Following a work-related injury, an employee will usually qualify for workers’ compensation benefits. These include medical benefits that will pay for all treatment that is needed, including emergency care, doctor visits, medications, surgery, and long-term or ongoing services such as physical therapy or psychological treatment. The California Division of Workers’ Compensation requires reviews to be performed to ensure that the medical treatment a person receives is necessary to treat their injuries or illnesses. This type of review is known as a utilization review, and workers will need to understand how a review will affect the benefits they receive.

Different Types of Utilization Reviews

All forms of medical treatment that are covered by workers’ compensation are subject to review. A physician or provider will submit a request for authorization (RFA), and this request may be reviewed by a claims adjuster, physician reviewer, or non-physician reviewer. Requests may be fully authorized, partially authorized, or denied. Reviews will generally fall into one of the following categories:

• Prospective review - In many cases, requests will be sent before medical treatment is provided. After an RFA is submitted, a decision must be made within five business days, and the provider must be notified of the decision by phone or fax within 24 hours. If additional information is needed, the provider must be notified within five business days, and a decision must be made within 14 calendar days after the RFA was originally submitted. If the provider is not notified of the decision or a request for additional information within five business days, they will be allowed to proceed with the requested treatment. In some cases, companies may create utilization review plans that provide prior authorization for certain types of treatment, and in these cases, a provider will not be required to submit an RFA.

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For people who are injured in the workplace, workers’ compensation can provide crucial benefits that will allow them to receive the proper medical care and support themselves while they are recovering. In many cases, injured workers will suffer from temporary setbacks, and they will be able to return to their previous positions after they have fully recovered. However, there are some situations where a person may suffer from permanent impairments that make it difficult or impossible to continue doing the work they had done in the past. While permanent disability benefits may provide assistance in these cases, a person will likely be looking to find work in the future that will fit within their limitations. However, doing so can be difficult, especially if a person has limited experience outside of their previous position or if they do not have the skills to pursue other types of work. Fortunately, certain workers may qualify for vocational rehabilitation that will allow them to receive training and pursue employment in new fields.

Receiving Supplemental Job Displacement Benefits

When a work injury results in a permanent partial disability, a person may qualify for supplemental job displacement benefits (SJDB). In these cases, a person will receive a voucher for $6,000 that may be spent on job training and other forms of vocational rehabilitation. Up to $1,000 may be put toward the purchase of computer equipment that may be used during job training and job searches. $600 may be spent on vocational counseling, and $500 may be used to pay for miscellaneous expenses. The remainder of the voucher may be used to pay for training programs from one or more state-approved providers or for expenses related to obtaining a professional license, including exam fees, license application fees, and licensing exam preparation courses.

A person can only qualify for SJDB if they have not received an applicable job offer from their former employer. In some cases, an employer may offer a position with modified work that fits within a person’s limitations. If this offer is for a position that will last at least one year and will pay at least 85 percent of the wages the person earned before being injured, the person will not qualify for SJDB. If a qualifying job offer is not made within 60 days after a claims administrator receives a return-to-work report from the person’s doctor, the person will be able to receive an SJDB voucher.

In many cases, people who are injured while on the job will qualify for workers’ compensation benefits that will address their medical expenses and ensure that they receive a certain percentage of their income while they are recovering from their injuries. While workers’ comp laws apply to all employees, people in high-risk occupations may be able to receive some additional benefits and protections to ensure that they will have the financial resources they need as they address work-related injuries. Police officers will want to understand the laws that apply to them in these situations, and they can take steps to ensure that they receive the full benefits they deserve following an injury or work-related health condition.

Full Disability Benefits for California Police Officers

For most workers, temporary or permanent disability benefits provide compensation for a percentage of the income that a person is unable to earn while recovering from their injuries. However, California law states that police officers are entitled to receive their full salary when taking a temporary leave of absence to recover from an injury or illness that arose out of their duties. This leave of absence can last for up to one year, and after that period, an officer may continue to receive workers’ compensation disability benefits.

The following types of officers are eligible for full disability benefits:

Employees 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.

Employers 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.

There 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:

When 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:

A 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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Being injured while on the job can lead to many difficulties, especially if a person is unable to return to work while they are recovering. If an injury is serious enough, it can permanently affect the types of work that a person can perform, and this can impact the income they will be able to earn during the rest of their career. Fortunately, a person who suffers an on-the-job injury will usually qualify for workers’ compensation benefits. However, navigating the process of filing a workers’ comp claim can be complicated, and it is important to understand how both temporary and permanent disability benefits will be handled in these cases.

Disability Benefits in CA Workers’ Compensation Cases

If an injury causes a person to miss more than three days of work, or if they need to spend the night in a hospital while receiving treatment, they can begin receiving temporary disability (TD) benefits. These benefits will provide two-thirds of the amount lost due to being unable to work. In total disability cases, a person will receive two-thirds of their pre-tax wages. In partial disability cases where a person can work part-time or at a lower wage while recovering, they will receive two-thirds of the difference between their pre-injury wages and the amount they are currently earning. Notably, TD benefits are calculated based on all of the income a person was able to earn before being injured, including hourly wages, overtime, salary, bonuses, tips, commissions, food and lodging expenses, and income earned from other jobs.

TD benefits may be paid for a maximum of 104 weeks within five years after a person was injured. These benefits will stop being paid when a person’s doctor releases them to return to the work they had formerly performed. TD benefits will also stop when a person reaches the point of maximum medical improvement (MMI), even if they suffer permanent impairments that will cause them to be unable to return to work fully. In these cases, a person may qualify for permanent disability (PD) benefits.

Employees who suffer work-related injuries can receive workers’ compensation benefits that will address their medical expenses and loss of income due to temporary or permanent disabilities. These benefits may be available to truck drivers who suffer on-the-job injuries. However, a truck driver’s ability to receive workers’ comp may be affected by their classification as an employee or independent contractor. Those who have suffered injuries will want to determine their options for receiving benefits or other forms of compensation.

Legal Issues Affecting Workers’ Compensation for Truck Drivers

Employers are required to maintain workers’ compensation insurance that will provide coverage for employees who are injured while working. However, many truck drivers are classified as independent contractors rather than employees. Since they do not work directly for a trucking company or motor carrier, independent contractors may not be eligible for workers’ comp benefits. 

However, recent changes to the laws in California and ongoing court cases may affect how truck drivers are classified. AB5, a law that went into effect in 2020, applies what is known as an “ABC test” to determine whether a worker may be classified as an employee or independent contractor. Under this test, a worker may only be considered an independent contractor if they are not under the direct control of a hiring company when performing work, they perform work that is outside of a hiring company’s typical business practices, and they are involved in an independently established business or occupation. Under these rules, some truck drivers may be able to receive the benefits that apply to employees. The California Trucking Association has filed a lawsuit challenging this law, and a court has allowed it to be temporarily exempted from these rules. Depending on how this case proceeds, truck drivers’ ability to be classified as employees and receive workers’ compensation benefits may change in the future.

There are multiple types of protections that apply to employees. Those injured in work-related accidents or who suffer health conditions because of their work have the right to receive workers’ compensation. A person will be eligible for these benefits no matter who was responsible for an injury. However, there are some cases where an employer or the company that provides them with workers’ compensation insurance may attempt to deny benefits by claiming that an injury was not work-related. If you have been injured in a workplace accident, or if you have suffered another type of work-related injury, you will want to make sure you take the correct steps to protect your right to receive workers’ compensation.

Steps to Follow After a Work Injury

1. Report the injury to your employer - As soon as possible after being injured in a workplace accident or becoming aware of a work-related injury, you should inform your employer. You can notify a supervisor, a member of management, or a business owner. If you do not report an injury within 30 days after the injury occurred or after you discovered that work conditions affected your health, you may lose the right to make a workers’ compensation claim.

2. Receive emergency medical treatment - Following an accident, you should go to an emergency room, urgent care center, or another medical provider to receive any immediate necessary treatment. When receiving treatment, you can inform the provider that your injury is work-related, letting them know that they should bill your employer for the treatment rather than requiring you to make payments.

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Anyone who has made an insurance claim is most likely familiar with the ways that a pre-existing condition can affect a case. Insurance companies may attempt to deny coverage because a person has previous injuries or existing health issues. This issue can also play a role in cases involving workers’ compensation insurance. An employer or their insurer may attempt to deny a claim by stating that a person’s injuries were not work-related but caused by a pre-existing condition. Injured workers will want to understand how to address these types of issues, and when they can make a workers’ comp claim based on the aggravation of a pre-existing condition.

Determining Whether an Injury Is Work-Related

Employees can receive workers’ compensation benefits for any injuries or illnesses that occurred due to the work they performed for an employer. In some cases, an employer or their insurer may claim that an injury occurred because of a person’s existing injuries or health issues rather than anything related to the work they performed. However, an injury or illness can only be considered a pre-existing condition if it was solely caused by an event that was not work-related or if it occurred outside of the work environment. If an injury or illness was partially caused by a pre-existing condition, the workers’ comp benefits a person can receive may be reduced based on the percentage of the injury that was related to their existing health issues.

Is an Aggravation of a Pre-existing Condition a New Injury?

If a workplace accident, an occupational illness, or the work a person performs causes a person’s existing injuries or health issues to become worse, they may qualify for workers’ compensation benefits. Typically, benefits will be available if the aggravation of a pre-existing condition is considered to be a new injury that occurred because of the work a person has performed. In general, a new injury must have led to temporary or permanent disabilities that are more serious than what a person had previously experienced, or new forms of medical treatment or changes to a person’s current treatment plan must be necessary to address the aggravation of a person’s condition.

There are many high-risk occupations where workers are at risk of being seriously injured. The agricultural industry is one of the most common sources of work-related injuries, and there are many ways that farm workers can suffer serious harm while on the job. Accidents involving tractors and other farm equipment can be especially dangerous, and workers who have suffered injuries in these types of accidents can work with an attorney to determine their options for receiving workers’ compensation benefits.

Common Tractor Accidents and Equipment-Related Injuries

Tractors are one of the most frequent sources of serious or fatal injuries on farms. Workers who are operating tractors or who are working near tractors or other equipment, such as harvesters and combines, may be injured because of:

• Rollovers/runovers - Tractors or other equipment may roll over for a variety of reasons, including driving at unsafe speeds, striking rocks or other hazards, operating a tractor incorrectly on steep slopes, or improper use of front-end loaders or other equipment attached to a tractor. Negligent operation of a tractor may also cause a worker to be run over. If a tractor rolls over on top of a worker or runs over a person, this may result in serious bodily harm, including damage to limbs requiring amputation or spinal cord injuries leading to paralysis. A tractor operator may also be injured in a rollover accident if a tractor did not have roll bars or other safety equipment meant to prevent injuries.

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Being able to hear correctly is crucial, and hearing loss can have a major impact on a person’s ability to perform work, as well as their daily life. As with other types of injuries, a person who suffers from work-related hearing loss may be able to receive benefits through workers’ compensation. In these situations, a person will need to understand when they will qualify for workers’ comp and the types of benefits they will be able to receive.

Noise-Induced Hearing Loss in the Workplace

Workers’ compensation benefits are available to those who suffered injuries or illnesses due to accidents in the workplace or because of the work they performed. In many cases, workers may suffer hearing loss because they are regularly exposed to loud noises while working. These issues may affect people who work around heavy equipment and machinery or in other noisy environments, including construction workers, factory workers, warehouse workers, agricultural workers, workers in the oil and gas industry, and those who are exposed to explosions or gunfire. 

Noise-induced hearing loss often involves damage to the hair cells in the inner ear that process sound vibrations and turn them into signals that are sent to the brain. When these cells are damaged, they will not grow back, and a person’s hearing will be permanently affected. The symptoms of this type of hearing loss may include difficulty hearing high-frequency sounds or understanding speech. A person may also experience pain in their ears or suffer from tinnitus, which involves ringing or whooshing sensations in the ears that make it difficult to hear other sounds.

There are many different situations where a person may suffer work-related injuries. Accidents in the workplace, occupational diseases, or health conditions that a person experiences because of the work they have performed will usually qualify for workers’ compensation benefits. A worker who receives these types of benefits will have their medical expenses fully paid for, and they may also receive compensation to address part of the income they lost while recovering from their injuries. There may be some situations where a person is unsure about whether they qualify for workers’ comp benefits, including when they are involved in car accidents that are related to their work.

Car Accidents and Workers’ Comp Benefits

In almost any situation where a person is injured while working, they will be eligible for workers’ compensation. Injuries suffered in a car accident may qualify for workers’ comp if the person was working at the time of the accident. If a person was “on the clock” or was driving as part of their regular work duties, they will usually be able to receive workers’ compensation. However, workers’ comp generally will not cover accidents that occurred while a person was commuting to or from work, although exceptions may apply in some cases.

As with other types of work injuries, fault for a car accident usually will not affect a person’s eligibility for workers’ compensation. Even if a person was responsible for a collision, they will still be able to receive benefits that address a work-related injury. However, there may be some situations in which a person’s actions will make them ineligible for workers’ comp. For example, a person may not be able to receive benefits if they were under the influence of alcohol or drugs at the time of a collision.

There is no doubt that the COVID-19 has affected almost every area of Americans’ lives, including in the area of job injury and safety. Our firm has written numerous blog posts about the high risk of exposure many workers have to the virus, as well as posts regarding how the federal government, the state of California’s government, and employers are addressing the multiple COVID-19 issues workers face. But a recent study by the University of California has revealed just how vulnerable food service workers are.

Threats to Food Service Industry Workers

There have been multiple incidents from around the country regarding the incidents of violence many food service workers have experienced from customers upset about enforcement of COVID-19 restrictions many restaurants have in place. Just last week, in one story that went viral, a hostess at a New York City restaurant was attacked by three out-of-town tourists when she asked the guests to show proof they were vaccinated, per the restaurant’s policy. They responded to her question by punching her repeatedly in the face. This type of scene has played out over and over again in dining establishments across the U.S.

However, it is not violent customers that put food service workers most at risk. According to the California study, food service has become one of the most dangerous industries during the pandemic because of the high rate of workers who have died from COVID-19. That rate of death is higher than almost any other industry.

Many people who choose the career path of a flight attendant do so because of the many fringe benefits that go along with the job, including free flight and travel opportunities, compensation and benefit plans, and flexible schedules. What many flight attendants likely did not bargain for was the high risk of violence from unruly passengers. A recent survey reveals just how common—and how dangerous—that risk has become. If you have been injured on the job as a flight attendant, by a violent passenger or some other cause, workers’ compensation benefits can provide financial relief.

Violent Passenger Incidents for Flight Attendants

The Association of Flight Attendants conducted a survey of 5,000 of their members and found that more than 85 percent of participants had dealt with some level of unruly passengers in the first half of 2021. As air travel has again begun to increase after last year’s pandemic travel restrictions were lifted, the number of incidents has spiked. Almost 60 percent of participants had dealt with at least five confrontations with passengers, and just under 20 percent had experienced at least one physical incident.

Some of the more common incident types reported by flight attendants included:

There are more than 11 million workers employed in the construction industry in the United States. While working in the industry can be a lucrative career, it can also be a dangerous one. The construction industry has one of the highest rates of worker injuries and death. If you have been injured in a construction accident, a Santa Clara County workers’ compensation lawyer can help you get the workers’ compensation benefits you may be entitled to.

High Injury Rate

According to the Occupational Safety & Health Administration (OSHA), 1 in 10 construction workers sustain work-related injuries each year. Fall hazards are the leading cause of these injuries. Many construction site accidents are the result of the employer failing to provide the proper safety equipment and/or safety training that is necessary to keep workers safe.

A recent contractor risk report compiled by insurance company AmTrust Financial Services reveals that workers who are employed by construction contractors who have been in business for less than four years make up 75 percent of construction industry workers’ compensation claim benefits that are paid out to injured workers. The report analyzed 26,000 claims that were filed over a 10-year period. California and Florida construction site accidents made up almost half of all the claims that the insurance company compiling the report paid out during the analyzed time period.

There are a number of dangers that warehouse workers are exposed to every day that expose them to high risks of being injured. For example, warehouse workers are around forklifts every day, but forklifts are also considered one of the biggest hazards to worker safety, responsible for more than 100,000 work accidents each year. Warehouse workers also suffer injuries because of conveyor belts, working on loading docks, storage of materials, and the manual lifting and handling of materials they are required to do.

As dangerous as working in a warehouse can be, data reveals that Amazon warehouse workers are especially at risk. This has led to lawmakers in California to take steps that would require Amazon to be more transparent about their practices and ban some of the policies Amazon currently has in place.

Major Growth of Amazon

There is no doubt over the past several years, Amazon has dominated online shopping, surpassing all of their competitors. That domination increased even more with the COVID-19 pandemic. With so many millions of people staying home and avoiding retail businesses, Amazon saw their revenue soar to $368 billion in 2020. The company also ended the  year with 950,000 employees, the majority of those employees working in fulfillment centers. Amazon is the country’s second-largest employer, following Walmart, which is at number one.

Unlike some other forms of bodily injury insurance, workers’ compensation insurance is no-fault. This means that an injured worker’s claim cannot be denied even if the incident that caused the injury was caused by the employee’s own unintentional negligence. There are some exceptions to that rule, however. For example, if an employee was under the influence of alcohol or drugs at the time of the incident, the employer does have the standing to deny the claim.

But what happens if the employee has a medical marijuana card under California’s Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA) and has been prescribed cannabis by their doctor to alleviate symptoms of a medical condition? Can a workers’ compensation claim be denied because of the employee’s use of medical marijuana?

California’s Medicinal and Adult-Use Cannabis Regulation and Safety Act

Under MAUCRSA, there are a variety of medical conditions that have been approved for medical cannabis use, including AIDS, cancer, arthritis, glaucoma, chronic pain, and seizures. A doctor needs to make a recommendation for cannabis use and specify the condition being treated in order for the person to apply to the state and obtain a medical marijuana card. But this type of recommendation is different from many other types of medical prescriptions because marijuana–even for medical use–is still illegal at the federal level.