Workers’ Compensation: What is it?
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Workers’ Compensation, in California, is a system to provide both compensation benefits and medical benefits to workers who suffer injuries or illnesses that are either related to, caused, or aggravated by their employment. Death benefits are also available to dependents of the injured worker as well as burial expenses.
Workers’ Compensation is a “no fault” system. Therefore, even if a worker was negligent - i.e. was clumsy and tripped, fell down and injured him/herself, the worker is still eligible to collect workers’ compensation benefits for that injury. For the most part, how the injury was caused does not matter as long as it the injury is recognized to be arising out of and in the course and scope of employment. If a worker is unsure whether a certain injury is covered, it is recommended that they contact an attorney or the Information & Assistance Officer at their local Workers' Compensation Appeals Board Office. Check your local phone book for its address. It should be located in the State Section under the Department of Industrial Relations.
Types of Injuries: Specific Injuries, Cumulative Trauma Injuries, and Aggravations of Pre-Existing Conditions
Injuries come in three types. There are specific injuries, i.e. a lifting incident, and there are cumulative trauma injuries, i.e. repetitive trauma from typing for a number of years. Finally, there are aggravations or accelerations of pre-existing conditions, i.e. for example, a bus driver with a pre-existing hypertension condition has it aggravated by his stressful work. As a result of the stressful work, the bus driver’s blood pressure medication is increased to control the condition. It is important to note that there is no requirement that the injury or disability be entirely industrial.
If an injury or disability is partially work-related and partially not work-related, the worker is still entitled to benefits. Some benefits may be reduced due that portion that is not work-related. Other benefits, such as total temporary disability, medical care, vocational rehabilitation and death benefits may not be reduced and the injured worker is entitled to collect the full benefit, without reduction, despite there being a non-industrial component.
The following is a list of medical conditions or illnesses which may either be industrially caused or aggravated. Note: the fact that the item is listed here does not mean that, with respect to your claim, there is an industrial component. Each claim is to be determined based upon the medical records and the nature of the injury. Further, it should be supported by expert medical opinion.
Achilles Tendon, Amputations, Arthritis, Asthma, Back: Sprains, Disk Bulges and Herniations, Blood Pressure, Burns, Cancer, Carpal Tunnel Syndrome, Cardiovascular accident (CVA), Cervical Spine: Sprains, Disk Bulges and Herniations, Chemical Burns, Colitis, Complex Regional Pain Syndrome, Cubital Tunnel Syndrome, De Quervain’s, Dermatitis, Depression, Diabetes, Epicondylitis, Fibromyalgia, Gastrointestinal Reflux, Hearing Loss, Heart Disease, Hemorrhoids, Hernia, Hepatitis, HIV, Hypertension, Irritable Bowel Syndrome, Jaw- TMJ, Kidneys, Knees, Liver, Lupus, Mitral Valve Prolapse, Myasthenia Gravis, Neck, Overuse Syndrome, Post-Traumatic Head Disorder, Post-Traumatic Stress Disorder, Psychiatric, Quadriplegia, Rotator Cuff, Reflex Sympathetic Dystrophy, Shoulder, Stroke Synovitis, Temporal Mandibular Joint (TMJ), Tendontis, Tennis Elbow, Tinnitis, Trigger Finger, Tuberculosis, Ulcer, Ulcerative Colitis, Vertigo, and Wrists.
Examples of Work Injuries
Workplace injuries take place in many ways. Examples of those injuries are as follows:
A furniture mover injures his back lifting a couch.
A secretary develops carpal tunnel syndrome from extensive typing.
A police officer who walks the beat for many years develops hypertension and heart problems.
A fast-food worker suffers a post-traumatic stress disorder as a result of an armed robbery.
Limitations on Psychiatric Injuries on or after 1/1/94
Psychiatric injuries in the State of California are now limited. First, if a psychiatric injury is not caused by a sudden and extraordinary employment condition, there is a six month employment requirement. The six months need not be continuous. Further, in order to establish that a psychiatric injury is compensable, an employee shall demonstrate by a preponderance of the evidence that actual events of employment were predominant to all causes combined of the psychiatric injury. There is an exception if the employee's injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act. The employee must demonstrate by a preponderance of the evidence that actual events were a substantial cause (at least 35 to 40 percent of the causation from all sources combined) of the injury. Further, no compensation shall be paid if the injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action. Thus, if a worker suffered a psychiatric injury as a result of a legitimate “poor” performance evaluation, it would not be considered an industrial injury under the current law.
Exceptions to Industrial Claims
There are certain limitations with respect to whether a claim is considered industrial. An injury may be barred if it (a) was caused by intoxication, (b) was intentionally self-inflicted, (c) arose out an altercation in which the worker was the initial physical aggressor, or (d) was caused in the commission of a felony or other crime specified in the Labor Code. Also, in some circumstances, if the worker has engaged in serious and willful misconduct, the award of benefits may be reduced by one-half.
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