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The complexity of workers’ compensation benefits can be confusing

On Behalf of | Jan 22, 2018 | Workers' Compensation |

Employees of California companies may be unsure of their eligibility for insurance benefits if they should suffer on-the-job injuries. Legally employed individuals — excluding contractors — who suffer medically verified injuries while on duty are typically entitled to claim workers’ compensation benefits. However, the injuries must be severe enough to interfere with the victim’s ability to work, and injuries suffered under certain circumstances are not covered.

Workers who intentionally inflicted their injuries, or who were hurt while intoxicated may be excluded. If an employee starts an altercation or fight that leaves him or her with injuries, or if the injury happens during criminal activities, benefits will likely be denied. Trauma or injuries suffered during voluntary acts or off-duty hours could also be excluded — even if they occurred at the workplace.

If valid workers’ compensation claims involve the aggravation of previous injuries or conditions, and existing disabilities are exacerbated, coverage might be approved. However, only aggravated injuries that need new or altered medical treatment will qualify for these benefits. Furthermore, employees may not realize that injuries suffered during participation in out-of-town conferences, company picnics or any company event at which attendance is mandatory, may be regarded as on-the-job injuries.

While the rules and regulations related to the California workers’ compensation insurance program are quite clear, some employers might attempt to avoid paying benefits. Workers who are struggling to get the benefits to which they are entitled may find comfort in learning that professional assistance is available. An experienced workers’ compensation attorney can navigate the legal and administrative procedures of benefits claims and the appeals of claims that were rejected.

Source: thenest.com, “Does California Workers’ Compensation Have to Cover Aggravation of a Pre-Existing Injury?” Kerry Zias, accessed Jan. 12, 2018