What Injuries Are Covered by Workers’ Comp?
California workers’ compensation covers a wide range of injuries and incidents. Below, we discuss the various categories of workplace injury, from those that lead to more direct and simple workers’ comp claims to those that can be more complex and challenging. If you suffer any illness or injury because of your time at work, call a knowledgeable Riverside workers’ compensation attorney for help maximizing your compensation.
The quintessential workers’ compensation claim is based on an accident that happens at work. You’re on a construction site, the scaffold collapses, and you suffer knee trauma, broken wrists, a head injury, etc. A workplace accident is covered by workers’ comp.
Complications arise when the injury occurs off-site. If an employee is injured, for example, in a car accident, workers’ comp coverage turns on whether they were actively engaged in workplace duties. If they were making a delivery for work, or driving to an off-site meeting with a client, they are likely covered. If they were simply commuting to work, grabbing lunch, or otherwise driving on their off-time, then they are not covered. Many workers’ comp cases turn on whether the employee was technically “on the job” at the time of the accident; make sure you have a seasoned workers’ comp legal team helping you prove your case to get the benefits you are owed.
Cumulative Trauma or Repetitive Motion Injury
Many injuries are caused by repeated strain or trauma over a long period of time, such as carpal tunnel syndrome, tendonitis, epicondylitis (tennis elbow), and back strain. Constant sitting, typing, lifting, twisting, pulling, and other strenuous activities can be just as harmful as a single, traumatic accident. California workers’ comp insurance will cover injuries that happen in a single accident as well as injuries that develop over time, so long as they were caused by work-related tasks.
The workers’ comp insurance provider may, however, try to “offset” or reduce the employee’s compensation award based on how much outside activity contributed to the injury. Make sure to work with a savvy workers’ comp attorney to maximize your recovery for a repetitive stress condition.
Workers’ comp covers occupational illnesses and diseases in addition to physical injuries. Workplace illness or disease can be caused by exposure to harmful chemicals, carcinogens such as asbestos or tar, biological agents such as infectious diseases, or physical agents such as radiation or bright lights. If your condition can be connected to your time at work, whether you suffer from cancer, asthma, brain damage, infectious disease or virus, or any other illness, you can seek workers’ comp.
You and your attorney will need to be able to prove a connection between your condition and your work. Workers in certain professions, such as police officers and other emergency workers, benefit from a presumption that certain conditions, such as cancer or heart disease, were caused by the job.
Aggravation of Pre-Existing Conditions
Workers’ comp covers only what happens on the job. Pre-existing injuries or illnesses are generally not covered by workers’ comp, although there are exceptions. If something happens at work that causes a “new” injury connected to an existing condition, the new injury may be covered.
For example, if a worker with a prior knee condition suffers a new tear or break because of heavy lifting or twisting on the job, that new tear or break could constitute a new injury covered by workers’ comp. The injury is new, even if it’s connected to an older injury or congenital knee condition. This is known as “aggravating” an existing condition.
If, on the other hand, the worker only suffers a “flare-up” or exacerbation of an existing condition, that might not be covered. If a worker already has arthritis in their back, for example, and they start to feel additional arthritis-related pain but are still able to work, that would not be considered a “new” injury.
Mental Health Disorders
In California, workers’ comp covers mental health conditions, provided the employee can satisfy certain conditions. The worker must suffer a medically diagnosed mental disorder, predominantly (at least 51%) caused by workplace activity, that limits the worker’s ability to work (i.e., is disabling), and was not caused by good-faith personnel actions (such as a demotion, poor performance review, or termination). The employee must also have worked that that company for at least six months.
Finally, injuries that are otherwise covered might be excluded for specific reasons. Workers are not covered for:
- Intentionally self-sustained injuries
- Injuries caused in pursuit of criminal activity, such as starting a fight
- Off-duty, voluntary activities, even if they happen at the workplace
If you or someone you love has been seriously hurt on the job in California, get help seeking the workers’ compensation benefits you’re owed by contacting the Riverside offices of Ochoa & Calderón for a consultation on your case.