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Personal Injury Claims and Worker's Compensation

In the state of California, employers are required by law to maintain workers’ compensation insurance for their employees, and ultimately, to provide medical treatment and pay workers’ compensation benefits to employees who are injured on-the-job. In theory, workers’ compensation is a system designed to minimize conflict between employers and their employees by providing an avenue for damages recovery that will not necessarily hurt the workplace relationship (under California law, it is illegal for an employer to take retributive actions against the employee in response to a workers’ compensation request).

Workers’ compensation was originally intended to nurture the employer-employee relationship and, to some degree, empower an employee without the resources to engage the employer in long and arduous litigation.

For example, for an employee to successfully obtain workers’ compensation benefits, he or she need not prove that the employer was at-fault for their injuries.

If you have been injured on-the-job and believe that you may qualify for workers’ compensation benefits, then you must file your workers’ compensation claim in a timely manner. In California, the initial deadline for filing is generally within thirty days of having developed the injury or illness at-issue.

Workers’ compensation claims are not simply a matter of reporting the injuries suffered. Filing a claim involves the filing of a number of documents related to different aspects of the claim. For a quick overview, please see the California Division of Workers’ Compensation page here: https://www.dir.ca.gov/dwc/forms.html.

Unfortunately, workers’ compensation is not a perfect system. Workers’ compensation in California provides several important benefits to employees, but it may limit the damage recovery of an employee where the injury would have otherwise allowed for greater damages. Further, workers’ compensation does not apply in every situation leading to an on-the-job, workplace injury, thus leaving some employees without coverage in their most vulnerable time.

For a start, let’s assess the situation, starting with the benefits of workers’ compensation.

Workers’ Compensation Benefits

California employers are required to pay:

  1. For all of your medical care, so long as such care is reasonably required to treat and cure the injury suffered on-the-job.
    a. Your employer’s workers’ compensation may be entitled not to cover you for highly experimental treatment that does not have proven efficacy.
    b. Importantly, your employer’s workers’ compensation plan may limit payment to select medical providers, so be sure to understand the situation fully before exploring an expensive treatment plan.

  2. Both temporary and permanent disability benefits.

  3. Supplemental job displacement benefits.
    a. The plan should pay some benefits out to help provide training so that you may transition into a more appropriate job after an injury (if a career switch is necessary due to the seriousness of the injury).

  4. Workers’ compensation death benefits, in the event that you die and leave dependents, then the plan must provide benefits to said dependents.

All in all, the workers’ compensation system appears – on the surface – to provide a wide variety of benefits. So, what’s the problem?

It is worth reiterating that your employer’s workers’ compensation plan need not allow you to freely choose your medical provider after an injury. To qualify for workers’ compensation benefits, they may limit your choice to certain pre-selected providers. This means that your trusted medical professionals may not be made available to you if you want to make use of your benefits.

Workers’ compensation plans do not cover damages for pain and suffering, which often constitute a substantial portion of personal injury damages. As a result, your accumulated pain and suffering from a workplace injury left unaccounted for and your potential damages recovery is cut down drastically. To a degree, workers’ compensation plans are necessarily incomplete because they do not account for this important component of an injury.

In a situation involving severe workplace injury – and thus involving potentially significant damages – qualifying for more than just workers’ compensation may lead to a better, more complete resolution. If you have a separate, legitimate personal injury claim against a third-party, for example, then you may not only be able to recover damages for pain and suffering, but you may pursue lost wages (past and future), and seek out preferred medical providers, among other advantages.

Third-Party Personal Injury Liability and Its Benefits

In many positions, one’s job duties may involve frequent engagement with third-party persons and entities (for example, a warehouse worker may regularly cooperate with postal workers to move goods to-and-from the warehouse). In such cases, injuries involving a third-party person or entity may give rise to a separate, legitimate personal injury claim against the responsible third-party person or entity. Though it may seem strange, being injured by a third-party on-the-job is much preferable to being injured by a co-worker, by Company property, or by your employer – being injured by a third-party empowers you to not only secure workers’ compensation benefits (if you qualify), but also to pursue legal compensation against the third-party through civil litigation.

Importantly, if you pursue both your workers’ compensation benefits and civil compensation under your third-party personal injury claim, then your employer may be able to claim certain reimbursements, reducing your potential damages award from the personal injury claim against the third-party. As this involves a complicated, highly fact-specific assessment, you should consult with a qualified personal injury attorney before moving forward with your claims.

Pursuing a personal injury claim against a third-party person or entity will potentially allow you to recover damages for: a) all reasonable past and future medical care received at preferred medical providers; b) past and future lost wages; c) loss of enjoyment (this is primarily a lifestyle factor – for example, a very physically active, amateur athlete may have suffered significant loss of enjoyment due to back injuries that prevent him from engaging in strenuous physical activity); d) pain and suffering; and e) personal property damage, among others.

For a helpful introduction to personal injury damages, please read our article here.

On-the-job injuries can lead to quite complicated legal scenarios. The guidance of a skilled and experience personal injury attorney will help you sift through the complication and understand the best way forward.