work injury word cloud

DID HOSPITAL WORKER’S GROIN INJURY RESULT IN AN INDUSTRIAL DEATH CLAIM? INJURED WORKER IN THE NEWS, #52

A Hospital Worker tragically died.   Law enforcement considers the death to be a homicide.  The alleged cause for the homicide was a kick in the groin.   Do the facts give rise to legitimate workers’ compensation  work-related death claim?

It is reported as follows:  a Hospital Worker had an altercation with a patient.   A mental health evaluation patient was trying to leave the hospital when the staff tried to prevent her from leaving.  The incident got physical.   The patient began to “swing her arms and pull away from security when (an employee) attempted to grab her arms. The Mental Health Unit eventually had to step in.” The patient allegedly started to kick and then struck a Hospital Worker with her knee in the groin.  The Hospital Worker, after the injury, was in the ICU for three days. Tragically, he died. katv.com

The article reporting on the matter indicated that “[a]uthorities say after a review of medical records and investigation, the cause of death is physiological stress associated with a physical altercation in the setting of cardiomegaly and obesity.”  katv.com

The coroner commented that “[t]here’s a lot of people walking around with the same medical conditions he had, that might live for another 15-20 or 25 years, had it not been for the kick to the groin.”  katv.com

This article will discuss the hurdles required to prove a death claim in this matter.  This article will discuss issues of causation and medical legal reporting.

Is The Coroner’s Opinion Enough to Prove the Death Is Work-Related?

The answer is “no.”  In California, Workers’ Compensation Law has standards of causation.  The doctors must express their opinion within the workers’ compensation framework.  With respect to a death claim, the medical evaluator should express their opinion within reasonable medical probability.  Further, with respect to a death case, the issue is whether the industrial injury was a “contributing” cause.  The South Coast Framing case  established the “contributing cause” standard for death cases.  (South Coast Framing, Inc. v. Workers’ Comp. Appeals Bd. (2015) 61 Cal.4th 291 [188 Cal.Rptr.3d 46, 349 P.3d 141].)  As we don’t know whether the Coroner’s opinion was within reasonable medical probability or whether it addressed causation as a contributing cause, on it’s face, it could not be used as evidence.

Thus, a medical opinion must have the correct language.   It should also be noted that criminal law has a different burden of proof.  Therefore, clarification is needed within a workers’ compensation framework.  It is possible that what might not be considered criminal causation can still be valid for the purposes of industrial causation.

What Medical Evidence  Is Needed To Proof the Death Was Work-Related?

In this matter, either the treating physician or a medical evaluator, QME or AME,  should be employed to render an opinion on industrial causation of the death.   The question would be whether the attack “contributed” to the injured worker’s death.  The worker’s involvement, i.e. physical activities, in the altercation can be viewed as a whole as opposed to the mere kick.  In other words, the stress, mental or physical, from the incident can be considered with respect to industrial causation for the death.  As noted, workers’ compensation should look at the totality of the incident and not the mere kick to the groin to make the assessment.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

approved work injury claim

WCITN #13: A Tragedy On The Way Home From Work

A NFL Referee tragically died recently after working a football game involving the Kansas City Chiefs and the Tennessee Titans. According to the reports, he “was driving home to Weldon Spring, Missouri, when he reportedly had a medical issue. Upon arrival, Metro Nashville police found Madsen unconscious. Police spokesperson Don Aaron said officers broke open a car window, removed Madsen from the vehicle and performed chest compressions. He reportedly was taken to St. Thomas Midtown Hospital, where he later died.” Nypost.com

Is This a Work Injury?

The answer is maybe.  It depends on the medical condition which caused his death.  If work contributed to the condition which resulted in his passing, a workers’ compensation death claim is possible.

If He Was Driving Home From Work, Would That Matter?  

Possibly.  First, there is the “going and coming rule” that may apply.  For the Referee, it could be argued that his commute would be an exception to the rule and would therefore be work-related.   Second, under a cumulative trauma theory of injury, if his working contributed to the condition, then it would be work-related.  Thus, even if his demise happened off of the worksite, this would not necessarily bar a claim.

How Would This Claim Be Proven?

A medical diagnosis is necessary.   Also, a medical opinion indicating that work contributed to the medical condition which caused his demise would be indicated.

What Benefits Would Be Received In This Claim?

In this matter, if the injury is work-related, the medical bills for the treatment would be paid.  Burial expenses would be paid.  Dependency benefits would be paid if indicated.

What If I Need Legal Advice?

If you would like a free consultation concerning any workers’ compensation case, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 28 years. Contact us today for more information.

deeply worried old man consoled by his wife

MEN, DEPRESSION, SUICIDE, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Stress impacts Men and Women differently.   Studies show there are differences in the workplace.  The findings are both significant and complicated.

This article will discuss depression, suicide, the differences between men and women, and the implications with respect to workers’ compensation cases.

What Is the Psychological Diagnosis of Depression?  

 Per the American Psychiatric Association, Depression (major depressive disorder) is an illness that negatively affects how you feel, the way you think and how you act.

”Depression symptoms can include: Feeling sad or having a depressed mood, Loss of interest or pleasure in activities once enjoyed, Changes in appetite — weight loss or gain unrelated to dieting, Trouble sleeping or sleeping too much, Loss of energy or increased fatigue, Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others), Feeling worthless or guilty, Difficulty thinking, concentrating or making decisions, Thoughts of death or suicide.” APA

A depression diagnosis requires these symptoms last for an extended period of time. “Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression.” APA

Which Sex Is Diagnosed Most with Depression?

 Studies show that women are diagnosed at twice the rate as men. “[c]omparatively, in Western countries, men are formally diagnosed with depression at approximately half the rate of women” (Kessler et al., 2005Wilhelm, Parker, Geerligs, & Wedgwood, 2008).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Note: These findings raise questions.  There is the issue of “men’s reluctance to express concerns about their mental health and reticence to seek professional health care (Emslie, Ridge, Ziebland, & Hunt, 2006Sharpe & Heppner, 1991Winkler et al., 2006).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

In other words, men may not seek mental health treatment. Thus, there would be fewer depression diagnosis for men.

Is There a Connection Between Depression and Suicide?

Severe depression can … significantly increase the risk for suicide.  (Emslie et al., 2006Kessler et al., 2005Wilhelm et al., 2008World Health Organization, n.d.), 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Which Sex is at Most Risk of Suicide?

Men have been found to have higher rates of suicide. “[S]uicide rates are approximately four times higher in Western men than in women (Centers for Disease Control and Prevention, 2012Hawton & van Heeringen, 2009Levi et al., 2003Moller-Leimkuhler, 2003Rihmer, Belso, & Kiss, 2002Statistics Canada, 2012a2012bWasserman, 2000Wolfgang & Zoltan, 2007).” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Thus, there is the question as to why men’s suicide rates are higher when their depression rates are lower.

Are There Suicidal Issues Related to Occupation?

The issue of suicide has multiple issues.  There is suicidal thought or ideation.  There is the act of suicide.

Studies have found high suicide rates in male-dominated workgroups. This included manual workers, farming, military and nursing.” 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Suicidal ideation is also an issue for men. Being a failed breadwinner can have an impact on suicidal thoughts. “Linkages between men’s work, depression, and suicide have also been described. Self-perceptions of being a “failed breadwinner” led older men with a history of depression to think about suicide (Oliffe, Han, Ogrodniczuk, Phillips, & Roy, 2011), whereas some middle-aged men countered suicidal ideations by focusing on work as a means of providing for their family (Oliffe, Ogrodniczuk, Bottorff, Johnson, & Hoyak, 2012. 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/1557988313490786

Is There a Connection Between Depression and Retirement?

Depressed workers are more likely to retire than nondepressed workers (Doshi, Cen, & Polsky, 2008) 1. Oliffe JL, Han CSE. Beyond Workers’ Compensation: Men’s Mental Health In and Out of Work. American Journal of Men’s Health. January 2014:45-53. doi:10.1177/155798831349078

What Does This Information Mean with Respect to Workers’ Compensation Claims?

These studies impact workers’ compensation cases in that they provide insight into the injured worker.

There studies show that there is some uniqueness for a man to file a claim for depression. These studies provide “red flags” as to certain occupations that men perform and their risk for suicide.  These studies may give some insight to employers as to whether depressed male  injured workers are going retire or return to work.  These studies show that working may assist a man’s mental state.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

Death Claims and Workers’ Compensation: What You Need To Know

California Workers’ Compensation Law provides for Death Benefits for the Dependents of Industrially Deceased Workers.  Besides benefits for Dependents, Burial Expenses are also provided. This article will discuss Death Benefits, Dependency, and Burial Expenses.   This article is simply a discussion of the benefits. Death Cases and Death Benefit Laws are exceedingly complex.  Each case needs to be handled based upon the particular case’s facts. Please consider this article as informational only and not in any shape or form an authority. In sum, it should be considered solely as a starting point for analyzing Death Claims and Death Benefits.

Death Benefits


Generally, for injuries on or after January 1, 2006, Death Benefits can range from $250,000.00 to $320,000.00.  Death Benefits are paid out over time. The amount of Death Benefits, for non-presumptive Dependents, can vary based upon the facts.

What Is A Dependent?


Dependents are individuals who, at the time of the injury, were reliant upon the Deceased Injured Worker for support. For spouses, dependency is determined at the time of death.   Dependency, for workers’ compensation death cases, involves the question as to how much support was provided to an individual by the Industrially Deceased Worker.  The amount of support can impact as to whether someone is to be considered as wholly(totally) dependent or partially dependent. The amount of support provided by the Industrially Deceased Worker can determine the amount of the Death Benefit to be paid.  Some individuals are considered as conclusively or presumptively dependent.

Case law has indicated that:

“[a] dependent must be either a good faith member of the employee’s household or family or related to the employee in one of the ways listed by statute, for example, a spouse, child, parent, or grandchild.”  Chevron vs. WCAB 1999 Cal. Wrk. Comp. LEXIS 5203, 64 Cal. Comp. Cases 1, 19 Cal. 4th 1182, 969 P.2d 613, 81 Cal. Rptr. 2d 521.

Certain Individuals have presumptions of dependency, i.e. minor children. Other individuals, however,” claiming entitlement to a death benefit must establish either total or partial dependency in fact.”   In other words, for an Individual to prevail on a dependency claim, they must be able to produce facts and documentation to support their dependency.

The Courts have discussed dependency:

“Division One of this court has proffered the following definition, taken from the dictionary and from treatises: “Generally speaking, a dependent is one who relies on another for support. [Citation.] Webster defines dependent as ‘One who is sustained by another, or who relies on another for support or favor.’ [Citations.] 1

Campbell on Workmen’s Compensation (1935 ed.) section 863, pages 767–768 states:

“Dependency is a present, existing relationship between two persons where the one is sustained by, or relies on, the aid of the other for his means of living. This does not mean absolute dependency for the necessities of life, but rather that the dependent looks to and relies upon the contributions of the injured employee in whole or in part as a means of supporting and maintaining such dependent in accordance with his accustomed mode of life. Dependency within the meaning of the Act involves the idea of a present, current reliance upon the decedent for support.’ [Citations.]”

(Industrial Indem. Co. v. Industrial Acc. Com. (1966) 243 Cal.App.2d 700, 705–706 [52 Cal. Rptr. 647, 31 Cal. Comp. Cases 238].)

It is important to note that the support can include maintaining such Dependent in accordance with their mode of life.   This is very similar to language used in divorce law.  The extreme example of this is a wealthy person who was supplying monies to their children in majority so that they can live the “lifestyles of the rich and famous.” [Note: my apologies to Robin Leach.]  These children would have a bona fide dependency claim.

What Is A Wholly (Total) Dependent?


Wholly Dependents are also known as “Total Dependents”. They are individuals who were largely reliant upon the Deceased Injured Worker for support. The best example of a Wholly Dependent individual is a minor child.

What Is A Partial Dependent?


A Partial Dependent is an individual who received some support from the Deceased Injured Worker.  The best example of a Partially Dependent Individual is a child of majority who receives some financial support. For example, the Industrially Deceased Worker paid the child’s car insurance or made car loan payments for them while they were attending college.

How Does One Know Whether They Are A Total or Partial Dependent?


Per caselaw, “[t]he identity of dependents, whether their dependency is total or partial, and the extent of partial dependency are “determined in accordance with the facts as they exist at the time of the injury of the employee.” (§ 3502 Massey v. Workers’ Comp. Appeals Bd. (1993) 5 Cal.4th 674, 677 [20 Cal. Rptr. 2d 825, 854 P. 2d 117, 58 Cal. Comp. Cases 367] ARCO, supra, 31 Cal.3d at p. 720.) The time of injury also controls the applicable statutory rate of the death benefit. (See § 4702.)

Therefore, the Dependent needs to establish the correct date of injury and make an analysis as to their support for that period of time.

How Does One Prove Dependency?


Per caselaw, [i]n order to substantiate partial dependency, the death benefit claimant must prove the actual dollar amount annually devoted by the decedent to his or her support. (ARCO, supra, 31 Cal.3d at p. 723.) Once the claimant has established partial dependency by proving the extent of the support actually contributed by the decedent, he or she has effectively proved “the amount annually devoted to the support of the partial dependent[]” within the meaning of section 4702(a)(4), which governs the calculation of the death benefit. (See 1 Hanna, Cal. Law of Employee Injuries and Workers’ Compensation (rev. 2d ed. 1998) § 9.05[4][d], p. 9–25, fn. 51.) “

What Are Burial Expenses?


Burial Expenses are provided by the Labor Code if an injury causes death.  The Burial Expenses are to be “reasonable.”  Further, for Injuries on or after January 1, 2013, Burial Expenses are payable up to $10,000.00.

In order to get properly reimbursed for burial expenses, it is recommended that receipts be obtained from the various vendors or religious institution involved.  Also, some form of explanation of the receipts would also be of assistance. They should be submitted to the insurance company for reimbursement.

Is There Any Caselaw Concerning Burial Expenses?



Yes.  There has been some litigation concerning what is “reasonable” burial expenses.

Burial Expenses Allowable When There is a Funeral Ceremony Without a Body


In Shoichi Iba vs. O’Conner 1947 Cal. Wrk. Comp. Lexis 130, in an Industrial Accident Commission decision, the Commission held that the expression burial meant more than the mere act of burying a body. It also embraced attending a funeral ceremony such as a church service.   Further, the absence of the body did not make a difference when a funeral ceremony was a part of the religious ritual of the faith to which the decedent’s family belonged.

Religious Ceremony Expenses in Connection with Burial Expenses Reimbursable


In Samarron vs. Rich Manufacturing, 7 Cal. Comp. Cases 233, 1942 Cal. Wrk. Comp. LEXIS 315, the Commission found that a funeral mass was allowable as a burial expense.   The grounds were that “on the ground that no technical distinction should be made in the interpretation of the words “funeral” and “burial”, and on the further ground that with persons belonging to certain religious faiths the burial of a member thereof, without the saying of funeral mass, would not be ecclesiastically valid in the eyes of the church.”

Are There Any Other Statutes or Facts That May Impact Dependency Benefits?


Yes. There are a number of statutes that impact the value of death benefits.  Consultation with an attorney is indicated with respect to those additional possible benefits.   Also, there are some statutes that may lower the death benefit.  Consultation is needed concerning those issues as well.

What If I Need Advice?


If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.

 

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