When an injury is covered under the Workers’ Compensation system, it is known as a “compensable injury.” The injury must stem from work-related physical or emotional harm. An important concept in workers’ compensation is that each employer takes an employee “as is.” This means the employer cannot deny workers’ compensation coverage simply because a person in perfect health would not have been injured. It is also irrelevant if the employer did not know about a worker’s prior conditions or if the employee never told the employer about past injuries or preexisting conditions. Here are some of the major categories of injuries that are covered in California’s Workers’ Compensation System.
- Specific Injuries: The most straight forward injury can be traced back to a single incident that happened while you worked. For example, you are hit by a falling object at work, you slip on something and fall, you cut yourself using a tool, you are involved in a car accident while delivering packages, or you hurt your back lifting a heavy object. Remember, it doesn’t matter if the injury was your fault, you are still entitled to Workers’ Compensation benefits.
- Cumulative Trauma or Continue Trauma Injuries: Sometimes injuries develop over the course of time due to the repetitive motions required in your job duties. Many times an injured worker does not know they have a cumulative trauma injury until they visit the doctor. Workers may feel that it’s their body feeling tired from a long day of work and usually take over the counter medication to relieve the pain. Common types of cumulative trauma injuries include, developing carpel tunnel syndrome from repetitive typing, developing a disc herniation from years of bending your back and picking up objects, tearing your shoulder muscle by constantly using arms as a warehouse worker.
- Sickness Due to Harmful Exposure: Common examples include being exposed to asbestos while working, using cleaning solutions that cause rashes, migraine headaches to stomach problems.
- Injuries that are Automatically Work Related by Law: These include police officers, fire fighters or other law enforcement personnel who develop heart trouble, cancer or hernias in occupations that involving protecting the public. Injuries where no other explanation is provided, it is presumed to be compensable.
- New Injuries Resulting from Prior Conditions or Prior Work Injuries: If you’re injured at work as a result of a preexisting condition, you may still have a compensable workers’ compensation claim. In order to qualify, your injury must be an “aggravation” (worsening) of a preexisting condition or a new and different injury resulted from a prior work injury.
Apportionment: Even if you are legitimately injured on the job and suffer a permanent disability, the insurance company may claim that it is only responsible for a “portion” of your permanent disability. The most common example is if you hurt your back at work, but had a prior car accident where you injured your back as well. A doctor will determine what percentage of your injury is work related and which percentage is attributable to your car accident (not work related).
- Psychiatric Injuries: These injuries cause emotional harm due to stressful conditions at work. However, in order to file a Psychiatric workers’ compensation claim, you need to have been employed for at least 6 months (does not have to be continuous) and you must prove that your psychiatric injury was at least 51% caused by your work. For example, if your stress is a combination of factors, including financial problems, a recent divorce and stress from work, the stress from work must be the “predominant cause” of the injury (51% or greater). The only exception is if your psychiatric injury was the result of you being the victim or witness of a violent act. In those circumstances, you only need to show that the violent act caused at least 35% of your psychiatric injury.
Psychiatric injuries due to the stress from physical injuries: A psychiatric injury that is caused by a physical injury is known as a “compensable consequence” of the original injury. For example, severe physical injuries cause anxiety or depression. If your injury occurred after 2013, you cannot get additional permanent disability. However, you can get treatment for the psychiatric injury. You may also receive treatment for sleep disorders or sexual dysfunction but are no longer able to get permanent disability if the disorder occurred after 2013.