Workers Compensation Law Attorney – No fault California workers compensation law sets forth a scheme that provides an important security net for those who fall victim to injury at work. The basic structure allocates the risk of job accidents and occupational hazards that create injury solely to the employer, regardless of negligence on the employer’s part. In exchange for this allocation of risk, the employer becomes immune from suit brought by employees in civil court for the non-intentional tort of negligence. This sort of trade-off means that employers do not face the possibility of costly and sometimes catastrophic civil litigation filed against them by their own employees. It also means that employees hurt by their company’s negligence will not have the same rights and remedies as they would possess without no-fault California workers compensation law in place. Instead, all victims (with exceptions – see below) gain the right to a medical benefit and money compensation system to get them better and to replace their income while doing so. This article will help readers gain a general understanding of what no-fault means within the California workers’ comp. system by exploring the main concepts that define what makes an injury covered (also known as “compensable”). This article is not intended to count as legal advice or guidance for any singular case or claim. Only after participating in a discussion with an experienced California workers compensation lawyer can someone obtain legal advice about a job accident claim.
The Application Of No Fault Rules To Job Accident Claims
No fault means that an injury is potentially covered regardless of who was at fault for creating the condition that caused the harm. Put another way, the employer can possibly be held liable to provide workers’ compensation despite the fact that it did nothing wrong to cause the injury. It also means that even where it did something wrong, the employer will be held to answer and provide monetary compensation and medical benefits, possibly at an increased rate (known as serious and willful misconduct). But just because the system is ‘no fault’ doesn’t mean that there are no rules regarding who can and who cannot receive workers’ comp. In California, the Labor Code and the California Code Regulations, interpreted by case law (judges), lays out the rules by which it is determined who is allowed to receive. Disputes over the issue of eligibility is an area of litigation at the WCAB where applicant’s hire lawyers to fight for the admittance of denied claims by the insurance company. So what are the rules that actually govern eligibility to collect? While the following paragraphs in no way convey a comprehensive analysis, they provide a very basic overview of what the law says about eligibility to draw from the employer’s insurance policy. Always remember, just because someone is eligible for workers compensation has nothing to do with the extent to which they can collect money and medical treatments.
Injury Arising Out Of And In The Course Of Employment (AOE/COE)
The basic principle is that an injury, regardless of mechanism (the way it occurs), must arise out of an in the course of one’s employment duties to trigger workers compensation. If it does not, it is not a compensable injury eligible for benefits. The question of whether an injury arises out of and in the course of employment is obviously one of fact where a lot of disputes crop up. Note that with the exception of psychiatric injury, any injury found to be 1% caused by job duties qualifies as work-related and may require payment of compensation to the claimant. Once AOE/COE is shown by a preponderance of the evidence by the applicant, the case must be admitted. Even where an accident happens at a job site or at the office, it is possible that the law will still find it non-work related (or not AOE/COE). Some examples include: 1) where intoxication of claimant caused claimant’s own injury; 2) where horseplay/skylarking of applicant created the circumstances leading to self-harm; 3) where applicant got hurt at work while engaged in mutual combat where the applicant was the initial physical aggressor; and 4) when claimant files the case after notice of termination or layoff where no medical records or report to employer were created prior to the notice. In addition to the argument that an injury happened off the job, the above are common factual questions pertaining to AOE/COE that exist in denied cases.
The short of it is that where bodily harm is found AOE/COE, it must be admitted by the insurance company regardless of who caused the accident leading to the harm. Admittance of a body part or health condition has nothing to do with nature and extent of harm and the amount of benefits and compensation that should legally be paid. The issue of AOE/COE is a threshold issue that solely pertains to whether eligibility exists to maintain a claim in the first place.
Workers’ Compensation Law Attorney Fighting AOE/COE Denials
Many legitimate job-related health conditions become denied by the insurance adjuster within 90 days of being submitted. A dilemma is created when the insurance denies a case on improper reasoning or because there is not enough information to fully evaluate the strength of the claim. Whatever the reason or lack thereof, claimant’s have the right to hire an attorney to fight unjust AOE/COE denials by the insurance company.
Our law firm fights against the insurance company in court on denied AOE/COE cases, where we believe merit exists for their admittance. Has your case been denied? If so, call us to discover if one of our best workers compensation lawyer in Pomona, Chino, La Verne, San Dimas, Glendora, Claremont, Montclair, Upland, Rancho Cucamonga, can assist with legal representation. For advice on the strength of your case, contact the law office at 844-584-8444 or email us by sending a free case consult form found at calinjurylawyer.com. We are currently helping accident victims in and around the following cities and/or areas: Azusa, Ontario, Fontana, West Covina CA, Covina, Diamond Bar, City of Baldwin Park Accident Lawsuit and La Puente. Don’t delay, it is possible to lose valuable rights when they are not asserted by your workers’ compensation lawyer on time!
Originally posted 2015-05-10 22:29:27. Republished by Blog Post Promoter