. Such injuries often force workers to take time off work when they are unable to function properly. It can lead to mental breakdowns due to being:

  • overworked beyond the point of exhaustion
  • being subjected to threats or cruel remarks
  • sexually harassed in the workplace.

Psychiatric workplace injuries are treated differently to physical injuries under the California workers' compensation system and it can be hard to verify that an injury did indeed occur. While physical injuries can be verified using objective measures such as x-rays and blood tests, psychological injuries are highly personal and based purely on the individual's internal experience, feelings and thoughts.

Also, psychological injuries can be caused by a combination of factors, including marital problems, financial troubles and other personal reasons completely separated from the individual's job.

In order for a psychological injury to be compensable, certain requirements must be met:

  • The worker must prove that the work environment was most likely the cause of the injury;
  • The worker must have been diagnosed with a mental illness that either requires medical treatment or that has caused disability;
  • The worker must have worked for the employer for a minimum of six months in total (not necessarily continuously).
  • The worker must prove that at least 51% of the injury was caused by working conditions.

The last requirement can be quite difficult to prove, as you have to show that personal reasons are not the main cause of the injury. As a result, the insurance company will scrutinize your personal life in search of any other issues that might have caused stress, including your history of psychological illness, current and past drug use, financial troubles, family problems, yoru criminal history, and various other sensitive issues. Of course, prying into your private life can add to your stress. If you were injured as a victim of violence or trauma in the workplace, the percentage is lowered from 51% to 35%.

Employers can contend that psychiatric injuries were caused by nondiscriminatory, good faith personnel actions. Therefore, you cannot base your psychiatric injury claim on:

  • legitimate criticism of your work performance;
  • denial of a promotion;
  • the workers' compensation claims process.

Strict proof requirements are not the only challenge with psychiatric injury claims. Benefits for these kinds of claims tend to be limited. If you suffer a work-related psychiatric injury, you may be entitled to temporary disability payments or medical fees. It is much harder to recover permanent disability benefits, as it is presumed that you will recover when you leave the work environment that has caused you so much stress.

When Physical Injuries are Paired with Psychiatric Injuries

When work-related physical injuries lead to psychiatric injuries, it will be easier to recover benefits. The same requirements apply, but it is easier to prove how the mental injury is work-related. A person who is badly injured at work and laid up at home recovering and suffering from considerable pain, it is easy to link the psychological issue to the physical injury.

Individuals who are the victims of violent acts in the workplace, or those who are exposed to such an act, may be able to recover permanent disability for their psychiatric injuries, as can those who suffer catastrophic injuries.

Am I Covered by Workers' Compensation?

California state law requires that employers carry workers' compensation insurance for all workers classified as employees, including illegal immigrant workers.  It may not apply to certain types of employees, namely:

  • independent contractors
  • domestic workers (babysitters, housekeepers and nannies)
  • seasonal workers
  • agricultural workers
  • undocumented workers.
Statute of Limitations for Workers' Compensation Claims

A statute of limitations determines the amount of time you have available to file a claim. You can forfeit your right to compensation by waiting longer than you should to file your claim. However, that does not mean that you should instantly agree to your employer's first settlement offer.

Businesses and their workers' compensation insurers want to out as little as possible, which is why you should speak to a professional lawyer before you sign anything. Workplace injuries may require more time off work and further treatment in months and even years to come. Once you have agreed to a settlement offered by your employer's insurance company, you forfeit your right to any future claims and rights relating to your injury.

It is a felony to knowingly makes false statements or fraudulent material representations in order to obtain or deny workers' compensation payment or benefits.

Workers' compensation benefits are made available to provide injured workers with:

  • medical treatment for the work-related illness or injury;
  • compensation for loss of wages during recovery;
  • assistance in returning to work.

If you believe that you are entitled to workers' compensation and your company or their insurers deny your claim, you should get in touch with a workers' compensation who will aggressively fight for your rights. Schedule a case review with Orange County Workers Compensation Attorney today by calling 949-423-3212.


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