Work-related injuries are a common occurrence, not just in California but the entire country. Even though employers are continuously putting measures in place to protect their employees against work-related injuries, they still occur. The resolve is to make sure that employees are well protected if they are injured while performing their duties, and this is effectively done through Workers’ Compensation Insurance. If you or your loved one has been injured at work, The Workers’ Compensation Attorney Group in Orange County will be more than ready to help you determine whether or not your type of injury is covered under the Workers’ Compensation Law.

Understanding the Workers’ Compensation

Workers’ Compensation is a type of insurance that gives monetary benefits to employees who have suffered work-related injuries or have been disabled in the course of performing their duties. The law requires every employer to provide means and strategies in place that will ensure that all employees are safe, irrespective of the kind of work they do in their workplaces. Even with those requirements, employees are still injured, and they have a legal right to sue their employers for any injuries they sustain in the course of their employment. The Workers’ Compensation Insurance, which is provided by the employer, is given for employees to agree to give up their right to sue their employers for negligence if they are injured at work.

The Workers’ Compensation protects both the employees and their employers. In exchange for not suing their employer, employees are guaranteed enough monetary compensation that will take care of all their medical needs as well as provide temporary wages for the period the employee will be away recovering. 

However, employees are required to understand their rights and know the kinds of injuries that are compensable under the Workers’ Compensation to avoid being caught by surprise when the time to pursue the compensation comes.

An injury that is covered under this type of insurance is referred to as a compensable injury. The injury must have been caused by factors that are work-related, both physical and emotional. Every employee is at risk of getting injured at their workplace, with those working in the construction and manufacturing industry facing a higher risk. However, this does not mean that other employees should not be covered. When the time comes to compensate an employee for an injury sustained at the workplace, it will not matter if their workplace was the safest of them all, or if the employee had past health issues or a history of similar injuries. The employee will still be compensated.

Compensable Injuries under Workers’ Compensation: What Is Considered?

An injury has to be work-related to be compensable under the Workers’ Compensation. Injuries that happen during breaks or when an employee is enjoying some free time are not covered for compensation. However, if the injury occurred when an employee was working, or out there but still performing his/her duties, that kind of injury will be covered.

Injuries that are covered under this insurance do not have to be as a result of slip-and-falls or falling objects necessarily. Slip-and-falls could be the majority type of work-related injuries reported in different states in the country today, but they are not the only ones. Some injuries take a long time to get noticed, for instance, those that relate to repetitive motion. These may take months or even years before they are spotted, but they deserve the same amount of compensation as the common injuries. There are illnesses, such as cancer and asbestos toxicity, which come as a result of working with the same objects, elements, or materials for an extended period. Emotional trauma is considered as a workplace injury as well, mainly if it is caused by some violence that occurred at the workplace.

Work-related injuries cover all forms of injuries that happen when you are doing something at your job or for your manager, or while you perform the usual duties, you do every day in your career. It could, for instance, be an accident involving a truck belonging to the company, a collision with your car as you were running a company errand, or even an injury sustained at a social event that was organized by the company where you work.

If you get injured during your break from work, maybe during tea or lunch break, you may get compensated because the injury will have occurred within the company property. Employers could also get paid for stress, depression, or anxiety if it is proven that the condition occurred or was made worse by a factor within your employment.

Work-related injuries should be reported and reported immediately however minor they may seem. The law obligates your employer to take immediate action to have you treated immediately you make that report, to prevent the problem from getting out of hand. Before that, an employee must find out if the injury is covered by workers' compensation. If yes, get the forms, fill them up and allow the claims manager to follow through with the matter.

Types of Injuries that are Compensable

Under California law, work-related injuries are not clearly defined, and so, one can quickly get confused and miss out on compensation for an injury that has already been covered. Here is a general list of types of injuries that could be compensated:

Physical Trauma

This is one of the most severe bodily injuries that a person can sustain. Physical trauma can either be blunt force trauma, caused by a force or an object that strikes the body resulting in broken bones, concussions or deep cuts; or penetrating trauma that is created when an object penetrates one's body or skin, leading to an open wound. Unlike most work-related injuries, this is the stress-free one to prove because it results from an identifiable event, and there is always proof of injury. Compensation claims for this kind of injury are usually straightforward, and even if the accident occurred from employee negligence, the insurance provider still pays the benefits.

Occupational Illness

This is a condition that results from a person’s continuous exposure to a chemical, biological, or physical agent to the point where the normal functioning of their body is affected, and their health is impaired. If you have been exposed to airborne pollutants in your workplace for a very long period, or chemicals or even excessive noise, they could result in conditions such as cancer and hearing loss. Some illnesses may seem minor, for instance, rashes, but there are others that are extremely serious, leaving you with migraines and other issues. This exposure can also aggravate a pre-existing condition, making it worse than it was. Aggravating a pre-existing condition is considered as a workplace injury as well.

Mental Injuries

Abnormal stress in a person’s workplace is likely to cause them anxiety and depression. Violence and traumatic events at work can also result in psychological injuries, which are compensable under the workers' compensation insurance. However, mental injuries take a long time to show and so, California law requires a person to show that they have worked for the same employer for six months or more before they can claim for compensation. There should also be proof that your employer is at least 51% responsible for your mental condition. Witnesses will be called in to help prove that you suffered work-related stress. In case you were a witness or a victim of a violent act at your place of work, you will be compensated for your mental injuries.

Mental-physical Injuries

These are the types of mental damages that result in physical injuries such as heart attack and stroke. Too much stress and anxiety can, for instance, result in heart disorders and cardiac-related issues. An increase in one’s blood pressure can weaken the heart muscle if it is chronic, causing heart failure or resulting in coronary disease. For you to get compensated for such an injury, there must be proof that you indeed have a mental injury that led to a physical injury. In addition to that, you will need to prove that your job is responsible for all that happened to you.

Physical-mental Injuries

Most physical injuries, especially those that are serious, affect a person’s mental health. Most reported cases of depression and anxiety usually come as a side effect to physical injuries. A worker who has been seriously injured at work and is unable to continue working permanently or even for a while will not feel good about it, and this could cause stress, resulting in depression. Mental injuries that result from work-related physical injuries are termed as compensable consequences to physical injuries and will be compensated. In some instances, sleep disorders, as well as sexually dysfunctional, may happen after a bodily injury and California State allows for these to be offset, allowing the injured worker to seek proper treatment for them.

New Injuries Resulting from Pre-existing Conditions

If you have a pre-existing condition or a previous injury that was worsened by an accident you suffered at work, or by constant strain at your workplace, you can claim for compensation. An accident can, for instance, cause a new injury, aggravate a pre-existing condition, or worsen it. Some of the pre-existing conditions that can be compensated in California include back injuries, degenerative disc disease, and a neck injury. If you had an accident before, a slip-and-fall at work or an auto accident while performing your duties can aggravate it. A medical report will be required to show your health and medical condition at the time of the accident and how the accident impacted the pre-existing injury.

Cumulative Trauma and Repetitive Stress Injuries

These types of damages can happen in any job and can affect all types of workers, including construction, factory, and office workers. A cumulative trauma or repetitive stress injury will not occur at a specific date or time. These injuries are also not as a result of a particular event. They are the types of injuries that develop gradually over some time until they affect the productivity of an employee. A worker may begin to feel as if they are just tired, but as the days go by, the pain and discomfort get worse, and this is the time they realize that they have been injured. Some conditions that could be compensated under cumulative trauma and repetitive stress include orthopedic illnesses like carpal tunnel syndrome and tendonitis.

Sickness from Harmful Exposure

Toxic exposure can be hazardous as it slowly affects the health of a person until the time they can no longer take it anymore. Continuous exposure to radiation, for instance, can significantly affect the lives of people. While employers will do their best to protect their employees against such exposure, other chemicals seem less dangerous, but they end up affecting the health of employees. Some cleaning solutions will, for instance, cause rashes, stomach issues, and migraine headaches that could cost a lot and take a while to get healed. Some employees are also continuously exposed to asbestos, which is a known cause of lung and mesothelioma cancers.

California Compensable Consequences

Other than compensable work-related injuries, there are physical problems and complications which come as a result of the original work-related injuries. In California, injuries at work are given great importance as they are the reason why many people are unable to earn a living like they usually should. An injured employee who suffers any consequence of the injury deserves the same amount of medical coverage and disability benefits as the ones they were entitled to in the primary injury.

Some of the compensable consequences in Orange County include:

  • An employee who gets addicted to the painkillers they have been taking for an extended period due to a work-related injury

  • A worker who is clinically depressed from a work-related injury that is far from getting better

  • An injured employee with carpal tunnel syndrome that has resulted in another type of overuse syndrome

  • An employee with nerve damage that resulted from a complication from an operation they underwent following a workplace injury

Most employers and insurance carriers have refused to accept claims for compensable consequences even when it is proven that the effects came as a result of the work-related injury the employee suffered. In that case, you need an experienced workers’ compensation attorney to be able to prove the underlying relation between the original injury and the secondary condition in court if your employer refuses to offer compensation for it.

In addition to that, there are specific injuries that are automatically seen as work-related in California, and these are automatically compensated for if the employee is quick to make a claim. These conditions may be heart-related illnesses, hernias, and cancer. Unless otherwise stated, these types of injuries will be treated as work-related and so will be eligible for compensation.

There are instances where the insurance company will refuse to take full liability for a legitimate claim for compensation, especially in cases where the injury has caused a permanent disability. In a case where an employee, who was previously hurt running or playing football gets injured on the same leg or knee at work, a doctor may report that only a certain percentage of that injury was a result of the work-related incident. The portion the doctor will give to that injury to work-related injury will be the only percentage compensation you will get.

Psychiatric Work-Related Injuries

There are job-related psychiatric injuries too, but most of them are treated as stress, and an employee can only make stress claims to get compensated for them. Most of these injuries result from emotional distress and mental injuries that employees get from certain conditions in their working environment. Psychiatric injuries will force an employee to take a break from their job when they realize that they can no longer work as efficiently as they did before. Some of the causes of these injuries are:

  • Overworking to a point where employees go beyond their point of overtiredness

  • Cruel remarks from supervisors and strict employers as well as endless threats made to employees every day

  • Sexual harassment in workplaces

Under California Workers' Compensation, psychiatric work-related injuries are seen as different from physical injuries because it is not easy for an employee to prove that they indeed got injured in their workplace. Physical injuries are way too easy to determine because pieces of evidence can be gathered through blood tests and x-rays, but a psychological injury will be quite personal, and an employee's personal feelings, thoughts, and experiences are painful to bring to the surface.

Again, there are other factors that can result in a psychological injury, which can worsen the situation if they are related to work stressors. These are, for instance, marital issues, personal problems, and financial woes. An evaluating psychiatrist may not be able to tell if for sure your injuries are purely work-related, or they have been fueled by some of the issues you are facing outside work.

For an employee and his/her insurance carrier to compensate for a mental injury, there are certain requirements the employee must meet:

  • The employee must prove that their workplace environment was the main reason why they suffered the injury. If there was abuse, threats, or overworking, he/she must provide sufficient proof to that effect.

  • The employee must be detected with a mental condition that has resulted in a disability or one that requires medical care

  • The employee must have been with that particular employer for not less than six months, though not necessarily continuously

  • There must be a medical report showing that at the very least, 51% of those injuries were caused by unfavorable working conditions.

The insurance company may be required to deeply analyze your personal life to see if they could find issues that could have caused you stress, to prove that the injury was not as a result of a personal problem that you were facing at the time of injury. For this reason, they may be interested in finding out if you have past psychological problems, financial issues, previous or current drug problems, family issues, and any other sensitive information they could get. Be on guard, because this could weigh heavily on your stress trouble.

Statute of Limitation in Presenting Claims for Workers’ Compensation

There is an amount of time within which you should act if you want your claim for workers’ compensation to be accepted, and this is the statute of limitations. If time passes and the time you are allowed to file for claims passes, you automatically forfeit your right to claim the compensation. This, however, does not mean that an employer should quickly take the offer their employer is giving in the first instant.

An employer, as well as the insurance company, will do their best to give you as little compensation as they can so they will not get into more significant financial losses. This explains why you need an experienced attorney by your side. Other than ensuring that you are sending your claims within the set timelines, your attorney will be sure to advise you on the right amount of money you should accept for the injuries sustained.

Note that specific injuries will require you to take a long time off work and continuous treatment in the years that follow.

Find a Workers’ Compensation Attorney Near Me

Issues surrounding workers’ compensation can be confusing for a worker who has not taken time to learn all there is to know about the insurance. No one foresees a work-related injury, and many injured employees are caught unaware, not knowing what to do next. At The Workers Compensation Attorney Group in Orange County, we understand how confusing it can be if you have been injured and you are not sure if the injury is covered under Workers’ Compensation Insurance. Talk to Orange County workers comp attorney at 562-485-9694 and let us help you figure it out.