THE CONTROLLED SUBSTANCE UTILIZATION REVIEW AND EVALUATION SYSTEM (CURES) AND WORKERS’ COMPENSATION: INJURED WORKERS, PRESCRIPTION DRUGS AND WORK INJURY TREATMENT: WHAT YOU NEED TO KNOW

Frequently, Injured Workers’ Medical Reports have the word “CURES” contained within it. This article will discuss what “CURES” means and the significance it has with respect to an Injured Workers’ claim and their access to treatment.

What is CURES?

The Controlled Substance Utilization Review and Evaluation System (CURES) “is a database of Schedule II, III and IV controlled substance prescriptions dispensed in California serving the public health, regulatory oversight agencies, and law enforcement. CURES 2.0 is committed to the reduction of prescription drug abuse and diversion without affecting legitimate medical practice or patient care.” Office of Attorney General, State of California.

In sum, Patients who are prescribed “controlled substances” will be tracked in a database.

What are Controlled Substances?

Per the United States Drug Enforcement Agency (DEA), “Drugs, substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.” For an alphabetical list of controlled substances, here is the link: https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf

What Are Schedule II Drugs? 

Per the DEA, “Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are: Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.”[emphasis added]

What Are Schedule III Drugs? 

Per the DEA, “Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some examples of Schedule III drugs are: Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, testosterone.” [emphasis added]

What Are Schedule IV Drugs? 

Per the DEA, “Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of Schedule IV drugs are: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol.” [emphasis added]

Who Has Access To CURES? 

According to the State of California, “CURES 2.0 is limited to licensed prescribers and licensed pharmacists strictly for patients in their direct care; and regulatory board staff and law enforcement personnel for official oversight or investigatory purposes.” Office of Attorney General, State of California.

What Does This Mean to Injured Workers? 

During your treatment for your industrial injury, your doctors may prescribe controlled substances that are subject to the CURES laws. This means that your prescriptions will be monitored with respect to drug abuse and diversion. Drug abuse applies to misuse by the individual patient. Diversion applies if the drugs prescribed are being distributed by the patient to other individuals. In sum, if your doctor is complying with CURES, your prescriptions, that are controlled substances with the reporting requirements, are being monitored.

Further, your medical provider may search CURES to see what medications you are taking. This allows them to make appropriate prescriptions in compliance with the mandate concerning drug substance abuse and drug diversion. They may document that they have done a CURES search within their medical reporting. Also, this search may alert your medical provider with respect to the need to address possible issues of addiction or substance abuse with respect to your course of treatment.

Is There Any Privacy Concerning CURES? 

Yes. Per the State of California “[t]he Health Insurance Portability and Accountability Act of 1996 (HIPAA) and confidentiality and disclosure provisions of California law cover the information contained in CURES 2.0.” Office of Attorney General, State of California.

What Information Is Contained In CURES?

Per the State of California, “California Health & Safety Code Section 11165(d) requires dispensing pharmacies, clinics, or other dispensers of Schedule II through IV controlled substances to provide specified dispensing information to the Department of Justice on a weekly basis.” Office of Attorney General, State of California.

For Injured Workers who are receiving “scheduled medication,” if it is a particular “scheduled drug,” it will be submitted to the CURES database.

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.

Photo by Halacious on Unsplash

WORKERS’ COMPENSATION LAWYERS, THE CALIFORNIA LAWYERS ASSOCIATION AND WORKERS’ COMPENSATION: ATTORNEYS REPRESENTING INJURED WORKERS: WHAT YOU NEED TO KNOW

The California Workers’ Compensation System is very complicated. Frequent changes in the law and current events require Attorneys practicing in workers’ compensation to stay up to date. In order to stay up to date, Workers’ Compensation Lawyers participate in educational programs.  Therefore, Associations that provide educational programs and address issues such as the standards for Lawyers practicing within the field is of import. Injured Workers are best served when their lawyers are active members of such Associations.

The California Lawyers Association (CLA) provides support to the Workers’ Compensation community to enhance the quality of the practitioners within the field. CLA has a Workers’ Compensation Section which supports the workers’ compensation community. The CLA Workers’ Compensation Section is essentially a spin-off from the State Bar.   The State Bar used to have a Section on Workers’ Compensation.  Lawyers would join the section by notifying the State Bar when paying their dues and pay an additional fee to participate.  Currently, the State Bar allows lawyers to join the CLA Workers’ Compensation Section by designating to do so and paying an additional fee.  The CLA, overall,  produces programs at the quality level of the State Bar.

Per the CLA, “[t]he purpose of the Workers’ Compensation Section of the California Lawyers Association is to serve our members, workers’ compensation practitioners, and the people of California by promoting an efficient and just compensation delivery system.”

Is The CLA Workers’ Compensation Section Exclusive for Applicant’s Attorneys? 

No. the Section is open to all participants in the workers’ compensation field. Therefore, both Applicant’s Attorneys and Defense Attorneys participated.

If an Attorney is a Member of the CLA Workers’ Compensation Section, It That Important? 

Yes and No. Any Lawyer can pay to be a member of the Workers’ Compensation Section. Therefore, being a member does not mean anything. Being an active member, however, is important. An active member, in my opinion, is one who regularly attends or participates in the various Educational Program provided.

Should an Injured Worker Value an Attorney Who Is a Member of CLA? 

Absolutely. As an active member, I have had the opportunity to attend countless seminars that CLA has provided. These seminars are well attended by both Applicant’s Attorneys and Defense Attorneys. The attorneys who I have seen attend these seminars are quite competent individuals. Further, the materials presented to them keep them apprised as to workers’ compensation law in general as well as recent case law and legislation that impacts the workers’ compensation system. Further, these seminars include many outstanding speakers and presenters in the industry. In sum, active participants in the Workers’ Compensation Section of CLA, are up to date on various workers’ compensation issues.

Further, participation in these programs allows Applicant’s Attorneys and Defense Attorneys to interact and debate ongoing issues within workers’ compensation. It is an opportunity to understand the positions that will be taken by the “other” side.

What are the Activities of the CLA’s Workers’ Compensation Section? 

The Workers’ Compensation Section of CLA is involved in the following activities: Publishing newsletters to keep members informed of new developments; establishing committees through which members may actively participate; presenting educational seminars on timely topics throughout the year; originating legislation which, upon approval, is made a part of our legislative program; recommending positions on pending legislation on behalf of the California Lawyers Association, and commenting on administrative regulations and rules of court.

What is the CLA Workers’ Compensation Section’s Purpose?

They ”are dedicated to serving our members, workers’ compensation practitioners, and the people of California by promoting an efficient and just compensation delivery system.”

Per the CLA website “[t]he purpose of the Workers’ Compensation Section of the California Lawyers Association is to serve our members, workers’ compensation practitioners, and the people of California by promoting an efficient and just compensation delivery system. The section, through standing committees, seeks to promote better legal practice, education and legislation affecting workers’ compensation. We review proposed state legislation and regulatory rules, and make recommendations to the authors. Our goal is to achieve the following constitutional mandate: Constitutional Basis of Laws

The Workers’ Compensations Act, codified in the Labor Code, with other related laws, has its jurisdictional basis in the California Constitution, Article XIV, sec. 4, which provides in part as follows:

The Legislature is hereby expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers’ compensation…to compensate…workers for injury or disability, and…for death…irrespective of the fault of any party…to the end that the administration of such legislation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without encumbrance of any character…””

What Type of Educational Programs Does CLA Provide in the Workers’ Compensation Section?

The Workers’ Compensation Section provides a wide variety of programs. There are seasonal programs which cover a large variety of topics. There are Rating Seminars which deal with rating issues. There are Specialization Seminars which assist attorneys in preparation of the specialization examination. Also, they also have Webinars on a large variety of topics as well.

What Other Services Does the CLA Provide? 

Per CLA, the “California Lawyers Association Workers’ Compensation Executive Committee, subcommittee on Technology and Social Media, offers access to our section members to listen to oral arguments made in Workers’ Compensation cases at various Districts of the California Court of Appeals.”

What Types of Committees Does the Workers’ Compensation Section Have? What Types of Things Do they Do?

The Workers’ Compensation Section has an Executive Committee, an Educational Committee, a Practice and Ethics Committee, a Legislation Committee, an Awards and Recognition Committee, Publications Committee, Membership Committee, Technology/Website/Social Media, a Community Outreach Committee, and an Unpublished Cases Committee.

These committees work on many different things such as improving the level of professionalism and competence for all individuals who practice before the Workers’ Compensation Appeal Board. They do so by providing quality and affordable education, public outreach, and assist with legislation.

How Does the CLA Workers’ Compensation Section Provide Assistance to the Workers’ Compensation Community? 

Per the CLA, the Section “seeks to promote better legal practice, education and legislation affecting workers’ compensation. We review proposed state legislation and regulatory rules, and make recommendations to the authors. Our goal is to achieve the following constitutional mandate: Constitutional Basis of Laws: The Workers’ Compensations Act, codified in the Labor Code, with other related laws, has its jurisdictional basis in the California Constitution, Article XIV, sec. 4, which provides in part as follows: The Legislature is hereby expressly vested with plenary power, unlimited by any provision of this Constitution, to create, and enforce a complete system of workers’ compensation…to compensate…workers for injury or disability, and…for death…irrespective of the fault of any party…to the end that the administration of such legislation shall accomplish substantial justice in all cases expeditiously, inexpensively, and without encumbrance of any character…”

What Do Members of CLA Workers’ Compensation Section Get? 

As a member, they are provide a newsletter, and provide access and discounts to Workers’ Compensation Section Programs and Publications. In addition, Members are allowed to participate in the Section and the Committee activities.

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 workers’ compensation cases for 28 years. Contact us today for more information.

Photo by Christopher Burns on Unsplash

PROSTATE CANCER AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Prostate Cancer is a medical condition for which there may be an element of “industrial causation.” Since Prostate Cancer, in certain circumstances, may be industrially-related, an Injured Worker could make a workers’ compensation claim for their Prostate Cancer. If the Workers’ Compensation Claim was accepted, the Injured Worker would be entitled to receive the full range of benefits.  This includes disability payments, medical care, and death benefits.

This article will discuss Prostate Cancer, Prostate Cancer Treatment, Permanent Disability as a result of Prostate Cancer, Industrial Causation of Prostate Cancer, Labor Code Statutes relating to Prostate Cancer, and Caselaw relating to decisions involving Prostate Cancer.

What is Prostate Cancer? What are the Signs of Prostate Cancer? 

Prostate Cancer is a disease in the Prostate Gland. It occurs when cells in the prostate grows abnormally and uncontrollably. It is a slow growing cancer which may cause symptoms with respect to both urine flow and sexual function. Additionally, there may be more generalized symptoms such as pain in the low back or pelvis area, weakness or numbness in the legs or feet, dizziness, or fatigue. Sources: National Cancer Institute and American Cancer Society.

How is Prostate Cancer Diagnosed?

Per the American Cancer Society, there are many tests that are used to both diagnose and stage prostate cancer. Basically, an individual will go through a series of testing in order to assist in diagnosis. Urology is the field of medicine that address Prostate Cancer. Doctors who specialize in Urology are Urologists.

Tests include

  • Prostate-Specific Antigen (PSA) [Blood Test]
  • Digital Rectal Examination (DRE) [Physical Examination Test]
  • Prostate Biopsy [Surgical Procedure] Tissues are removed from the Prostate. A Pathologist makes a determination as to whether the tissue is negative for cancer, suspicious for cancer, or positive for cancer. Note: negative results does not mean that the individual should not be concerned about cancer. Further monitoring should be conducted.
  • Imaging Studies: X-Rays, Magnetic Resonance Imaging (MRI), Ultrasound (Transrectral ultrasound aka TRUS), Radiology, Bone Scan, Computed Tomography (CT), and Lymph Node Biopsy

What are the Non-Industrial Risk Factors of Prostate Cancer?

There are a number of risk factors for prostate cancer. These risk factors include family history of prostate cancer, inherited genetic mutations, conditions such as prostatitis, inflammation of the prostate, and benign prostatic hyperplasia or BPH, a noncancerous enlargement of the prostate gland, diet high in red meats and high-fat dairy and low in fruits and vegetables, obesity, Age: approximately 60 percent of cases are diagnosed in men older than 65, Race and ethnicity (note: African-American men and Caribbean men of African ancestry are more likely to be diagnosed with prostate cancer.)

Please note: Research has also shown that a healthy lifestyle, including a well-balanced diet and maintaining a healthy weight, may reduce prostate cancer risk.

What are the Industrial Risk Factors for Prostate Cancer? Are There Other Factors?

Prostate Cancer can be work-related in two fashions. First, there is a scientific basis for showing that there is a causative factor in certain occupations or occupational exposures with respect to the development of Prostate Cancer. Second, there is a legal basis for showing a causative factor. A legal basis is a statutory presumption. For certain law enforcement officers and safety officers, they are afforded a “Cancer Presumption.” If they fit within the elements of the “Cancer Presumption,” they can be legally found to have industrial cancer without having to prove it on a scientific basis. Their Departments, however, are afforded the opportunity to “rebut the presumption.”

How is Prostate Cancer Work-Related?

Prostate Cancer can be work-related in a variety of manners. Prostate Cancer can be work-related with respect to certain:

  • Worksite Exposures: Certain Pesticides, Chromium
  • Occupations: Administrative and Management Positions, Firefighting and Law Enforcement, Pilots, and Agriculture
  • Work Activities: Shift Work
  • Labor Code Sections: Labor Code Presumption for Cancer 3212.1

See Cancer Med. 2018 Apr; 7(4): 1468–1478, Published online 2018 Mar 1. doi: 10.1002/cam4.1358 Prostate cancer surveillance by occupation and industry: the Canadian Census Health and Environment Cohort (CanCHEC)

Jeavana Sritharan, Jill MacLeod,  Shelley Harris, Donald C. Cole, Anne Harris, Michael Tjepkema, Paul A. Peters, and Paul A. Demers; and J Cancer Prev. 2019 Jun; 24(2): 91–111.

Published online 2019 Jun 30. doi: 10.15430/JCP.2019.24.2.91, Occupational Risk Factors for Prostate Cancer: A Meta-analysisSrmena Krstev and Anders Knutsson

What is the Statutory Basis for Supporting Industrial Prostate Cancer?

Labor Code Section 3212.1 provides for a “General” Cancer Presumption. This Presumption applies to certain Safety and Law Enforcement Officers. This Presumption has been used to specifically make claims for “Prostate Cancer.” It provides as follows:

“(a) This section applies to all of the following:

(1) Active firefighting members, whether volunteers, partly paid, or fully paid, of all of the following fire departments:

(A) A fire department of a city, county, city and county, district, or other public or municipal corporation or political subdivision.

(B) A fire department of the University of California and the California State University.

(C) The Department of Forestry and Fire Protection.

(D) A county forestry or firefighting department or unit.

(2) Active firefighting members of a fire department that serves a United States Department of Defense installation and who are certified by the Department of Defense as meeting its standards for firefighters.

(3) Active firefighting members of a fire department that serves a National Aeronautics and Space Administration installation and who adhere to training standards established in accordance with Article 4 (commencing with Section 13155 ) of Chapter 1 of Part 2 of Division 12 of the Health and Safety Code.

(4) Peace officers, as defined in Section 830.1, subdivision (a) of Section 830.2 , and subdivisions (a) and (b) of Section 830.37, of the Penal Code , who are primarily engaged in active law enforcement activities.

(5)(A) Fire and rescue services coordinators who work for the Office of Emergency Services.

(B) For purposes of this paragraph, “fire and rescue services coordinators” means coordinators with any of the following job classifications:  coordinator, senior coordinator, or chief coordinator.

(b) The term “injury,” as used in this division, includes cancer, including leukemia, that develops or manifests itself during a period in which any member described in subdivision (a) is in the service of the department or unit, if the member demonstrates that he or she was exposed, while in the service of the department or unit, to a known carcinogen as defined by the International Agency for Research on Cancer, or as defined by the director.

(c) The compensation that is awarded for cancer shall include full hospital, surgical, medical treatment, disability indemnity, and death benefits, as provided by this division.

(d) The cancer so developing or manifesting itself in these cases shall be presumed to arise out of and in the course of the employment.  This presumption is disputable and may be controverted by evidence that the primary site of the cancer has been established and that the carcinogen to which the member has demonstrated exposure is not reasonably linked to the disabling cancer.  Unless so controverted, the appeals board is bound to find in accordance with the presumption.  This presumption shall be extended to a member following termination of service for a period of three calendar months for each full year of the requisite service, but not to exceed 120 months in any circumstance, commencing with the last date actually worked in the specified capacity.

(e) The amendments to this section enacted during the 1999 portion of the 1999-2000 Regular Session shall be applied to claims for benefits filed or pending on or after January 1, 1997, including, but not limited to, claims for benefits filed on or after that date that have previously been denied, or that are being appealed following denial.

(f) This section shall be known, and may be cited, as the William Dallas Jones Cancer Presumption Act of 2010.”

Is There Caselaw concerning Industrial Prostate Cancer?

Yes. There has been some significant litigation with respect to Prostate Cancer.

Most caselaw has related around the “Cancer Presumption” and the issues related to it. Issue of interest in presumption litigation can include the burden of proof, the potential rebuttal of the presumption and the statute of limitations. The following are a sample of cases. County of Fresno vs. WCAB (2019) 84 C.C.C. 996 (writ denied) (Issue: whether claim barred by Statute of Limitations); County of Orange vs. WCAB (2005) 70 C.C.C. 1499 (Prostate Cancer found industrial. Defendant failed to rebut presumption.) Faust vs. City of San Diego (2003) 68 C.C.C. 1822 (Panel Decision) (Issue: the procedure concerning both establishing presumption and rebutting the presumption. In summary, in a case where an applicant has invoked the presumption of section 3212.1, the applicant has the initial burden of showing (1) that he or she was employed in an included capacity; (2) that he or she has been exposed to a known carcinogen during the employment; and (3) that he or she has developed or manifested cancer. When the applicant has made this showing, the burden shifts to the defendant to rebut the presumption by evidence that: (1) the primary site of the cancer has been identified; and (2) that the carcinogen is not reasonably linked to the disabling cancer.)

What is Permanent Disability Impairment for Prostate Cancer?

Permanent Disability Impairment for Prostate Cancer is multi-factorial. Prostate Cancer directly impacts two Activities of Daily Living (ADLs), urination and sexual function. The AMA Guides for Permanent Impairment, 5th Edition, has a Table 7-8 which addresses the Criteria for Rating Permanent Impairment Due to Prostate and Seminal Vesicle Disease discusses Prostate Cancer. It provides that “[f]or Prostate and seminal vesicle ablation; occurs almost exclusively with extirpative surgery for prostate cancer; combine impairment estimates for prostate and seminal vesicle loss with impairment for sexual dysfunction or urinary incontinence if present (see the Combined Values Chart, p. 604.)”

In sum, Permanent Disability Impairment from Prostate Cancer can be complex due to the nature and extent of both the condition and the treatment that has been provided.

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.

Photo by Gus Moretta on Unsplash

FRAGRANCES AND WORK-RELATED ASTHMA: WORK INJURIES CAUSED BY EXPOSURE TO PERFUME AND FRAGRANCES: WHAT YOU NEED TO KNOW

Workplaces contain many chemicals that can irritate a Worker’s Lungs.   These irritations can occur in two ways.   It can occur when a Worker with pre-existing conditions, such as asthma, is exposed to the chemicals.   Also, it can occur with Worker who has no pre-existing conditions.

Asthma is a significant illness within the United States Population. Per the Centers for Disease Control and Prevention, in 2018, 24,753,379 individuals suffered from the disease and 2,607,598 of them were from the State of California.   In addition, there are large amounts of the population that suffer from Childhood Asthma, 5,530,131, in the United States.   The large number of individuals with Asthma implies that there is a large number of the workforce has pre-existing Asthma.

This article will discuss Asthma, Fragrances, Perfumes, and Work-Related Asthma.

What Is Asthma? What Is Occupational Asthma or Work-Related Asthma?

Per the American Academy of Allergy, Asthma & Immunology, “Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs. If you have asthma your airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggers your symptoms. This makes it difficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightness.”

Occupational Asthma “is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.”  Per the CDPH, “[a]sthma is work-related when it is caused or made worse by something at work. Symptoms can start right after an employee breathes in a substance, or hours after leaving work. Sometimes a person can suddenly develop work-related asthma from substances they have worked around for years.”

What are Fragrances?

The term “fragrances,” for the purposes of this article, refers to perfumes and products that contain “fragrances.” A “fragrance” is essentially a pleasant scent.  In essence, a perfume is a “fragrance” that is placed upon a person.   Besides perfumes, various commercial and household products are enhanced with “fragrances” so that they “smell” good.

Both perfumes and fragrances contain chemicals effect an individual’s respiratory system.  As a result of exposure to these perfumes or fragrancies, an individual may suffer from respiratory symptoms which can include wheezing, chest tightness, cough, shortness of breath, or difficulty breathing.

What About Air Fresheners?

There are problems with Air Fresheners.   Per CDHP, “Air fresheners and deodorizers come in many forms: plug-ins, sprays, liquids, and gels. These products mask bad odors rather than get rid of them. Air fresheners add chemicals to the air that can cause asthma and other health problems such as headaches and allergies.”

How Does an Industrial Onset of Asthma Arise?

Occupational or Work-Related Asthma can be from a single event of inhalation or inhalation of a substance over a prolonged period of time.

What Are Examples of Industrial Exposures?

Use of Air Fresheners: There was one report where the use of an air freshener triggered asthma symptoms required the Worker to go to the emergency room for a visit.  As a result, the Worker required treatment of oral steroids to control their asthma.

Scented Lotions: Scented lotion from one worker got on a co-worker’s jacket.  This exposure worsened the co-worker’s asthma symptoms and gave him hives.  He was required to go to the emergency room 6 times as a result of it.

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.

OUTDOOR WORKERS, INSECT-RELATED INJURIES, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Many Occupations which involve “Outdoor Work.”   “Outdoor Work” exposes workers to insects.  Particularly in the outdoors, there are insects that can either carry illnesses or can exact injuries.  The common method of transmission of these illnesses or injuries are “bites.”   The severity of an Insect Bite Injuries can range from mild to fatal.  A Insect Bite, in the workplace, can bring rise to a workers’ compensation claim and entitlement to both monetary benefits and medical care.

Human succumbing to diseases related to insect exposure has become more prevalent.   Irrespective of work-relatedness, insect-related disease cases have tripled from 2004 to 2016.  Further, there have been new germs [that are insect related] which have been either discovered or introduced since 2004.   CDC

The increase in these types of cases is explained by a vibrant economy and tourism in that “[c]ommerce moves mosquitoes, ticks, and fleas around the world; Infected travelers can introduce and spread germs across the world; and Mosquitoes and ticks move germs into new areas of the US, causing more people to be at risk.”  CDC

This article will discuss “Outdoor Work,” the types of insect exposures that occur in the workplace, and the types of injuries that can occur in the workplace. The article will discuss special laws that apply to certain insect bite injuries as well as caselaw of interest with respect to insect bites.

What Type of Occupations Involve “Outside Work?”

There is a large variety of occupations that involve “outdoor work.”  Occupation Groups with “outdoor work” can include Agriculture, Construction, Fire and Safety, Forestry, Landscaping, Law Enforcement, Lifeguard. Mining, Prison, and Refining,

How Common Are Insect Bite Injuries?

Per the ACAAI, “[t]housands of people enter hospital emergency rooms or urgent care clinics every year suffering from insect stings. It has been estimated that potentially life-threatening allergic reactions occur in 0.4% – 0.8% of children and 3% of adults. At least 90 – 100 deaths per year result from insect sting anaphylaxis.”   Some of these individuals were working at the time they were stung.

What Are Common Insect Bites?

Per the ACAAI, “[t]he majority of insect stings in the United States come from wasps, yellow jackets, hornets and honeybees. The red or black imported fire ant now infests more than 260 million acres in the southern United States, where it has become a significant health hazard and may be the number one agent of insect stings.”

What Are the Consequences of Insect Bites and Insect Bite Allergies?

Per the ACAAI, “[t]he most serious reaction to an insect sting is an allergic one. This condition requires immediate medical attention. Symptoms of an allergic reaction may include one or more of the following: Hives, itching and swelling in areas other than the sting site, Abdominal cramping, vomiting, intense nausea or diarrhea, Tightness in the chest and difficulty in breathing, Hoarse voice or swelling of the tongue or throat, or difficulty swallowing.

An even more severe allergic reaction, or anaphylaxis can occur within minutes after the sting and may be life-threatening. A dose of epinephrine (adrenaline), typically administered in an auto-injector, and immediate medical attention are required. Symptoms may include: Dizziness or a sharp drop in blood pressure [or] Loss of consciousness or cardiac arrest.”   It should be noted that “People who have experienced an allergic reaction to an insect sting have a 60% chance of a similar or worse reaction if stung again.”.

The California Department of Public Health (CDPH) has reported on a tragic story of a date palm tree worker who died after he was attacked by multiple bees at an organic orchard in Southern California.

What Insects are Problematic?

Some of the problematic insects include bees, fleas, mosquitos, and ticks.

What Types of Diseases Can Rise from Insects?

Mosquito-borne diseases can include California Serogroup Viruses, Chikungunya Virus, Dengue Viruses, Eastern Equine Encephalitis Virus, Malaria Plasmodium, St. Louis Encephalitis Virus, West Nile Virus, Yellow Fever Virus, and Zika Virus.

Tickborne Diseases can include Anaplasmosis/Ehrlichiosis, Babesiosis, Lyme Disease, Powassan Virus, Spotted Fever Rickettsiosis, and Tularemia.

Flea-borne disease can include the Plague.

Can Bites Cause Other Injuries?

Yes. Sometimes the bite itself can cause injury.  For example, there are Africanized Honey Bees.  They have a venom that can impact various human organs. Further, a multitude of bites cause anaphylactic shock due.

Other bites of concern include fire ant bites, hornet bites, scorpion bites, and wasp bites.

If Someone is Allergic to Insect Bites and They are Bitten at Work and Sustain Illness, Is it Work-Related?

Yes.  Pre-existing conditions do not bar an Injured Worker from making a workers’ compensation claim.   An aggravation or acceleration of an underlying condition can be considered as a work injury.  Therefore, a Worker who is allergic to particular insect bites could be able to claim an injury if they were bitten while at work.

Are There Statutes Which Protect Injured Workers Who Sustain Work-Related Insect-Bites?

Yes.  There are two statutes which protect certain Police and Safety Personnel with respect to certain types of insect bites.

There is a statute that provides for a statutory presumption for Lyme Disease, Labor Code Section 3212.12, which applies to certain Police, Safety and Conservation Corps members. For an article on the Lyme Disease Presumption click here.

There is a statute that does not specifically address insect bites but does address some insect bite injuries.   There is a statute that provides for blood-borne illnesses.   This statute applies to insect-bites in that some of them involve a blood borne transmission of a disease or illness.   In those circumstances, the presumption would therefore apply to an insect bite.   Labor Code Section 3212.8 provides a blood borne disease presumption to certain Safety and Law Enforcement Officers.   For an article on the Blood Borne Disease Presumption, click here.

Is There Case Law Concerning Insect Bites?

Yes. There are various issues relating to insect bites in the workplace.

There are issues of whether the bite should be considered as a work-related event.

LYME DISEASE: In the matter of County of Mendocino vs. WCAB (1995) 60 C.C.C. 220, the “WCJ found that Applicant sustained a tick bite while employed by Defendant but could not conclude whether Applicant presently had Lyme Disease. However, the WCJ stated that the medical history was clear that the problems Applicant had were the result of the tick bite in question, and whether or not it was called Lyme Disease, the medical evidence clearly showed that, from this tick bite, Applicant suffered damage, including lost time from work and need for medical treatment, as well as possibly the need for future medical treatment.

WEST NILE VIRUS: In Leggette vs. CPS Security (2020) 85 C.C.C. 321(Board Panel Decision) the WCAB found that Applicant sustained an injury for West Nile Virus when Applicant bitten by mosquitos while working as a security guard at a construction site.

What if I Need Advice?

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