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What Qualifies as a Workers’ Comp Claim?

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In General

Generally speaking in most cases, to have a workers’ compensation claim in the State of California, you need to have the following elements met at the very least:

  • an injury that occurred while you were within the “course and scope” of your work AND
  • an injury that leads to disability of some kind (whether temporary or permanent) OR that requires treatment

Even if as little as 1% of the injury has been caused by work, that will be enough to trigger the employer’s or insurance carriers’ duty to provide you with medical treatment for those injuries.

If your injury is so minor that it can be dealt with by using a first aid kit, that will not amount to a workers’ compensation injury that entitles you to benefits. Also, generally speaking, there following things will negate any entitlement to workers’ compensation benefits:

  • injuries caused by intoxication
  • injuries that is self-inflicted injury or death
  • injuries that have arisen by the injured worker causing a fight
  • injuries that have arisen from committing a crime

If you would like to look into the details, you can find the statutory authority here: Labor Code section 3600.

Psych/Stress Injuries

Purely psychiatric injuries require more, and this can be found in Labor Code section 3208.3. In addition to the above, there needs to be a diagnosis, and 1% causation will not be enough. Instead, you need to have a “preponderance of the evidence,” which basically means that more than 50% of your injury has to have been caused by work in order for the employer or insurance carrier to be obligated to provide you with treatment.

“What if I’ve been fired? Can I still file a work comp claim?”

If you have been fired, the law has been designed to protect employers against workers’ compensation claims that are made by prior employees “in retaliation” for being fired or laid off. However, there are many, many exceptions to this. If you have been injured at work and have been fired or laid off, please feel free to contact me so that we can discuss whether any of the exceptions to this rule apply in your case. Chances are that you will still have a claim and can obtain the benefits that you have rights to claim.

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