If you are a member of the California workforce, you might have some questions about the workers’ compensation system of the state. Knowing that you have such insurance coverage may provide peace of mind, but nobody wants to file a benefits claim that the company rejects. Does the program cover all injuries, and what happens when you suffer an accident that aggravates an existing one?
Pre-existing conditions can be a tricky aspect because your employer might attempt to avoid paying for an injury that already existed before you joined his or her company. However, it is not the date of the original injury that matters but the date of the subsequent incident that aggravated the pre-existing condition.
What are the requirements for workers’ compensation coverage?
Regardless of whether you suffer a new injury or an injury that exacerbates a previous one, meeting the following eligibility requirements should make you eligible to receive workers’ compensation benefits:
- You must be a valid, full-time employee of the company. If you are a contractor, you might not be eligible for benefits.
- You must receive medical treatment and have documented proof such as doctors’ bills and medical reports.
- Your injury must cause a disability that inhibits your ability to perform your duties.
- Only injuries suffered while you were on duty will qualify for compensation.
- On duty also includes attending a compulsory work-related conference or company picnic. Injuries suffered during such events qualify as on-the-job injuries.
If the injury happened when you were under the influence of drugs or alcohol, the workers’ compensation program would not cover your medical expenses, and the same applies for intentionally self-inflicted injuries. Furthermore, you will not receive benefits if you started an altercation or physical fight that left you injured, or if your actions while committing a crime led to an injury. Benefits also do not cover injuries that occurred when you were off-duty, even if you did voluntary tasks at your workplace while you were off the clock.
What about pre-existing injuries?
If you have an existing condition, and a workplace accident aggravates that old injury, you can claim workers’ compensation benefits. However, you must meet the following terms:
- You must meet the basic requirements for workers’ compensation benefits as set out above.
- The injury must exacerbate or aggravate another condition such as an already injured back or another body part.
- New medical care or altered current treatment must follow the new injury. If for example, you already receive treatment for an existing back injury, and a fall from a scaffold at work causes an injury that necessitates additional or revised treatment, you can claim benefits for the aggravation of a pre-existing condition.
Filing workers’ compensation claims for pre-existing medical conditions can be rather challenging for many employees. An experienced California workers’ compensation attorney can help you navigate every step of this process and can fight any wrongfully denied claims to help ensure you receive all benefits to which you are rightfully entitled.