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Not All Injuries Qualify For Workers’ Comp Benefits In California

There are some situations where injured employees may not be eligible to attain workers’ comp benefits to cover the expenses associated with the accident.

According to the State of California Department of Industrial Relations, employers are required by law to provide workers’ compensation benefits to any worker that becomes injured on the job. The injured employee is eligible to receive benefits for a specific event that occurred in the workplace or a series of repeated exposures that lead to an injury. For instance, an employee could receive workers’ compensation benefits if that employee fell off of a ladder at work and injured his or her back.

Injuries Must Be Work-related

Regardless of who is at fault, employees are eligible to receive benefits, which may include medical care, temporary disability benefits and supplemental job displacement benefits, as long as the accident was work-related. Due to this, employees may not be able to acquire compensation if the injury occurred while:

  • On their lunch break-For instance, an employee who sprains his ankle while walking to a nearby restaurant during his lunch break will likely not receive compensation for his injury.
  • Attending a company event-Injuries that occur at company events, like baseball games, corporate picnics or holiday parties, may not be covered under workers’ compensation.
  • Travelling-While injuries that occur on business trips are usually covered, employees who become injured while travelling to and from their place of work will usually not receive benefits.
  • Violating a workplace safety rule-For example, an employee who chooses to drink alcohol while performing her workplace duties may not be eligible to receive compensation for her injuries.

To ensure their injuries can be traced back to their line of work, employees should receive necessary medical care and report the accident to their employer as soon as possible.

Disputing A Claim

Employees who suffer from a work-related injury and find that there is a disagreement regarding whether or not their injury should be covered under workers’ compensation have a right to challenge this decision. This can be done either because it is believed that the injury is not work-related or for another reason.

When this occurs, the California DIR states that employees must have an evaluation performed by a qualified medical evaluator, file a case at one of the Division of Workers’ Compensation offices and file an Application for Adjudication of a Claim. To request a hearing before a judge, employees must also file a Declaration of Readiness to Proceed. At this hearing, injured employees and the claims administrator appear before a judge to discuss a settlement. If a settlement cannot be reached, the case will be scheduled for trial.

Employees who wish to dispute a workers’ compensation claim must be prepared to provide adequate documentation and evidence of their injuries. If you were injured in a workplace accident and were denied compensation, consult with an attorney who can work to resolve your case in your favor.

Keywords: injury, work, workers’ compensation