When can you claim workers’ comp for pre-existing injuries?


Although state legislature administers the workers’ compensation program of California according to the set of regulations they established, the program is there to have the backs of injured workers. The goal is to provide financial assistance that will relieve the burden of mounting medical bills and lost wages of victims of occupational injuries. All the same time, it protects employers from costly litigation if workers file lawsuits.

Regardless of the industry in which you work, it will be a good idea to gain knowledge of the workers’ compensation system, the rules and regulations, and the required steps to take if you were injured. While learning about the system, you may benefit from understanding which injury types qualify for compensation and which do not.

Essential facts about workers’ compensation eligibility

Being prepared and knowing how to proceed after a workplace injury can simplify the process, speed up medical care and benefits claims.

Requirements for coverage

Regardless of whether your injury is new or existing, the following are basic requirements to meet before you can file a benefits claim:

  • You must be a legally employed member of the workforce of the employer with whom you file the workers’ compensation claim.
  • As a contractor, you will likely not qualify for benefits.
  • Your injury must be severe enough to keep you from doing your work.
  • The injury must have occurred during the performance of the duties assigned to you.

What about pre-existing injuries?

Do you have questions about aggravating an earlier injury while doing your work? This is how the compensation for pre-existing injuries works:

  • Your injury must meet the above requirements for eligibility.
  • Your injury must aggravate an existing disability in a way that necessitates changes in the current treatment or a different type of medical treatment.
  • An example is if you have an existing back problem that causes some level of disability for which you receive medical treatment. A work-related fall exacerbates the disability, requiring increased medical treatment.

The workers’ comp system is on your side

The need for an injury to be work-related does not mean it must have happened at your workplace. The following injuries are examples of off-site injuries that might be covered:

  • If you suffer an injury while attending a company picnic where attendance was compulsory, you can claim benefits. However, the injury must be severe enough to limit your ability to work.
  • If your employer sends you on a road trip to attend a conference, any injuries suffered en route or in your hotel room qualify as workplace injuries. Again, it must be severe enough to cause temporary or permanent disability.

Which injuries are excluded?

To avoid illegal claims, the workers’ compensation system does not cover injuries of the following types:

  • If you start a fight or altercation at work, you will be responsible for any injuries you suffer.
  • If you intentionally cause your own injury, the program will not provide coverage.
  • If your injury is the result of intoxication or drug-related impairment, the program will not consider your claim for benefits.
  • If you suffer injuries at work while committing a criminal act, a claim for compensation will be invalid.
  • If you suffer off-duty injuries that are not in any way work-related, your injuries will not be covered.
  • Take note that even injuries that you suffer while participating in voluntary activities at your workplace will not qualify for benefits.

Knowing these facts about the California workers’ compensation system can be a benefit. If you have any questions about your eligibility for compensation or the claims procedures, help is available. An experienced workers’ compensation attorney can provide the support and guidance you need to obtain all the benefits for which you are eligible under applicable state laws.

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