Certified Specialist, Workers' Compensation, The State Bar of California
Board of Legal Specialization
California Workers' Compensation laws were enacted to provide benefits to employees who are injured due to their work. Its goal is to provide employees with prompt medical care to cure or relieve from the effects of a work injury, and to prevent the injured worker (in almost all cases) from filing a lawsuit for damages against the employer. The law provides that the employee be paid temporary disability indemnity for up to two years during the time the employee is getting medical treatment and is certified by a doctor as unable to work. It provides for medical treatment for life, without deductibles and co-pays, to address the effects of the injury. It also provides for permanent disability payments based on a complex statutory formula system based on analysis by a specially trained physician. It may also provide a substantial voucher that can be used to pay for retraining if an employee with permanent disability is unable to return to the job.
All employers are required to provide coverage for their employees so that these benefits can be obtained when necessary. Normally, this is done when your employer purchases a policy of Workers' Compensation insurance. Some very large employers, as well as government entities, are allowed to provide the benefits directly without purchasing insurance. Either way, these benefits have been secured in advance of someone being injured, and therefore an employee should not feel hesitant about requesting these benefits when needed. Nor should an employee be afraid to file a claim for benefits. Labor Code 132a provides for severe penalties for discriminating against an employee for filing a claim, or making known an intention to file a claim.
Unlike bodily injury lawsuits in civil court, Workers' Compensation benefits are awarded without regard to fault. If you had an injury on the job because of a mistake you made, it does not matter: You are still entitled to recover benefits. We once saw a claim from a construction worker that sawed himself off of a beam while building a house. That was not a bar to recovery. It also is true that the employer does not have to be negligent in any way for benefits to be awarded. Neither negligence on your part or your employer's part will be considered.
In order to receive benefits, you must have been an employee when the injury occurred. This statement sounds simple, but it is not. Often, employers try to classify workers as “independent contractors” in order to try to escape liability for their injuries, but it turns out that the law has an acid test to determine who is and who is not an employee and each case turns on its facts.
Even if you are clearly an employee, the injury must have arisen out of the employment and must have occurred in the course of your employment. For example, normal commutes to and from work are not covered (although there are numerous exceptions to that rule). Certain impairments may arise from work even if the health issue first arises off the job. Disabling events such as a heart attack or stoke may occur at home but may have been caused in part by work stresses and therefore may be eligible for indemnity and medical care. Again, each case turns on its facts and the legal implications of those facts may not be self-evident.
Sometimes employees do not know their employment caused or aggravated a disabling condition until after they stop working. Typical examples of this are illnesses which do not become evident until long after a harmful exposure at work, or where you were not told by a doctor of the possible connection to work until well into retirement. Breathing disabilities and noise-induced hearing loss are typical examples. In such cases, benefits may still be awarded if the facts are carefully developed and properly presented.
If your case is being denied by the insurance company for any reason, be sure to seek legal help before giving up.