What is Covered by Workers’ Compensation?

Under California’s workers’ compensation law, nearly all injured workers must receive benefits if they were hurt on the job. In addition, the state has a no-fault workers’ compensation law, which means there is no requirement that an injured worker show that their employer was at fault or negligent. 

Common Work-Related Injuries

The most common types of workplace injuries that result in workers’ compensation claims are cuts, sprains, and muscle strains. These may seem like relatively minor injuries, but they often need medical treatment and may result in missed work.

There is no definitive list of accidents, events, or conditions that may lead to workplace injuries, but most tend to fall into at least one of the following categories:

  • Slipping, tripping, or falling on wet floors, icy walkways, or uneven surfaces
  • Vehicle accidents while riding or driving for work-related purposes
  • Accidents involving machinery or tools
  • Being struck by something that fell off a shelf or was dropped by a coworker
  • Electrocution that causes burns, organ damage, nerve damage, or brain injury
  • Exposure to dangerous substances like asbestos, chemicals, or lead
  • Fires or explosions
  • Overexertion that results in physical injury
  • Workplace violence

Additionally, working in some fields is more likely to result in workplace injuries than others. For example, police officers, corrections officers, firefighters, and construction workers are far more likely to get hurt on the job than someone working in an office environment.

Workers’ Recovery and Benefits: What You Are Entitled To

If you are injured on the job in California your employer must provide for your medical care, regardless of whether you miss any work. You may also be eligible for one or more of the following benefits, depending on the nature of your injury and its impact on your ability to perform your job:

  • The cost of medical treatment, including prescription drugs, transportation, and medical devices
  • Temporary disability payments if the injury results in missed time at work
  • Permanent disability payments when you can’t return to work
  • Vocational retraining if your injury keeps you from pursuing your current trade and your employer does not offer modified employment
  • Death benefits for those who die during work-related activities

If your injury entitles you to temporary or permanent disability benefits you are entitled to receive up to two-thirds of your pre-tax gross weekly wages, up to a maximum of $1,356 per week for injuries that occurred after January 1, 2021. In addition, in most cases your benefits will not be taxed.

Pre-Existing Conditions May be Covered

Under California’s workers’ compensation law, if you have a pre-existing condition that you aggravate while on the job it will be treated as a separate injury if it satisfies one of the following requirements:

  • The aggravated injury results in the need for additional medical treatment 
  • The aggravated injury must increase your temporary or permanent disability
  • The aggravated injury either requires a new treatment plan or changes an existing plan

Unfortunately, “exacerbating” a pre-existing injury will not qualify as a new injury. These exacerbations are flare-ups or recurrences of pre-existing conditions.

No Right to Bring a Civil Lawsuit

While California’s workers’ compensation law is considered by many to be generous by providing no-fault coverage for most worker injuries, it does have one major drawback: It bars workers from bringing civil lawsuits in most situations. That means you can’t expect to see the type of large recovery that you would receive in a personal injury case.

The primary reason for the reduced recovery is that employers are not required to pay damages for pain and suffering in workers’ compensation cases. Your settlements are usually limited to the costs of treating your injuries and compensation of missed work.

Who Qualifies for Workers’ Comp and How Do You Apply?

California’s workers’ compensation law requires that most workers who are injured while on the job receive benefits, no matter who is at fault. Additionally, temporary workers, part-time employees, and independent contractors may be eligible. Finally, there is no requirement that the injured worker be a legal U.S. resident to receive benefits.

However, some categories of workers are exempt from workers’ compensation, including business owners without employees (except roofers), domestic workers related to their employer, and people who work for their food or housing.

Filing a Claim

To file a workers’ compensation claim you will need to request a Workers’ Compensation Claim Form from your employer. Employers are required by law to provide the form within one work day of the injury, so if you do not receive one, you should contact a workers’ compensation attorney to ensure that your rights are protected.

After filling out the form and submitting it to your employer, it is then submitted to the insurance company. The insurance company then has 14 days to update you on the status of your claim. If you submit a form and your employer does not deny your claim within 90 days of receiving it is presumed that workers’ compensation will cover your injury

What Happens When Your Claim is Denied?

Most workers’ compensation claims are settled without any difficulty, but in some cases an insurer will choose to deny your claim. If that happens, you will still have the option of filing an appeal with the Workers’ Compensation Appeals Board and ask it to review the determination.

When to Hire a Lawyer

As a general rule, you can handle most workers’ compensation claims when there are minor injuries or your employer admits that it is responsible without getting a lawyer involved. However, you should contact an attorney to represent you in the following situations:

  • Your claim is denied
  • Your employer fails to pay your benefits on time
  • Your employer offers a settlement that does not cover all of your medical bills or lost wages
  • You cannot return to work due to a disability
  • Your employer retaliates against you for filing a claim

While California’s workers’ compensation law bars you from suing your employer in most circumstances, you may be able to file a civil lawsuit if your employer was not insured or engaged in serious misconduct.

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