Protecting Both Sides

“California is a no-fault workers’ compensation state,” explains Vivian Valdez Saldaña, an attorney at Valdez & Valdez in Fresno who has represented both workers and employers. “It means the employee does not have to prove their injury was caused by the fault or negligence of someone else or themselves.”

The no-fault nature of workers’ comp was born out of something Kelsey Paddock refers to as “the great compromise.” 

“The idea is: In exchange for limited liability for employers, employers and insurance companies are unable to bar or greatly reduce benefits to injured workers based on their own fault,” says Paddock, a workers’ compensation attorney at AmTrust Financial Services. But when an employee’s conduct constitutes gross negligence, “things can get trickier,” she adds. 

Despite carefully prescribed safety measures, employers cannot prevent every workplace accident. When accidents happen and injuries occur, the California Workers’ Compensation Act is triggered. The intention of the act is to provide a “non-litigious way to deliver both medical and disability benefits to injured workers in a quick and efficient fashion,” says Paddock.

Both attorneys emphasize the importance of timely claim reporting. “When an employee is injured at work, they should immediately alert their employer,” Saldaña says. 

“The injured employee is technically obligated to report their injury to the employer within 30 days,” Paddock adds.

Once notified, employers must provide a DWC 1 form (workers’ compensation claim form) to the injured employee. “When in doubt, always immediately provide a claim form,” says Paddock. “Nothing matters if it’s not recorded.”

Potential Workers’ Compensation Benefits

Primary workers’ compensation benefits in California include medical expenses, regular payments to help cover lost wages if you have a temporary or permanent disability, job retention, and potential death benefits.  

“Medical care should be obtained immediately so injuries are documented and a treatment plan is put in place,” says Saldaña. Adherence to this plan aids both the employee and employer. Once again, a quick response is key. 

Workers’ comp is a wage replacement benefit, Paddock says. “In addition to temporary disability benefits, in the event an injured worker sustains permanent disability, they are also entitled to payment that correlates to the percentage of permanent disability they have sustained.”

When injuries prevent an employee from returning to their preinjury job, they “may be entitled to vouchers to pay for job retraining or education,” says Saldaña. 

Coverage Is Not Absolute

The cardinal tenet of a California workers’ compensation claim is the injury must have arisen out of the “scope and course of employment.” But discerning isn’t always clear-cut.

“In California, the scope is very broad. Every exception is riddled with its own exception,” Paddock says. 

For instance, there is a “going and coming” exception, says Saldaña. “If you are tasked to do a job for your employer and are injured en route, that is covered by workers’ comp.” 

An intoxication defense exists, but the bar for this defense is very high. Additionally, sometimes the 30-day reporting rule is excused, adds Paddock.

“California is one of the more heavily litigated states when it comes to workers’ comp because the nature of coverage is somewhat convoluted,” says Paddock. Photo evidence, witness interviews and security videos can be helpful, because recollections change over time.

California law is unique, and its workers’ comp laws are no exception. “We don’t just have the typical specific injuries, we also have cumulative trauma claims where the employee can just prove that, over time, the repetitive nature of the job has led to an injury,” says Paddock. Examples include carpal tunnel syndrome and repeated harmful exposure to chemicals.

Prevention Leads to Protection 

One of the best ways to prevent injuries—and litigation related to them—is to be proactive. “Provide as much safety training as you can. Conduct regular safety meetings where you review any relevant safety policies and procedures,” says Paddock. “Safety training should not just be a one-time thing at the time of hire.” 

“Safety signage on equipment is also good,” adds Saldaña.

Informal preventative measures, such as cracking down on horseplay and providing ergonomic work equipment, can help.

“Management and supervisory staff should be well-versed in the proper procedures regarding how to respond to an injury,” Paddock says. Proper response can help “mitigate long-term costs.”