Workers Compensation Claims

We will defend YOU and limit your liability from fraudulent workers’ compensation claims.

Every California employer is required by law to maintain workers’ compensation insurance in order to ensure the employees receive financial support for time the employees must take off work due to injuries sustained while on the job. Although the vast majority of workers’ compensation claims are settled through the employer’s workers’ compensation insurance policy, there are certain (and potentially costly) exceptions.

When an employee gets hurt on the job, he or she will usually file a claim for workers’ compensation benefits. However, an employee who believes that his or her injury is not covered by the employer’s workers’ compensation insurance policy, may now sue you for damages. In such cases, the employee’s case is no longer just a benefits claim. The workers’ compensation claim and a separate civil action in California Superior Court will proceed at the same time. Your workers’ compensation coverage will likely NOT provide you with a defense counsel to defend you in the separate civil action.

In addition, there are certain factors that may affect your employee’s eligibility for workers compensation. The following are some defenses that can be used to limit an employer’s liability for workers compensation:

1) The employee failed to give you notice of his or her job-related injury within 30 days of sustaining the injury.

2) The employee’s workers’ compensation claim was not filed within the one year statute of limitations, which begins from the date of his or her work-related injury or illness.

3) The employee’s injury was self-inflicted or intentional. This is because California’s mandatory workers’ compensation insurance is meant to only cover those injuries caused by an accident or the employee’s carelessness.

4) The employee’s injury was not linked to activities that are within the course and scope of the employee’s employment, i.e. the employee was injured during his or her commute or during a rest or meal break. Was the employee clocked in at the time he or she was injured? Was the activity the employee engaged in at the time of injury within the course and scope of his employment?

5) The employee’s injury is a result of the employee’s own willful negligence or horseplay. For example, any behavior that violates the company’s policy at the time of injury (including drugs and intoxication) will probably not be covered by workers’ compensation insurance.

6) The employee did not attend mandatory doctor appointments. When an employee files a workers’ compensation claim, he or she is required to attend an independent medical examination, and employees cannot refuse medical treatment without good cause.

7) The employee is unable to determine or explain the cause of his or her injury. This is because the employee bears the burden of proof and must show why the accident happen.

8) The employee’s injury is not as bad as the employee claims, i.e. if the employee is cleared to return to work sooner.

9) The employee’s injury was caused by a pre-existing condition. If the employee has a pre-existing condition that resulted from an injury not sustained at work, the employee is only responsible for the aggravation to the pre-existing condition.

Our firm can provide you with an aggressive, innovative, and practical defense to help resolve the matters. We know that workers compensation claims can sometimes be rife with fraud, but it can also cause a significant disruption in your time and business.