What Types of Injuries are Compensable Under Workers' Compensation?

The most important factor for determining whether an injury is compensable under California law is whether or not the injury is related to a person’s work. Obviously, an injury that occurred while you were at home but that keeps you from working is not a job-related injury. But, if there was an accident at work, or if the nature of your work caused an injury by a repetitive action over time, then you should be covered for injury and your injury is most likely compensable.

There are a number of instances where an injury or an illness could be considered to have developed due to a job-related cause. It is fairly obvious that a person injured in an accident involving machinery or other heavy falling objects on the job site should be compensated. Another common occurrence is a slip-and-fall due to hazardous conditions on the job site. However, situations that are not as obvious – such as repetitive motions that are required by tasks at work (even something as simple as typing, which can cause carpal tunnel syndrome) – can also lead to a compensable situation.

There is the matter of illnesses that develop due to hazardous working conditions, such as cancer developed due to asbestos toxicity in work sites or breathing in other carcinogens from poorly-ventilated production facilities.

Sometimes, employees are injured while operating company-owned equipment or vehicles. You could even be compensated for an injury that occurred during a company-sponsored social event if attendance was a requirement of your job.

One of the most important things you can do if you are injured in any work-related incident is to report the injury as soon as possible, no matter how insignificant the injury may seem. All employers in California are required to provide medical evaluation and treatment of any injury or illness arising from any work-related activity.

While there is no one-size-fits-all description of a compensable injury under workers’ compensation guidelines, there are a number of examples that might be helpful to illuminate the situation.

• An injury with physical trauma – One of the most straightforward types of compensable injury on a job site is a purely physical injury that arises from an identifiable accident or event. This could be a broken bone in the arm caused by falling machinery, or a back injury caused by a collision while driving a company vehicle. There is a clear injury related to a specific event. One does not have to prove liability in this kind of situation; the benefits available to you are evident and can be quickly processed and approved.

• An illness that results from your occupation – Especially when people work in an area with certain types of contaminants, exposure over a long period of time can result in illnesses that range from simple rashes to compromising the body’s internal systems. Additionally, for those who work around loud noises, hearing loss or migraine headaches can become an issue.

• A physical injury compounded by mental anguish – There are situations where symptoms such as depression and anxiety are associated with a physical injury inflicted on the job. When there is reliable medical evidence to demonstrate the link between the injury and the mental expressions, a compensable claim can be entered.

• A physical injury or illness caused by mental issues – There are cases where a stress-related situation at work has been proven to have caused issues such as heart attacks or other cardiovascular incidents.

• A mental injury – This type of claim is likely when a worker has been exposed to a high level of work-related stress, an act of workplace violence, or a traumatic incident that occurred at work. Generally, an employee must have worked for an employer for at least six months in order to claim this type of stress. Also, the employer must be at least 51% responsible for the situation that caused the stress in order to be held liable. The one exception to these guidelines would be if a worker witnessed a violent or traumatic event at work.

• An injury caused by cumulative trauma or repetitive stress – These types of injuries are not tied to one specific event or accident at work. They tend to develop more slowly and, over time, contribute to the deterioration of the worker’s ability to perform the job. Examples of this type of injury would include back pain caused by repeated heavy lifting, or orthopedic injuries such as tendinitis or carpal tunnel syndrome caused by repetitive hand movements.

• An injury that results from aggravating a pre-existing condition – If you have a pre-existing condition that is aggravated by conditions or activity on your job, you may be entitled to compensation. Sometimes, a completely new injury is inflicted when a pre-existing injury or condition is aggravated by work-related activity.

In addition to the work-related injuries and illnesses that arise directly from incidents in the workplace, there are additional situations that sometimes arise as a direct consequence of the work-related injury and that may continue over time. This is what is known as a compensable consequence.

A compensable consequence is a new physical complication or issue that extends from the original workplace injury. If a succeeding condition is determined to be a compensable consequence, then the same benefits that were attached to the original workplace injury will apply to the effects of the consequence.

Some examples of compensable consequences could include:

Compensable consequences might include:

• A worker who becomes addicted to painkillers that were prescribed for a workplace injury

• A worker who suffers from depression due to an injury that occurred on the job and does not subsequently heal

• A worker who suffers a second injury due to overcompensation caused by carpal tunnel syndrome

• A worker who suffers nerve damage due to complications from surgery for a work-related injury

It is quite common for workers’ compensation insurance providers to deny these types of claims from injured workers. The assistance of a qualified workers’ compensation attorney can be most beneficial in this instance. The attorneys at Workers Compensation Attorney Law Firm are experts at identifying the kinds of causal relationships that exist between a secondary condition such as these and the originating injury in the workplace.

Some workers are most likely to be approved automatically for workers’ compensation claims. These include, for example, law enforcement and other first-response types of employees who suffer from back injuries, hernias, heart trouble, and even cancer. These types of injuries are assumed to be consistent with workplace risks and are assumed to be compensable.

There is a particular type of workers’ compensation injury that is purely mental or emotional in nature. These are known as stress claims since they are psychological injuries that result from workplace conditions. Some commonly cited contributors to stress-related claims include:

• A worker who becomes exhausted due to overwork

• A worker who is subjected to cruel remarks or threats in the workplace

• A worker who is sexually harassed in the workplace

Stress claims such as these are more difficult to prove and are handled differently in the workers’ compensation system. Since physical injuries can be demonstrated by objective means such as x-rays or magnetic resonance imaging, they are not easy to dispute. However, psychological injuries are much more subjective and tend to be based on a person’s feelings, their internal experience, and their thoughts.

There are some important guidelines for psychological injuries in order to prove that they are compensable under workers’ compensation rules. These guidelines include proving that the work environment was demonstrably the cause of the psychological injury; a formal diagnosis of a mental condition that requires some form of medical treatment or causes disability; a minimum term of employment that equals six months or more with the same employer (not necessarily continuously); and the workplace environment must be found to be at least 51% responsible for the psychological injury.

Of course, if an employer can demonstrate that the injury could be due to other personal reasons – such as a distressed marriage or substance abuse by the employee – then a stress claim could be denied. Attorneys for insurance companies will scrutinize a victim’s personal life in minute detail in order to disprove a stress claim if they can. This is another reason to have a professional firm like Workers Compensation Attorney Law Firm on your side in order to maximize your case.

Additionally, it is important to realize that there are some legitimate grounds on which your stress claim could be rejected. A psychiatric injury claim cannot be based on legitimate criticism of an employee’s performance on the job, nor can it be based on denial of a promotion at work. Basically, if an employer can claim good faith, nondiscriminatory actions by their personnel department in dealing with your situation, your chances of proving a successful claim will be diminished.

This is something of a special case and is actually much easier to prove compensability than a psychiatric injury alone. When you suffer a work-related injury, it is quite possible that you may be confined to a hospital or your home for some length of time. During this time, you may suffer from considerable pain and become prone to depression, anxiety, or other psychological injuries. These psychological conditions can be demonstrated much more clearly when they are tied to a physical injury that was suffered on the job.

In some instances, psychological injuries related to a workplace injury can qualify a worker for temporary or permanent disability payments. Be sure to have your workers’ compensation attorney examine and explain all of the possibilities to you.

Some employers will require an employee making a claim under workers’ compensation to undergo an examination by a company-approved physician or other health care provider. Other employers may not have this same requirement, so it really depends on your employer and the plan that they have agreed to sponsor.

If you are required to have an examination by a company-approved health care provider, there are some things that you can do to help protect yourself and bolster your case for claiming benefits. Remember, the doctor you see may be sympathetic to your cause, or they may feel that they should help to justify a case against you and in favor of your employer.

You do have the right to have a qualified workers’ compensation attorney attend any required medical screening with you. This is a role that Workers Compensation Attorney Law Firm staff members are happy to fulfill.

• Be sure to keep a record of all providers that you see; get the names of doctors, nurses, technicians – anyone who is involved with your case.

• Keep good notes on what happens during your examination, including all instructions and advice that you are given.

• Make a record of any tests, examinations, or other procedures that are ordered for you. If you do not understand the purpose of any procedure that is ordered, do not be afraid to ask!

• Should you feel uncomfortable or dissatisfied with the medical care provider that examines you, you also have the right to request using a doctor of your own choice. In fact, you may be able to pre-designate a doctor or health care facility for your treatment in case of an injury sustained at work. You will need to check with your employer to see if this benefit is offered.

One particular circumstance that is often used to determine if an injury was work-related – and therefore compensable under workers’ compensation – is known as the Coming-and-Going Rule. If you are in an accident or are otherwise injured while in the course of your normal travel to or from work, you are most likely not eligible for workers’ compensation benefits. This type of injury is not compensable.

However, if you are traveling for a job-related purpose or if you are assigned work at a location that is removed from your normal working environment, then a tie to your work can be demonstrated and any injury you receive could be considered compensable and make you eligible for workers’ compensation benefits.

If you have any questions about a situation involving coming-and-going from work with regard to an injury you have received, it is a good idea to check with a qualified workers’ compensation attorney.

While the vast majority of injuries that occur in places of work are compensable under California workers’ compensation rules, there are some instances in which an injury might not be considered as a compensable injury. These could include:

• Any injury inflicted as the result of criminal activity

• Any injury that results from a violation of known or posted company policies

• Any injury that is the result of drug use or alcohol intoxication

• Any injury that is the result of drug use or alcohol intoxication

• Any injury that could be considered as self-inflicted

• Any injury that is considered a pre-existing condition, unless the condition has been exacerbated by current job responsibilities

Just as there are exceptions for employees in which their injuries might not be considered compensable, there are also exceptions for employers that might allow an employee to claim an injury or illness as compensable.

• Any injury that is caused or directly attributable to employer recklessness or malice

• Any injury that is caused by an employer who willingly violates federal or state laws, such as those enforced by the Occupational Safety and Health Administration (also known as OSHA.)

• Any injury that is intentionally inflicted by an employer or representative of an employer

• Any injury that results or is exacerbated by bad-faith administration of any claims made under workers’ compensation

• Any injury that could be attributed to an employer acting in a dual-capacity role, such as a property owner, landlord, work-equipment manufacturer, or medical provider. There are legal responsibilities for each of these roles, in addition to that of the employer.

• Any injury to an employee’s property

• Retaliation by an employer against an employee who pursues a workers’ compensation claim. You cannot be penalized by means of demotion or firing for seeking to obtain your rights when injured on a job.

• An employer could also be liable for non-physical situations such as discrimination or defamation.

Third parties are those that are not directly related to the employer – and are therefore not required to carry workers’ compensation insurance – but who may nevertheless have some responsibility for an injury that occurs at the place of work. Examples of third parties with legal responsibility could include manufacturers of faulty equipment used in a workplace, landlords that are negligent in their upkeep or maintenance of property where a workplace is located, equipment or property inspectors who are negligent in the performance of their tasks associate with employee safety, any medical provider who is negligent in the treatment of a work-related injury, a fellow employee in a company who intentionally inflicts harm on a co-worker, or even an insurance company that provides shoddy administration of workers’ compensation claims on behalf of an employer.

In these instances, the most likely course of action for recovering damages due to a compensable action will be in the form of a lawsuit. A qualified legal professional, such as those at Workers Compensation Attorney Law Firm, can help you decide whether a lawsuit is needed or would be beneficial to your case.

Finally, it may be possible that your employer has an interest in sharing in a lawsuit against a third party, particularly if the employer has been diligent and has paid all premiums for workers’ compensation insurance. Your attorney could help to coordinate any such legal action with your employer.

If you have any question as to whether an injury you received in connection with your job is compensable under workers’ compensation in the area of Los Angeles, CA, you should not hesitate to contact a qualified workers’ compensation attorney. The staff of Workers Compensation Attorney Law Firm is ready to assist you in getting answers to all of your questions as well as helping to guide you through every step needed in filing a claim for workers’ compensation benefits.

You do not have to wonder whether your work-related injury or illness would be considered compensable under California workers’ compensation law. You can know very quickly whether or not you are entitled to financial compensation for your medical care and/or lost wages.

Call the professionals at Workers Compensation Attorney Law Firm at 310-956-4277.