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?

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.


Many occupations are susceptible to work injuries.  One of these occupations is that of a Dental Hygienist.  More specifically, Dental Hygienists are at risk for musculoskeletal disorders (MSDs.)  This has been recognized by the California Department of Public Health (CDPH.)

This article will discuss the occupation of Dental Hygienist, how Dental Hygienists are at risk for musculoskeletal disorders, and caselaw of interest.

What is a Dental Hygienist?

Per the American Dental Association(ADA), a Dental Hygienist is a licensed position which varies from state to state.  Note: The practice of dental hygiene in California is regulated by the Dental Hygiene Board of California.

The tasks of Dental Hygienists can include “patient screening procedures; such as assessment of oral health conditions, review of the health history, oral cancer screening, head and neck inspection, dental charting and taking blood pressure and pulse, taking and developing dental radiographs (x-rays), removing calculus and plaque (hard and soft deposits) from all surfaces of the teeth, applying preventive materials to the teeth (e.g., sealants and fluorides), teaching patients appropriate oral hygiene strategies to maintain oral health; (e.g., tooth brushing, flossing and nutritional counseling), counseling patients about good nutrition and its impact on oral health, making impressions of patients’ teeth for study casts (models of teeth used by dentists to evaluate patient treatment needs,)[and] performing documentation and office management activities.”

Dental Hygienists can work in a variety of locations.   This locations include Dental Offices.  This can include Dental Offices of General Practitioners as well a Specialty Practitioners’ Offices such as Periodontics and Pediatric Dentistry.

Dental Hygienists also may work at Public Health Agencies, Hospitals and Community Health Clinics. They can work for public school systems, dental schools and dental hygiene educational programs.  Dental hygiene services can be performed in hospitals, nursing homes, prisons and public health clinics.

Note: Activities of interest involve the activities in which the patient is in the dental chair and the Dental Hygienist is performing services upon them.

What Are Musculoskeletal Disorders (MSD)?

Per the Centers for Disease Control and Prevention (CDC), Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs.

What Types of Musculoskeletal Injuries Do Dental Hygienists Sustain?

Dental Hygienists are susceptible to a multitude of musculoskeletal disorders.  Upper Extremity problems are common.  These upper extremity diseases or conditions include tendonitis, tennis elbow, and carpal tunnel syndrome.

Has There Been Any Caselaw Concerning Dental Hygienists with Cumulative Trauma Musculoskeletal Injuries?

Yes. In Barnes vs. WCAB (2013) 78 C.C.C. 1137 (writ denied), the case involved a Dental Hygienist who suffered a cumulative trauma musculoskeletal injury to her neck and back.  In the matter, there was a dispute as to whether there was also an aggravation of an underlying fibromyalgia and chronic fatigue syndrome.  In the case, there was a finding of industrial causation for those body parts.

Are Musculoskeletal Disorders for Dental Hygienists a Concern for the State of California?

Yes.  The State of California is concerned over the risk of injury for Dental Hygienists. The State recommends ergonomics programs in order to promoted a safe and efficient workplace.

What Are Ergonomics?

Per OSHA,  “ [w]orkers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker’s risk of injury.

Work-related MSDs can be prevented. Ergonomics — fitting a job to a person — helps lessen muscle fatigue, increases productivity and reduces the number and severity of work-related MSDs.”.

Are There Ergonomic Tools for Dental Hygienists?

Yes. The State of California offer videos designed for Dental Hygienists.  Here is the link. https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/OHB/Pages/ErgonomicsDentalHygiene.aspx

There are videos which include topics such posturing and position, use and choice of instruments and body strengthening.

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.


Cleaning Products can be a source of Industrial Asthma also known as Occupational Asthma.   There are certain occupations that account for a large percentage of these claims.  This article will discuss Industrial Asthma, the occupations that are at risk for Industrial Asthma.  It will also discuss caselaw on the issue as well.

What is Industrial Asthma?

Per the American Academy of Allergy, Asthma, and Immunology, “Occupational asthma has become the most common work-related lung disease in developed countries. However, the exact number of newly diagnosed cases of asthma in adults due to occupational exposure is unknown. Up to 15% of asthma cases in the United States may be job-related. Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while “on the job.”  Often, …symptoms are worse during the days or nights…work[ed], [and] improve[d] when…[there is]time off and start again when…[there is a return] to work.”

What Occupations Are Impacted by Industrial Asthma?

The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%.) Cleaning Products and Work-Related Asthma 10 Year Update DOR 10.1097 JOM.0000000000001771

It has been found that Cleaners are at risk of some asthma‐associated symptoms and reduced lung function. Respiratory health in professional cleaners: Symptoms, lung function, and risk factors https://doi.org/10.1111/cea.13597

A “study found that professional cleaners have an increased risk of current asthma and reduced lung function. Cleaners identified as having asthma were more likely to be non‐atopic, less likely to have a doctor diagnosis of asthma ever, and had airway obstruction that was less responsive to bronchodilator administration. Amongst cleaners, working in cafes/restaurants/kitchens and/or use of multi‐use cleaner and upholstery sprays was associated with a significantly increased asthma risk, whilst exposure to glass cleaning sprays was associated with reduced (pre‐bronchodilator) lung function.” Respiratory health in professional cleaners: Symptoms, lung function, and risk factors    https://doi.org/10.1111/cea.13597

Further, concerns of Industrial Asthma relate to domestic cleaners as well.  See Job hazards and respiratory symptoms in Hispanic female domestic cleaners Kristina W. Whitworth,Brenda Berumen-Flucker,George L. Delclos,Sonia Fragoso,Claudia Mata & David Gimeno Ruiz de Porras,Pages 70-74 | Published online: 29 Apr 2019 https://doi.org/10.1080/19338244.2019.1606774 (“In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR(bronchial hyperresponsiveness) symptoms and is potentially exposed to myriad occupational hazards.”)

What Types of Agents Do Cleaners Use that May be Involved with Industrial Asthma? 

“Cleaners are frequently exposed to a range of agents including chlorine/bleach, ammonia, ethanolamines, chloramine‐T, aldehydes, and quaternary ammonium compounds (QACs),7 which may contribute to both new‐onset asthma through sensitization (in a minority) or irritation, and exacerbation of pre‐existing asthma.8 Importantly, as many people worldwide, other than cleaners, are exposed to cleaning products, asthma due to, or exacerbated by cleaning products is a considerable public health concern.”  Respiratory health in professional cleaners: Symptoms, lung function, and risk factors,  https://doi.org/10.1111/cea.13597

Is There Any Caselaw Concerning Cleaners and Asthma? 

In LAUSD vs. WCAB (2007) 72 C.C.C. 1719 (writ denied), a Health Care Assistant was found to have sustained an injury to her lungs and in the form of asthma when Applicant was exposed to toxic fumes during daily cleaning duties from chlorine gas that evaporated from hypochlorite found in the cleanser, “Dispatch.”

Is there anything Important that an Injured Worker can do if They believe that They have Industrial Asthma?

There are three things that are recommended.   First, the Injured Worker should seek medical attention to diagnose and treat their condition.   Second, the Injured Worker should documents the chemicals and cleaning material that they use on the job.   Third, the Injured Worker should seek a consultation whether an industrial injury claim should be pursued.

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.

Insurance Companies and their Duty to Investigate in Workers’ Compensation Cases

With respect to my Workers’ Compensation Claim, Does the Insurance Company handling my Claim have a duty to treat me fairly?

Yes. California law requires that Injured Workers be treated fairly. Regulation Section 10109 section (e) provides that “Insurers, self-insured employers and third-party administrators shall deal fairly and in good faith with all claimants” Not only does this section apply to the injured worker, it also applies to any dependent’s claims as well. Dependent’s claims may arise upon the injured worker’s death. In those circumstances, there can either be a death claim or an accrued benefits claim on a “live” claim. In other terms, any outstanding unpaid benefits owed up to the date of death.

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What Are California Workers’ Compensation Medical Appointments and Evaluations?

How Can They Damage a Worker’s Claim of Industrial Injury?

In California Workers’ Compensation Law, Injured Workers attend both medical treatment appointments and medical legal evaluations as part of their claims. While these appointments are intended to provide either treatment or assess aspects of Injured Worker’s claim, such as permanent disability, these examinations and evaluations can also inform Insurance Companies of information that cast doubt as to the validity or the severity of both, the Injured Worker’s claim and/or their entitlement to benefits. These items are frequently called “red flags.” Many doctors who contract with insurance companies will note these “red flags” within their reporting.

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