Injuries and Illnesses Covered Under Workers Compensation

Before you even think of filing an injury or work-related illness claim, you need to understand whether you are covered under workers compensation or not. Workers compensation in California is a state-mandated program that provides financial and medical benefits to employees who suffer work-related injuries or illnesses. Every workplace is different and each job has its inherent dangers. Workers compensation is a social insurance program designed to protect the workers irrespective of who was at fault.

The workers’ compensation system in California is a no-fault scheme. This means that workers can receive benefits regardless of who was at fault for the injury or illness. The primary purpose is to ensure that workers receive medical treatment, disability benefits, and the necessary care to facilitate a swift and healthy return to work.

Compensable Injuries Under Workers Compensation in California

Workers’ compensation in California is a no-fault system designed to provide benefits to workers who are injured or become ill due to their jobs. A compensable workplace injury refers to any injury or illness that an employee sustains as a direct result of their job or workplace conditions and for which they are entitled to receive workers’ compensation benefits. These benefits may include medical treatment costs, wage replacement, and sometimes rehabilitation or retraining support.

Specific Criteria to Identify Work Comp Injuries

To classify any injury as workplace-related, there are specific criteria that should be satisfied:

  • The injury occurred during the course of employment or while performing work-related duties;
  • The injury resulted in a temporary or permanent disability, medical treatment, or lost wages; and
  • The injury was reported to the employer within 30 days of the incident.

Examples of Compensable Injuries

  • Physical injuries such as slips, trips and falls, auto accidents, muscle strains, hearing or vision loss, bone fractures, machinery accidents, or injuries due to lifting heavy objects.
  • Fatal Injuries caused by sudden events, such as electrocution, being crushed or stuck between objects, being struck by an object, burns, or cuts.
  • Repetitive Stress Injuries (RSIs) caused by repetitive motions or tasks, such as carpal tunnel syndrome, back pain, or tendonitis.
  • Occupational illnesses due to repeated exposure to harmful substances such as asbestos, dust, or toxic fumes. Examples include respiratory diseases like asthma, lung cancer, or mesothelioma.
  • Stress-related injuries such as anxiety or depression.
  • Mental or emotional injuries resulting from witnessing or being involved in a traumatic event at work.

Injuries and Illnesses Not Covered Under Workers Compensation in California

Although workers compensation covers almost all types of workplace-related injuries and illnesses. However, if an injury results from any act of an employee outside the scope of employment, such an injury is not covered under workers compensation in California. Before a victim or an employee pursues an injury claim, it is important to understand whether your claim falls within the purview of workers compensation or personal injury laws of the state.

Exclusions or circumstances exempted under workers compensation system include the following:

  • Lunch break injuries are not usually covered unless they occur on company premises or during a “working” lunch.
  • Injuries resulting from horseplay or intentional misconduct are not covered.
  • Workplace violence such as a physical fight between co-workers is not covered under workers compensation
  • When an employee’s conduct violates company policy causing injuries in due course.
  • Injuries suffered while an employee is intoxicated or using illegal drugs.
  • Injuries from participation in off-duty recreational activities.
  • Pre-existing medical ailments are not covered.
  • Common diseases such as influenza or colds are typically not covered.
  • Injuries suffered due to acts of god like lightning, heavy storms, tornadoes, etc
  • Willful attempt to injure oneself or another.
  • Injuries suffered while a worker was engaged in unlawful activities.
  • Employees who suffer a heart attack may not be covered unless it is proven to be work-related.

Employees Not Covered Under Workers Compensation in California

Yes, it is true that workers compensation is exclusively designed for the benefit of employees and helps them to get back to work at the earliest. Employers have a legal obligation to ensure that they have adequate workers compensation insurance. But to avail the benefits you need to understand whether you fall under the identified categories of employees or not.

Not all injured persons can file for workers’ comp benefits. The law mainly covers full-time and part-time employees. Independent contractors or sub-contractors are usually not covered under workers compensation benefits. Depending on your working relationship, you may have to pursue a claim from your employer directly.

Other employees not covered includes:

  • Related Domestic Workers: Workers who are directly related to their employer are excluded from coverage.
  • Aid Workers: Individuals working for support such as food or housing instead of a paycheck.
  • Volunteers: This includes volunteers for non-profits who may not be covered.

Hire Our Workers Compensation Attorney to Rightly Pursue Your Injury Claim

The legal team at Pacific Attorney Group knows that a workers’ compensation attorney can play an essential role in your claim process. Our attorney can help you understand your rights, guide you through the filing process, negotiate with the insurance company, and represent you in any hearings or appeals. If your claim is denied, we can help you appeal the decision and advocate for your rights.

Insurance companies often try to minimize their liability and reduce the benefits they pay. Therefore, with our expert attorneys on your side, together we can level the playing field and increase your chances of receiving the full benefits you deserve. By understanding your rights and the benefits available to you, you can take full advantage of workers compensation system and receive the care and compensation you deserve.

Call us today  to schedule your free no obligation meeting with our workers compensation attorney.