CA High Court Indirectly Affirms Workers’ Compensation Claim Flexibility

Workers’ compensation is designed to protect both employers and employees from unexpected costs arising from a work related injury or illness. Although not all workers are covered, including contractors, workers’ compensation provides people with funding, as well as peace of mind when they are unable to work.

Here is an example of how workers’ compensation functions: if an assistant is putting away heavy filing boxes, but slips and severely injures her back, workers’ compensation insurance should be available to cover medical expenses and portions of lost salary.

In exchange for these benefits, employees forfeit their right to sue their employer for damages as workers’ compensation benefits preclude such action. An employee, however, may still bring a claim against a third party, other than their employer, who is at fault, .

Recent Developments in Workers’ Compensation

According to the Insurance Journal, in 2004 California reformed the way doctors could declare a person unable to work, thus making them eligible for benefits, in hopes of creating a more predictable process. Physicians would now have to abide by the guidelines set forth by the American Medical Association (AMA). If a patient (employee) did not qualify under these guidelines, then they would not be eligible for benefits.

However, recent developments have challenged these rigid guidelines as physicians felt they needed more leeway to appropriately characterize a person’s injury. For example, the Insurance Journal reports that a California man was given a 12 percent disability rating according to the AMA guidelines. This was not enough to qualify the man for workers’ compensation benefits. His doctor nonetheless felt his injuries, which did not allow him to sit for prolonged periods, prevented him from performing his job.

The man appealed to the Workers’ Compensation Board (WCB) which agreed. The employer appealed to the Fifth Circuit which affirmed the WCB’s ruling. Similar cases have been declined by the California Supreme Court and other courts, essentially affirming the added leeway.

Impact on Employers and Employees

The increased leeway means more workers will likely be eligible for workers’ compensation benefits. If this expected result comes to pass, then insurance companies end up paying more due to the increased number of approved claims. This, in turn, will raise companies’ premiums in California, which is something lawmakers were hoping to avoid with the 2004 reforms.

Anyone who has been injured at work or who has questions about California workers’ compensation law should speak with an experienced attorney to discuss their options and potential recoverable claims.