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gilroy workers comp lawyerEmployees who experience work-related injuries are entitled to workers’ compensation benefits. These benefits, including coverage for medical treatment and partial compensation for income lost due to a temporary or permanent disability, are available regardless of who was at fault for an injury. If a person can show that they were injured in a workplace accident or otherwise suffered injuries or health issues that arose out of the work they performed, they will qualify for workers’ comp benefits. However, workers should also be aware of the potential for workers’ compensation fraud, including situations where employees or employers may be accused of committing fraud.

What Is Workers’ Compensation Fraud?

There are a variety of fraudulent activities related to workers’ compensation that may be committed by employers or employees. An employee may be accused of making a false workers’ comp claim in order to receive benefits. For example, if a person suffered a back injury after falling down while at home, they may contact their employer and falsely state that the injury occurred while lifting heavy objects at work. By doing so, they may hope to receive coverage for medical treatment, and they may plan to take time off work while recovering and receive temporary disability benefits.

Employers may commit multiple types of workers’ compensation fraud. In some cases, fraud will involve misclassifying workers as independent contractors rather than employees to avoid paying workers’ compensation benefits. Employers may also commit fraud by discouraging employees from making workers’ comp claims. For example, they may state that a particular type of work-related injury is not covered or that an employee does not qualify for benefits because they were at fault for a workplace accident.

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san benito county workers' compensation attorneyEmployers will often offer their employees the opportunity to work from home. This has been a significant benefit for many workers during the COVID-19 pandemic, since remaining in the home can help employees prevent possible infections while still ensuring that they are able to accomplish their daily tasks. However, as more and more people telecommute, situations may arise where employees may experience work-related accidents or injuries even when they are not in an office or a location that would typically be considered a workplace. In these cases, employees may be unsure about whether they are eligible for workers’ compensation benefits.

Eligibility for Workers’ Comp Following an Injury When Working From Home

Workers’ compensation provides benefits in most situations where an employee is injured in the workplace. Even though a person’s home is a separate location from the premises owned or leased by an employer, it is still considered a workplace if a person performs work there. Generally, an employee is eligible for workers’ comp if they were injured during the course of their employment, and the injury arose out of the work they performed. Eligibility is not affected by who was responsible for an injury; even if an injury occurred because of an employee’s mistake, the person will still be eligible for workers’ compensation benefits, as long as the injury was work-related.

Determining whether an injury that occurred in a home office or other areas of a person’s home was work-related will depend on whether the injury arose out of the work that the person performed. Injuries or illnesses that were directly or indirectly caused by work will be covered, but injuries caused by hazards in the home that were not related to work will usually not be covered.

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gilroy workers comp lawyerThere are many ways a person may be injured in the workplace or because of work-related activities and tasks. While workers’ compensation covers situations where employees are injured while working, there are some cases where workers and employers may disagree about whether an injury was work-related. These disagreements often address pre-existing conditions, and an employer may claim that an employee’s injury was solely the result of a non-work-related illness or health condition rather than the work the person performed or the conditions in the workplace. However, workers’ comp benefits are available in cases where a work injury resulted in the aggravation of a pre-existing condition. Workers with pre-existing conditions will want to understand how the California Department of Workers’ Compensation decides whether work-related factors aggravated their injuries or health issues.

Workers’ Comp Benefits for New Injuries or Illnesses

In general, workers’ compensation covers new injuries that occurred due to workplace accidents, conditions that affect a person while working, or work-related activities that a person engages in. An injury may be considered an aggravation of a pre-existing condition if a worker experienced a temporary or permanent increase in disability or required new medical treatment or changes in the medical treatment that they had been receiving. However, there are some situations where a recurrence of a previous injury or health condition may be considered an “exacerbation” rather than a new injury. 

To determine whether a pre-existing injury or illness was aggravated by a work-related injury, the Department of Workers’ Compensation may consider:

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gilroy workers compensation lawyerWhen working for an employer, workers have certain rights, including the ability to receive workers’ compensation benefits when they experience work-related injuries. While these benefits are available in most situations where a person suffers an injury or illness that occurred while they were working or was related to the work they performed, there are some situations where questions may arise about whether an injury was truly work-related. By understanding how work injuries are defined, a person can ensure that they will be able to receive the benefits they deserve.

Determining Whether an Injury Qualifies for Workers’ Compensation

Generally, an injury will be considered work-related if events or conditions in their work environment caused or contributed to the injury. This means that if a person was injured in a workplace accident or experienced health issues that occurred while they were working or because of work-related activities, they will qualify for workers’ compensation.

There are a few exceptions that may apply to injuries that take place in a person’s work environment, including:

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gilroy workers compensation lawyerA person who suffers injuries while working will be eligible for workers’ compensation benefits. In many cases, an injured worker will file a workers’ comp claim for injuries that occurred in workplace accidents. However, benefits are also available in situations where a person experienced illnesses or health issues that were related to the work they have performed. When addressing occupational diseases, workers can get legal help from an attorney who can help them understand the types of benefits they can receive and address any issues that may affect their ability to receive workers’ comp benefits.

When Is an Illness or Disease Work-Related?

Workers’ compensation is available to address any health issues that arose out of the work a person has performed. Work-related illnesses may occur because of issues such as:

  • Exposure to toxic chemicals - A person may be exposed to harmful substances due to an accident in the workplace. For example, a chemical spill at a factory may release toxic fumes that are inhaled by workers, leading to issues such as lung injuries, skin disorders, or chemical burns. A person may also experience health issues due to regular exposure to low levels of toxic chemicals. For instance, agricultural workers may be exposed to pesticides on a daily basis, and these chemicals may cause illnesses such as respiratory disorders or cancer.

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