Reconciling Work-Related Injuries With Pre-Existing Conditions In The State Of California
Work Related Injures and Pre-Existing Conditions
When a California employee suffers a work-related injury and files a claim for workers’ compensation benefits, the employer’s insurance carrier may attempt to deny the claim on the basis of the existence of a pre-existing health condition. In other words, the insurance company argues that the injury occurred outside of, or prior to, the employment context. This argument is an effort by the employer’s insurance carrier to rebut the mandatory presumption that an employee’s claim of injury is legitimate – that the injury did in fact occur, and was in fact work-related.
As one might expect, there can exist some gray area between pre-existing conditions and work-related injuries. Take, for example, an employee who suffers from a curvature of the spine (scoliosis) and slips and falls on his back at the workplace. The scoliosis precedes employment, while the slip and fall was concurrent with employment. The employee will argue that his back was injured by the slip and fall, while the employer’s insurance carrier will argue that the employee’s pre-existing scoliosis was the source of the back injury rather than the slip and fall. California’s workers’ compensation system seeks to address this gray area by relying on a percentage system. Under California law, as long as a work-related event is at least 1% responsible for the injury, the employer’s insurance carrier will be held 100% responsible for the employee’s medical care. Clearly, this model favors employees. The reason for this is assumedly historical; in the early 19th century before workers’ compensation came to exist, the burden of proof with regard to a work-related injury was on the employee. The only way an employee could obtain compensation from an employer for a work-related injury was in court. There, the employee had to prove the injury was the result of negligence on the part of the employer. Doing so took time and money, and was by no means guaranteed to yield a monetary recovery for the employee. To remedy the situation, the workers’ compensation system was adopted – initially on the federal level, then by each state. Turning back to the gray area between pre-existing conditions and workers’ compensation claims, to impose more than a 1% threshold with regard to the role played by a work-related accident in an employee’s injuries would be to potentially return to the days in which an employee must bear the burden of proof with regard to establishing that an injury did in fact occur, and that it was in fact work-related.
Work Related Injures and Pre-Existing What To Do If You Have Been Injured In A Workplace Accident and Have a Pre-Existing Condition In The State Of California
Have you been injured in a work-related accident in the state of California? Do you also suffer from a pre-existing condition, such as scoliosis, hypertension, or diabetes? California’s workers’ compensation system can be complex to navigate, and an employer’s insurance carrier may attempt to deny a claim on the basis of the existence of a pre-existing condition. To ensure that you receive the maximum compensation you are entitled to for your injuries, contact an experienced California workers’ compensation attorney.