The state of California has established a Workers' Compensation (WC) program that is authorized through the state constitution and is administered by a set of regulations set forth by the state legislature. The purpose of the WC program is to assure that employees injured on the job receive medical and lost wage compensation through the WC program and to prevent costly lawsuits against employers.
Program Covered Injuries
For an injury, whether it be brand new or relating to a pre-existing condition, to be covered by WC, certain factors have to be present. The injured party must be a legal employee of the employer. Contractors are not covered. The injury must be medically verified and cause the worker a disability that interferes or prevents her from working. The injury must have occurred while the worker was on the job and carrying out duties required to perform the job.
Excluded Injury Types
Certain types of injuries are excluded from coverage by law. Any injury that was intentionally self-inflicted or occurred while the worker was intoxicated is excluded. If the worker gets injured in a fight or some type of altercation that she started, the injury is not covered. Injuries that result during the course of committing criminal activity are excluded. Any kind of injury that occurs while the worker is participating in truly off-duty and voluntary activities, even if at the workplace, is excluded.
Under California law, if the injury is covered based on the standards set forth in the above sections and involves an aggravation of a pre-existing condition, it is covered by WC. However, such an injury must cause an increase in some existing disability and require the need for new medical treatment or the change in existing treatment. For example, a worker has a pre-existing back problem and suffers a fall at work, causing a greater disability that requires new or increased medical care. Such an injury would be covered as an aggravation of a pre-existing condition.
The requirement that the injury be work related and while on the job is liberally applied for the benefit of the employee. For example, an employee who is required to attend an out-of-town conference and then is injured in their hotel room at night would be covered. Participating in a company picnic where everyone is expected to attend, where an injury is sustained is another such example. Any type of covered injury must cause enough of a disability to make the worker not be able to work at all or significantly impair her ability at work. Injuries, no matter how bad, that require only temporary medical treatment with no ongoing disability are not covered.
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