What Is A Compensable Injury?

A compensable injury is a work-related injury to an employee that entitles them to receive compensation in the form of workers’ compensation benefits. In California, in order for an injury to be compensable, the injured worker must be an employee and their injury must arise from employment during the course of employment. It is always important to note that just because an injury takes place at work or during work hours does not automatically mean that the injury is accepted as a workers’ compensation insurance claim.

Keep reading to learn all you need to know about what’s considered a compensable injury under California workers’ compensation law.

Compensable Injuries under California Workers’ Comp Laws Explained

If you have a qualified workers’ compensation claim in California, it is essential to understand what constitutes a ‘compensable injury.’ Suppose the insurance company recognizes and agrees that you suffered an injury or illness on the job. In that case, compensable injury is the injury that they have acknowledged and will pay for the medical care you may require for the rest of your life.

A non-compensable injury, on the other hand, is an injury the insurance company does not recognize as the result of a work-related circumstance. The workers’ compensation insurance company will not pay for nor cover any diagnosis or medical care they have not acknowledged.

Examples of compensable injuries under California workers’ comp laws include:

1. Slip and fall injuries: An employee is at work, and during the course of their regular duties, he slips on a wet floor and suffers a head injury. Workers’ compensation would cover this injury.
2. Parking lot injuries: An employee walks into work and falls and injures himself in the parking lot. If the injury takes place within a reasonable amount of time before their work shift or after their work shift and the parking lot is attached to or owned by the place of employment, the injury should be covered. However, if that same employee was injured while jogging through the parking lot on their day off, workers’ compensation would not cover that injury.
3. Lunch injuries: If an employee stays on the employer’s property during his lunch hour and is injured, that injury may be covered, but only if it resulted from a reasonable activity during the normal course of employment.
4. Ingress and egress injuries: The time required for an employee to enter and exit the premises before and after work is generally covered by workers’ compensation. If an employee is walking into their work building and trips and falls, this injury may be covered, as entering the building by way of the employer’s sidewalk is an act reasonably within the course of normal business.

When Does an Injury Arise Out of Employment?

If an injury arises out of employment, then it is the result of a hazard of that employment, i.e., the injury must have been caused by or linked to employment in some fashion. California requires that a physician provide evidence of how the employment led to the specific injury in question. That might require that the claimant provide a medical report describing how the work-related event resulted in their injury.

Different jurisdictions can apply varying tests to determine whether or not an injury arose out of employment. Standard tests include the Increased-Risk Doctrine, the Actual-Risk Doctrine, and the Positional-Risk Doctrine. California requires that employment increase the risk that the injured employee would contact the eventual source of the accident.

Some types of injuries can be challenging to determine regarding whether or not they arose out of employment. State statutes may instead address causation for these types of injuries. Two common examples of these injuries are the aggravation of a pre-existing condition and repetitive trauma injuries. Other types of injuries that may be explicitly addressed under state statutes include acts of nature, occupational diseases, unexplainable accidents, medical malpractice, cancer, and hernias.

What Is the Meaning of in the Course of Employment?

An injury that occurred in the course of employment means that the injury took place while the injured employee was on the job or performing duties that are related to employment. This generally depends on the time, place, and circumstances of the incident that caused the injury.

Generally, travel by an employee while conducting the employer’s business is considered to be within the course of employment. That includes travel to business meetings out of town and any local travels during regular business hours. All business trips are considered to be within the course of employment, even when an employee runs a special or emergency errand for the employer, as long as the errand furthers the employer’s business purposes.

Will My Company’s Doctor Need to Examine My Injury to Make a Compensable Injury Claim?

While every situation is unique, some employers will require you to see a doctor or other health care provider before claiming worker’s compensation. Some companies do not have this requirement, so it depends on your employer’s company policy. 

If you’re asked to see a doctor approved by your employer, there are some things to keep in mind to ensure that your rights are protected and strengthen your case. For instance, you do have the right to bring your workers’ compensation lawyer with you when seeing the company-approved doctor. KCNS Law Group’s workers’ compensation lawyers are more than happy to fulfill this role with our clients. Here are some other points to remember: 

• Keep thorough records: Make sure you document all names of physicians, technicians, nurses, or anyone involved in your medical examination. Also, note any examinations, procedures, or tests that are ordered for you. That will be useful later on with your case. 
• Document the doctor’s advice: Write down any instructions the doctor gives you and anything else that stands out during your examination. 
• Ask questions: If you do not understand why you’re being asked to undergo any procedures or tests, don’t be afraid to speak up and ask for clarification on why it’s required. 

If you feel uneasy or dissatisfied with the physician that examines you, you may request to see another doctor with whom you do feel comfortable. Furthermore, you may be able to pre-select a healthcare facility or doctor for your treatment in the event of an on-the-job injury. However, you will need to check with your employer to ensure that this benefit is covered under the workers’ compensation policy.

Get in Touch with an Experienced California Workers’ Compensation Lawyer Today

If figuring out how California workers’ compensation insurance applies to your injuries feels confusing, you are not alone. KCNS Law Group, LLP’s workers’ compensation attorneys can analyze your case and break down the process in an easy-to-understand way. Our workers’ compensation attorneys are passionate about helping individuals who have suffered injuries or illness while working by no fault of their own. Our legal professionals have dedicated their careers to standing up for the rights of their clients and are happy to review your case to explain your legal options for attaining compensation.

To learn more about Compensable Injuries in Workers Compensation, scheduling a free initial consultation is your next best step. Get the information and legal answers you seek by calling (818) 937-9255 or completing a contact form today.