Workers’ compensation claims in California are again on the rise. With construction in the state increasing along with overall job numbers, more workers are becoming injured on the job. And according to the California Workers’ Compensation Institute, work injury claim payouts will increase in 2016. In 2015, the maximum workers’ comp benefits a worker can receive are $1,103 per week. In 2016, CWCI expects that to increase to $1,128 per week for injuries that occur after January 1, 2016.
But in order to receive benefits, an injured worker must first show that an injury he or she suffered qualifies for workers’ compensation benefits. One qualification to receive workers’ compensation is to show that the injury suffered “arises out of and occurs in the course of the employment.”
In general, the AOE/COE standard refers to the time, place, and circumstances under which the injury occurs, and that it occurs because of the employment. In other words, the injury must be caused by employment.
Within this standard, gray areas exist. One such case recently came before the California Supreme Court.
LINK BETWEEN WORK AND THE INJURY SUFFERED
On May 28, 2015, the California Supreme Court clarified one aspect of the scope of employment standard. The case arose when a worker suffering injuries from a fall received several prescriptions for pain medication. Four months into his injury, he died from the combined toxicity of Ambien, Xanax, Elavil, Neurontin, and Vicodin. The workers’ compensation physician prescribed two of the drugs; the employee’s personal physician prescribed the others.
The worker’s family filed for death benefits, claiming the drugs the worker needed after the injury contributed to his death. The workers’ compensation judge awarded the family death benefits, but the Workers’ Compensation Appeals Board Court of Appeal reversed the decision. The case then rose all the way to the California Supreme Court.
The state’s highest court ultimately held that the worker’s family could receive death benefits. In issuing its decision, the Court noted that “an employee is entitled to compensation if a new or aggravated injury results from medical or surgical treatment for an industrial injury.” Put more plainly, because the worker died from medication received after a work accident and the drugs prescribed by the workers’ compensation physician contributed to the workers’ death, the family was eligible for death benefits.
While this case has some unique considerations, it provides a good example of how complex workers’ compensation claims can be. Such claims also often involve significant stakes; the financial wellbeing of a family can be on the line.