If you have been injured at work and are experiencing physical, emotional, or financial difficulties because of your injuries, you could be eligible for workers’ compensation benefits under California Laws. Also, if you are injured while on the job or while conducting job-related activities off your employer's premises in California, you are still eligible to receive a compensatory claim from your employer's state-ordered workers’ compensation insurer.

At The Workers Compensation Lawyer Law Firm, we know how many occupations subject employees to a high risk of unexpected injury or impairment, as well as chronic ailments caused by repeated motions and everyday stress. We're always ready to help you in collecting your lawful workers’ compensation benefits so that you can be free of the strain that the work-related injury has put on you.

How an Injury is Established to Be Compensable Under Workers’ Compensation

An injury has to be work-related to be covered by workers' compensation. That means that in California, you  must show that your injury both:

  • Arising out of employment (AOE)
  • Happened in the course of employment (COE)

Arising Out of Employment (AOE)

When a judge decides if an injury occurred as a result of your employment, his or her focus is usually on the injury's origin or its causation. When an injury occurs as a result of the job, it is considered an occupational hazard.

This will require you to present specific types of proof to demonstrate that the injury was caused by your work. In California, for instance, a physician must show not only if but also how your occupation caused the injury. It could require you to provide a report from your doctor describing how the ob-related incident caused your specific injury.

Because of the form of certain injuries, determining whether they were caused by work is extremely difficult. As a result, state laws may handle causation for such injuries separately. Repetitive trauma and aggravation of an already existing condition are two common scenarios.

A pre-existing illness might be aggravated in two different ways.  To begin with, an injury sustained at work might aggravate an already-existing illness, making it much worse. Secondly, a pre-existing illness can aggravate an injury caused at work.   Even though you can often recover compensation for an aggravation of an already existing ailment, the state could adopt various methods to limit compensation, such as permitting compensation only if your employer was aware of your condition when he or she hired you.

Repetitive injury is a kind of injury that develops over a period instead of occurring as a result of a single event. As a result, determining when and where they originated might be challenging. Repetitive injuries occur when you repeat the same movements, like using vibrating machinery daily.

Occurring in the Course of Employment (COE)

The time, location, and conditions of your accident determine if an injury happened in the line of employment.

The Going and Coming Law asserts that you are not in the scope of work if you are commuting to and from work. As a result, an injury sustained on your way to or from your workplace will not be compensated under workers' compensation. However, there may be exceptions if the business pays for your transit or if you are still working for your employer. If the going or coming path is generally unsafe or is otherwise the only route to your workplace or is managed or developed by your employer, an exception could be made.

If you eat, drink, or seek warmth, comfort, or treatment while still at your workplace, the Personal Comfort Law is applicable. Even though these actions are unique to you, they are regarded as necessary and incidental to your job.   As a result, when you eat a meal on your employer's property, it is usually regarded as part of your job. If you, on the other hand, leave the property to have a meal, any mishap that occurs is beyond the scope of work, except if you were still working for your employer.

You might be hurt in a variety of ways while on the job. California has its own set of regulations that handle a variety of occurrences in addition to those listed above. However, if an injury is to be compensated by workers' compensation, it should be proven that it came from and occurred during the course of your employment in each case.

Types of Injuries Compensable Under Workers Compensation

Workers' compensation benefits may be available to workers who have been injured or get ill as a result of their occupations. Injuries don't have to be a result of unexpected accidents, such as losing limbs due to faulty machines to be eligible under workers' compensation. Employees can experience injuries or suffer occupational conditions over time. As a consequence of exposure at work, certain workers might contract infectious disorders (like COVID-19).

Occupational Illnesses

Employees who get diseases and illnesses resulting from work-related exposure are usually covered by workers' compensation. Traditional occupational ailments such as coal workers' pneumoconiosis, which is caused by coal dust exposure as well as asbestosis, caused by asbestos exposure, and the coronavirus/COVID-19 are examples of work-related ailments.

It can be quite simple to demonstrate that traditional workplace illnesses were caused by work environments if the medical connection is well documented and exposure outside the workplace is uncommon.

When the sickness is deemed a "common sickness of life," meaning a sickness that most people develop during their lifetimes for various reasons, proving the employment link could be more challenging. That isn't to say that getting workers' compensation benefits for cardiovascular disease, lung cancer, and other common diseases is always difficult except when the state laws have explicitly ruled it out. Employees, on the other hand, will require solid medical proof that their disease was caused or exacerbated by occupational exposure.

The state considers that occupations such as firefighters and law enforcement officers are inherently risky and hence require additional workers' compensation coverage. As a result, when the above-mentioned personnel suffer specific illnesses (such as heart attacks or some forms of cancer), the laws believe that their ailments are tied to their jobs.

Workers’ Compensation for the Coronavirus

If you're unable to work as a result of contracting COVID-19 or being exposed to the virus while working, you may be entitled to workers' compensation benefits, which may include temporary disability compensation when you've been quarantined. As a basic guideline, you'll have to establish that you have been exposed when working, as well as how your occupation represents a unique danger of exposure more than that which the rest of the public faces.

The most notable examples of occupations with this type of elevated risk are medical practitioners and emergency responders. An administrative directive in California provided a presumption to any employee who has been tested positive for COVID-19 after 2 weeks on the job at his or her employer's workplace.

Repetitive Motion and Stress Injuries

Excessive usage or repetitive movements could result in cumulative trauma and repetitive stress injury with time (RSI). Repetitive action or excessive usage of tendons, muscles, or bones might cause stress on the body parts, resulting in pain, reduced usefulness, or even impairment in some cases. RSI can impact employees who suffer from wrist or finger soreness or back problems as a result of leaning forwards over their workstations, and also factory and construction employees who stress their necks, backs, shoulders, and knees daily when lifting, moving, and transporting materials.

The following are among the most typical kinds of RSI:

  • Carpal tunnel syndrome affects wrists and hands
  • Tendonitis that affects the elbows or knees
  • Bursitis that affects the shoulders, elbows, or hips
  • Shoulder problems, including rotator cuff
  • Back pain from carrying, leaning, bending, or lifting repeatedly

Repetitive stress isn't the most apparent sort of occupational injury, however, it's still a work-related injury. If it remains unaddressed, RSI can result in persistent pain, reduced movement, weakness, and, eventually, incapacity to work. Workers' compensation insurance is required by California law to cover any workplace-related injury or illness, even repetitive stress injury. Your employer as well as their insurer should compensate provided you can show that the RSI is directly linked to your job.

If you think you could have RSI, notify your employer right away about the injury, pain, or any symptoms you're experiencing. After that, you need to consult a physician to have your injuries diagnosed and treated. The more you wait, the worse the condition will become, and it will be more difficult to prove that your ailment was caused by work rather than other activities.

Stress-Related Injuries

Not all employment injuries are entirely physical."Stress claims" is a term used to describe work-related psychological injuries, in contrast to psychological illnesses that are caused by physical injuries, like PTSD. Employees with psychological impairments may need to take some time off because they are incapable of completing their tasks or engaging with other employees. This might occur when an individual is consistently driven to fatigue or if they have been constantly threatened at their workplaces, for instance.

Stress injuries are covered by California workers' compensation, but the regulations are somewhat unique. Psychological injuries are much harder to determine than physical trauma since they are based on the employee's subjective mental feelings rather than a bodily injury. A fractured bone can be seen on an X-ray, however, a stress-related mental injury is not visible.

To be eligible for workers' compensation for a stress-related, psychological ailment, you must meet additional criteria, which include:

  • You have a psychiatric disorder as described in the Diagnostic and Statistical Manual of Mental Disorders
  • You can show the real conditions of your employment predominantly ( 51%) that caused your psychiatric condition. If an employee has been subjected to workplace abuse, the percentage is lower
  • Personnel acts undertaken in good faith aren't the source of the illness, for instance, criticism of a worker's competence, punctuality, or professionalism
  • The condition was not brought on by the legal process itself.
  • You have sought medical attention or has been disabled due to the ailment
  • You have been with the company for six months or more

It's worth noting that "stress" isn't a psychiatric disorder in itself. Stress, on the other hand, can be a sign or side effect of other diagnosable conditions including severe anxiety, PTSD, or chronic depression. When you've been subjected to considerable work-related stress, to the extent that you're incapable of performing all or any of your work tasks, engage a skilled workers' compensation attorney who will help you evaluate your situation. Regardless of whether you were fired from your job, you could be entitled to workers' compensation benefits.

If you are seeking psychological injury compensation benefits, you must have documented proof from your physician to substantiate your workers' claim for damages, along with the conditions listed above. Your medical history, employment history, work satisfaction, working environment, and other aspects must all be considered while making a diagnosis. Medical records, testimonies from colleagues, relatives, and friends,  and other proof should all be used to back up the doctor's statement.

Aggravation of Pre-existing Conditions

Pursuing workers' compensation benefits becomes difficult if you've had a pre-existing illness. This is particularly true if your illness is connected to your present claim. A pre-existing illness, however, does not always ban you from receiving workers' compensation benefits.

Certain types of injuries are specifically excluded from coverage under California workers' compensation statutes. Workers' compensation doesn't cover injuries that have been purposefully self-inflicted or which happened while you were intoxicated. Injuries received outside of employment are also not covered under worker's compensation. Workers who were injured in a physical altercation they initiated as well as in the course of committing a crime aren't covered. Workers aren't covered for genuinely off-duty, volunteer activities, even though they take place at work. Pre-existing conditions, however, are not always disqualified if the illness was made worse by employment. A fusion of covered as well as non-covered activities can lead to injury. The legal implications of this compounded injury are examined in the next section.

What Qualifies as a Pre-existing Condition?

Diseases or injuries that occurred before a work-related injury are known as pre-existing health conditions.  Herniated discs, shattered bones, tendonitis, knee problems, back problems, neck injuries, and so on are examples of pre-existing conditions. Overall health or medical problems like age-related spine deterioration, carpal tunnel syndrome, PTSD, arthritis, depression, or anxiety are also examples of pre-existing health conditions. If you start working with any of such injuries, diseases, or conditions that weren't induced by your present job, you will be unable to pursue workers' compensation benefits for that injury.

If you've had a pre-existing condition, like those listed above, you may still be eligible for workers' compensation, even though the case is connected to the injury. Workers' compensation in California will pay an injury related to a pre-existing illness if the condition was caused by workplace activity that resulted in another injury that exacerbated the pre-existing illness.

Consider the case of a healthcare professional whose lower back is affected by arthritis. While on duty, she tries to assist a patient to get out of bed, causing a protrusion in her back disc in the already affected area.  The health professional is incapable of working due to the disc injury. Even if it was linked to a pre-existing ailment, the bulged disc is a current injury induced by workplace activities. According to California law, fresh occupational action causes a fresh injury, a fresh requirement for medical assistance, or a shift in the trajectory of ongoing treatment. If this is the case, the damage is referred to as an "aggravation." Workers' compensation will cover the costs of the aggravation.

It's vital to remember that workers' compensation can not pay claims for pre-existing illnesses that "flare up" when you're working. Workers' compensation will not qualify in the case above if lifting a patient only made arthritis worse, producing some pain but without impairing the worker's capability of working. The intense pain is an "exacerbation" of an underlying ailment rather than "new" damage. Workers' compensation does not include exacerbation, which is a temporary development in the indications of an underlying ailment. Differentiating between exacerbation and aggravation is difficult and takes the expertise of a competent workers' compensation lawyer.

The Action of Compensable Consequences

Aside from work-related illnesses and injuries that result primarily from workplace events, other issues can emerge as a primary result of the work-related injuries and could persist gradually. This is referred to as compensable consequences.

A "fresh" physical condition or difficulty that arises as a result of a previous employment injury is a compensable consequence. If a subsequent illness is considered to have become a compensable consequence, the damages of the repercussion will be covered by similar compensation as the initial work-related injury.

The following are examples of compensable consequences:

  • An employee who develops a dependency on opioids is administered for an occupational ailment
  • An employee who is suffering from depression as a result of a work-related injury that doesn't heal
  • An employee who sustains a subsequent injury as a result of carpal tunnel syndrome-related overcompensation
  • An employee who develops nerve damage as a result of problems from a workplace accident injury

Workers' compensation insurers frequently dismiss these kinds of cases from injured employees. In this case, the counsel of an experienced workers' compensation attorney could be extremely advantageous. Workers Compensation attorneys are skilled at determining the types of causal connections that occur between a subsequent ailment like this or the underlying occupational injury.

Certain workers' compensation cases are more probable to be accepted automatically. Workers in enforcement agencies and other first-responder roles, for instance, who endure hernia, back injuries, heart problems, or sometimes cancer, fall into this category. These kinds of damages are thought to be related to employment hazards and are compensable.

What Types of Employee Injuries Does Workers Compensation Not Cover?

Most events that arise in the scope and course of work perhaps with prior consent from your employer beyond the workplace are covered by workers' compensation insurance. At the end of the day, workplace occurrences involving employee injuries must be assessed in a case-by-case manner. Unfortunately, there are some circumstances in which an injured employee's claim is not recognized. Below are some examples:

  • Driving to and from Work

If a worker gets hurt while commuting to work or from the workplace, it's not considered part of their job and is thus not compensated except if the employer gives consent.

  • Intoxication/Deliberate Acts

If a worker is inebriated and under the influence of an illicit substance, and the inebriation is the primary reason for his or her injury, the damage is usually not compensated.

  • Horseplay

Horseplay at work, in general, serves no purpose at the workplace, hence any injuries sustained as a consequence would be uninsured. If a worker is injured in the event of the horseplay but was not actively participating in it, it is treated as a special case.

  • Intentional Acts

When an employee induces an illness or injury on themselves at work, they aren't protected by a Workers' Compensation insurance plan.

  • Unlawful Acts

A company's Workers' Compensation insurance coverage does not cover worker injuries caused by illegal conduct on the job.

  • Infractions of the Policy

Workers who are harmed while breaching corporate policies, processes, or procedures are not covered by workers' compensation.

  • Employees Who Have Been Laid Off

Employees who've been cut off or fired from their jobs are no longer protected by workers' compensation insurance, except if the injury occurred before their termination.

Statute of Limitations for Workers’ Compensation Claims

The time you legally have to submit a claim is determined by the statute of limitations. By delaying longer than necessary to submit your claim, you risk losing your rights to claim compensation. That doesn't suggest that you should accept your employer's initial settlement offer immediately.

Employers, as well as their workers’ compensation insurance providers, want to spend as little money as possible, that's why you must consult an attorney before signing anything. Occupational accidents may necessitate more time away from work and therapy in the months or years ahead. You give up your rights to any potential lawsuits and rights connected to your injuries if you consent to a payment provided by the employer's insurer.

Making false claims or making fraudulent substantial statements to secure or reject workers' compensation or benefits is a felony. Workers' compensation payouts are offered to offer the following to injured employees:

  • Medical assistance for work-related injuries or illnesses
  • Restitution for lost income during recovery
  • Help with getting back to work

Find a Proficient Los Angeles Work Injury Attorney Near Me

If you have any concerns or questions regarding your workers' compensation claim in Los Angeles, CA, you should contact a workers' compensation attorney who will aggressively defend your rights. Call The Workers Compensation Lawyer Law Firm today at 310-956-4277 for a free consultation.