Workers' Comp FAQ

Your questions about Workers’ Compensation Answered

Have you been injured at work? The process of claiming workers compensation benefits may be difficult and lengthy, but an expert Orange County Workers Compensation Attorney can guide you through it.

Below, our Workers' Comp FAQ will answer some of the basic questions you may have about the topic. Please note that some things may differ slightly, based on your specific situation. That is why it is important to seek specialist legal representation.

Workers Comp FAQ: Frequently Asked Questions

What is workers' compensation insurance?

Workers comp insurance is a mandatory insurance that many businesses carry. The insurance covers medical costs as well as a portion of lost wages employees may incur when they become ill in the workplace or if they are injured on the job. In addition, it provides protection for companies against employees wishing to sue them for the conditions of the workplace that may cause illness or injury. Workers compensation also provides death benefits to the dependents of a worker who dies while working.

Workers compensation laws differ by state, with court decisions and state laws controlling the system, deciding how claims are handled and how they resolve disputes.

Employees may, in rare cases, take employers to court for willful violations of safety regulations that result in injuries. This includes cases of failure to carry sufficient workers' compensation insurance and extreme negligence.

What does it mean when we say California is a no-fault state?

Workers compensation benefits are paid benefits regardless of who caused the accident that led to injury. It also safeguards companies against litigation and stops employees from suing one another.

What types of injuries are compensable under California's workers' compensation laws?

Physical injuries that can be connected to employment conditions or requirements are compensable, such as:

• lung cancer that results from second-hand smoke in a building that permits smoking;
• carpal tunnel syndrome caused by too many hours working at a computer;
• a broken leg from falling off scaffolding on a construction site;
• a slip and fall accident in a poorly lit stairway without a rail.

Psychological injuries can also compensable, including:

• harassment by a superior;
• slander, libel and similar actions by employers or colleagues.

Does my injury count as a work-related injury?

Work injuries occur in the course of employment, or while you do something on behalf of your employer. It typically includes those incidents that occur at your place of work, but it can also be those that occur in company-owned vehicles or offsite at locations where an employee had to do something related to his or her work, such as social events or parties sponsored by the employer.

What if I was somewhat to blame?

Injuries that occur during lunch time may be considered work related if it happens on the employer's premises or if it happens at a restaurant during a lunch-time client meeting.

However, the court is divided on whether injuries caused by horseplay or by a disregard for company safety rules is compensable under workers' compensation. States and even courts within certain states tend to be divided on the issue.

• In some cases, injuries can occur at a work-sponsored event where alcohol was provided.
• Depression and anxiety are two of the mental injuries that can be covered if they were caused by the employment.
• The worsening of preexisting conditions during the course of employment may also be covered.

Am I covered by workers compensation?

Although companies are required to carry workers' compensation, only workers who are classified as employees (not independent contractors) are covered by the insurance. California specifically includes illegal immigrant workers in their cover. You may not be covered if you are:

• a seasonal worker
• an agricultural worker
• a domestic worker (babysitter, nanny, housekeeper)
• an undocumented worker.

Do small business owners have to buy workers compensation insurance?

If you employ workers who are not part owners in your business, you have to buy workers' compensation insurance. Sole proprietors and their partners may also buy workers comp insurance to cover themselves.

What is an employee under California workers' compensation law?

• Employees include family members who work in the company, but are not considered employees. This applies to spouses, children and parents, and not to extended family.
• Some laws stipulate that independent contractors are not employees, however, the state may treat uninsured contractors, subcontractor, or their employees as employees. That means that if they are injured on your premises or while they are working for you, you will be liable.

What are an employer's responsibilities when an employee is injured on duty?

Employers are responsible for helping injured employees with lost wages and other costs sustained during injuries on duty. Workers' compensation insurance covers a portion of the worker's regular wages during his or her recovery from work-related illness or injury.

Railroad workers and independent contractors are not covered by workers' compensation laws.

Is my injury work-related?

It is important to ascertain whether your injury is truly work-related before you pursue a claim for workers' compensation or employer-provided relief. If you were injured while carrying out work duties or tasks on behalf of your employer, it is typically work related, as are injuries that occured on your employer's premises, or at events sponsored by your employers, even if it is not on company property. Here are some guidelines to help you reach a conclusion as to whether it is a work-related injury:

• No-fault states, such as California, often include injuries on work premises that were caused by your disregard for workplace safety rules. However, the courts may be divided on this.
• Unless your injury took place in the company cafeteria, most injuries that occur during lunch breaks are not considered compensable.
• Injuries that were partly caused by alcohol consumption at work functions such as holiday parties or work-sponsored events may still be considered work-related.
• Emotional and mental conditions that are determined to have been caused by one's job or as a result thereof, are treated in the same way as physical injuries.

Are my workers' compensation benefits taxable?

Workers compensation benefits are typically not taxable on a federal or state level, but a portion of the benefits may be taxed if you receive supplemental security income or social security disability insurance. In terms of federal income tax, workers' compensation is fully tax exempt, as are payments to survivors.

It falls in the same category as:

• public welfare fund payments;
• sickness or physical injury compensatory damages (not punitive);
• no-fault auto insurance policy disability benefits for loss of earnings capacity resulting from injuries, or loss of income;
• compensation for permanent disfigurement or loss of a function or part of your body.

If I return to work while receiving workers' compensation benefits, will the payments cease?

Probably. If you will be receiving the same wages you earned prior to the injury, the benefits will probably end. However, if you are unable to return to the same job and earning the same wages as before due to your injury, you may continue to receive a lesser amount of benefits to cover the wage loss.

Does the no-fault law enable an employee to claim workers' compensation no matter what led to the injuries?

No. While workers' compensation covers most injuries, employees do not have carte blanche to act irresponsibly or purposefully injure themselves and still collect benefits. Benefits are rarely awarded for injuries caused by illegal drug use or intoxication, even at business functions.

If an employee was injured while he or she was not actually on work premises, can he or she still claim compensation benefits?

The details of the specific case and the law will determine whether an employee has recourse. However, the law provides for injuries that arise out of or occur within the person's scope of employment.

For instance, an employee who is injured at a restaurant while out to lunch with a client, may receive appropriate compensation. Likewise, an employee who is injured while running an errand outside of the workplace on behalf of his or her employer may be entitled to compensation, unless he or she has deviated from the said task for personal reasons.

When an employee who attends a recreational event organized by the company for which he or she works, such as a team building experience and is injured at the time, he or she may still be entitled to compensation. This applies even if the event does not take place on the company's premises.

What if worker's compensation is not an option?

The fact that you are not eligible for workers' compensation benefits does not mean that your employer is not responsible for  an injury you sustained while on duty. An independent contractor contract may be worded in a way that mandates arbitration for disputes such as injuries on duty. Likewise, employees may, in rare cases, sue their employers for intentionally inflicted injuries that were sustained in the workplace.

So, I can sue my employer?

California's no-fault compensation laws typically bar employees from suing their employers or co-workers for workplace injuries, since worker's compensation insurance is provided to benefit employees. However, there are some exceptions. It is best to speak to an expert Orange County Workers Compensation Attorney about your case to see whether you have grounds for filing a suit against your employer.

What if my employer intentionally caused harm?

If you believe that your employer intentionally caused you physical or mental harm, you may sue them for intentional harm. These cases are known as intentional torts and include battery, assault, false imprisonment, intentional infliction of emotional distress, fraud, defamation, invasion of privacy, conversion and trespassing.

What if my injury was caused by faulty equipment?

Sometimes, you may be injured in the workplace and you don't believe you or your employer is to blame, but rather defective equipment from a third party. If this happens, you may sue the manufacturer of the equipment. Your employer or their insurance company may request that you repay a portion of the workers' compensation benefits you have received thus far. Ideally, your employer and their insurer should become party to your lawsuit to help you recover the value of paid benefits.

Can I sue my employer for denying or terminating my compensation benefits?

In most cases, workers' compensation claims are handled through and administrative process, rather than through the California courts. You may only appeal the benefits award once the administrative process has been exhausted, and after all parties have completed every step required to settle the claim.

Your appeal will be processed through a worker's compensation board or a specifically nominated court.

Once you have satisfied all the statutory requirements of the process, may you seek redress in California's civil court. It is important to retain a specialist Orange County Workers Compensation Attorney to assist you with this process.

Will I have to go to court?

Many worker's compensation claims never make it to court. Instead, settlements are reached through mediation before it reaches litigation.

How can I get a professional opinion about my case?

An expert Orange County Workers Compensation Attorney can provide an initial case review, which will enable them to assess whether you have grounds for litigation. The attorney will ask many questions about your case and your current health status, and ask you to give them a few days to consider your case.

If they decide to take on your case, you will have to provide access to your medical records and evidence of your employer's negligence or willful actions that led to the injury. That will be followed by more consultations. It is important to be honest and open during the consultations and to provide as much pertinent information as possible to fast track the process.

You don't have to suffer alone. Let one of our expert attorneys guide you through the process and help you secure the compensation you deserve. Get in touch with Orange County Workers Compensation Attorney today by calling  949-423-3212 right now.