Chapter 3: Workers' Compensation
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Questions and Answers

What evidence did the employer submit to contest the employee's claim of lead exposure at work?

  • The employee did not work in the shop area. (correct)
  • There was lead contamination in the work area.
  • The employee had previous work-related injuries.
  • The employee wore protective gear while working.

What is the presumption regarding specific medical conditions for certain employees?

  • They are always considered non-work-related.
  • They require proof from the employee for compensation.
  • They are presumed to arise from employment but can be contested. (correct)
  • They only apply during the first year of employment.

What must an applicant demonstrate to link a psychiatric disability to a physical injury?

  • The psychiatric injury occurred before the physical injury.
  • The employer was aware of the psychiatric condition beforehand.
  • There was a clear psychological diagnosis present at work.
  • There was something in the workplace that caused or contributed to the physical condition. (correct)

How long do the presumptions about work-related injuries last after termination of service?

<p>Five years. (B)</p> Signup and view all the answers

In the case mentioned, what was noted about the 'after-the-fact realization' of an injury?

<p>It does not determine whether the injury was caused by work. (B)</p> Signup and view all the answers

What is the primary function of the workers’ compensation system?

<p>To offer medical treatment and financial benefits to injured workers (C)</p> Signup and view all the answers

Which of the following is NOT considered a physician under Labor Code §3209.3?

<p>Nurses (D)</p> Signup and view all the answers

Why are physician reports critical in the workers' compensation system?

<p>They help resolve claims and determine benefits (A)</p> Signup and view all the answers

What must physicians ensure about their reports in contested cases?

<p>They need to be detailed, accurate, and unbiased (D)</p> Signup and view all the answers

In the context of workers’ compensation, what does 'Arising Out of Employment (AOE)' refer to?

<p>Injuries that are caused by the work environment (C)</p> Signup and view all the answers

What is a key requirement for a physician when preparing an occupational history?

<p>To use precise language consistent with workers' compensation terminology (C)</p> Signup and view all the answers

What component of the physician's report contributes significantly to decision-making in compensation claims?

<p>Detailed, accurate, and unbiased reports (D)</p> Signup and view all the answers

What should a complete occupational health history include?

<p>Information on all jobs, job duties, and exposure to hazards. (A)</p> Signup and view all the answers

How does the Labor Code define a specific injury?

<p>An injury resulting from a single incident or exposure. (A)</p> Signup and view all the answers

What is considered a cumulative injury?

<p>Lower back pain developed from repeated lifting over time. (A)</p> Signup and view all the answers

Which condition is classified as an injury by the workers' compensation system?

<p>A disease resulting from employment that needs medical treatment. (C)</p> Signup and view all the answers

What defines first aid according to the Labor Code?

<p>One-time treatment for minor injuries without the need for medical care. (A)</p> Signup and view all the answers

What is necessary for a condition to be officially recognized as an injury?

<p>It must cause disability or necessitate medical treatment. (B)</p> Signup and view all the answers

If a worker experiences symptoms from preventive health care, what does the Labor Code classify this as?

<p>A derivative injury. (C)</p> Signup and view all the answers

What information is NOT typically included in an occupational history?

<p>Personal health conditions before employment. (D)</p> Signup and view all the answers

Which of the following statements about cumulative injuries is incorrect?

<p>They are limited to physical trauma. (A)</p> Signup and view all the answers

What must be included in the 'history' section of the Doctor's First Report?

<p>Detailed information about the injuries observed (C)</p> Signup and view all the answers

Which of the following activities are considered 'incidental' to employment?

<p>Traveling for a company meeting (C)</p> Signup and view all the answers

What did the court state in Albertson’s Inc. v. WCAB regarding subjective stress?

<p>It requires additional evidence to support a claim (D)</p> Signup and view all the answers

What is the requirement under Labor Code § 3600(a)(6) for a compensable injury?

<p>The employment must be a positive factor in the injury's development (D)</p> Signup and view all the answers

Which scenario is generally covered by workers' compensation?

<p>An employee trips in the employer-owned parking lot (D)</p> Signup and view all the answers

Which circumstance would likely NOT lead to workers' compensation coverage for an injury?

<p>Injury sustained while significantly deviating from the work route (D)</p> Signup and view all the answers

How might a workers' compensation judge determine compensability?

<p>By considering the nature of the employment and related evidence (C)</p> Signup and view all the answers

What type of evidence may a physician provide regarding an injury?

<p>Elevated blood lead levels consistent with workplace exposure (D)</p> Signup and view all the answers

In what scenario would an employee NOT be considered covered under workers' compensation?

<p>Injured while playing a game with coworkers during breaks (B)</p> Signup and view all the answers

What factors does the doctor consider when assessing hand overuse injuries?

<p>Both on-the-job and off-the-job activities (C)</p> Signup and view all the answers

Which injury is suggested to be potentially caused by both job-related and personal activities?

<p>Flexor tenosynovitis (D)</p> Signup and view all the answers

In the context of a workers' compensation case, who ultimately decides if an injury occurred in the course of employment?

<p>A workers' compensation judge (D)</p> Signup and view all the answers

What role does a physician play in establishing the facts regarding an injury's occurrence?

<p>They gather and offer information about the exposure (A)</p> Signup and view all the answers

What is significant about the latency period in occupational diseases?

<p>It can obscure records of exposure (B)</p> Signup and view all the answers

When determining compensability, what evidence may a judge consider?

<p>Evidence from the employee, employer, and witnesses (C)</p> Signup and view all the answers

What common misconception might someone have regarding the doctor's report in compensable injury cases?

<p>The doctor decides compensability (C)</p> Signup and view all the answers

What can potentially contribute to flexor tenosynovitis according to the doctor's input?

<p>Combination of work and recreational activities (D)</p> Signup and view all the answers

What is a crucial part of an occupational history to determine a disease's relation to work?

<p>Comprehensive details of work processes (D)</p> Signup and view all the answers

How might the judge's decision be influenced in a workers' compensation case?

<p>By the evidence provided by all parties involved (D)</p> Signup and view all the answers

Flashcards

Workers' Compensation

A medical system that provides benefits like medical treatment, income replacement, and compensation for injuries.

Medically Driven System

In this system, medical information is the primary factor for crucial decisions, like determining eligibility.

Occupational History

A detailed account of a worker's job history, including past injuries, work activities, and any known hazards.

Injury

An event that causes physical harm or injury.

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First Aid

Immediate care given to an injured person before professional medical help arrives.

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Aggravation

When an existing injury is made worse by a work-related event.

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Recurrence

A recurrence of a previous injury.

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What is an 'Injury' in Workers' Compensation?

Any injury or disease that arises from work activities. This includes both specific injuries (single incident) and cumulative injuries (repeated trauma over time).

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Specific Injury

A single incident that causes an injury, like falling and injuring your back.

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Cumulative Injury

An injury that develops over time from repetitive stress or exposure to harmful conditions, like back pain from repeated lifting.

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Aggravation of an Injury

An event that worsens a pre-existing injury, potentially making it more serious.

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Recurrence of an Injury

The return or reappearance of a previous injury, often triggered by work-related activities.

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Derivative Injury

A condition caused by the treatment of a work-related injury, even if the treatment itself was not directly work-related.

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Injury from Preventive Health Care

A condition that arises from a workplace's preventive health care measures, specifically for healthcare workers. This could be a reaction to a vaccine or a side effect from a specific safety protocol.

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Flexor Tenosynovitis

A medical condition that may be caused by repetitive hand motions from work activities like assembly or knitting.

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Carpal Tunnel Syndrome

A condition caused by pressure on the median nerve in the wrist, often resulting in tingling and numbness in the hand.

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Course of Employment (COE)

The process of determining if a worker's injury or illness is related to their employment.

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Medical Literature

The evidence used to link a worker's illness or injury to their job, including medical studies and reports.

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Latent Period

The amount of time between exposure to a hazard and the development of an illness or injury.

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Injury Occurring in the Course of Employment (COE)

When an injury occurs in the context of the worker's job, regardless of how it happened.

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Workers' Compensation Judge

A judge or arbitrator who decides whether an injury is work-related and eligible for compensation.

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Physician's Input

Relevant information a doctor provides to help determine if a worker's injury is related to their job.

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Presumptive Conditions

A medical condition that is presumed to be work-related when it affects certain groups of employees like firefighters, police officers, and correctional employees.

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Rebuttable Presumption

A legal assumption that can be challenged by providing evidence to the contrary.

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Shifting Burden of Proof

The employer must prove that the employee's condition is not work-related.

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Psychiatric Overlay

A psychiatric injury that stems from a physical injury caused by work.

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Causation in Psychiatric Overlay

The medical condition that caused the psychiatric injury must be work-related.

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Incidental Activities

Activities outside of the job description but related to employment are considered part of "course of employment" under workers' compensation.

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WCAB & Courts on 'Incidental' Activities

The Workers' Compensation Appeals Board (WCAB) and California courts recognize that activities outside the job description, but related to employment, are covered under workers' compensation.

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Work-Related Travel

Travel for work is generally covered by workers' compensation unless there's a significant deviation from the agreed-upon route.

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Workplace Premises Injuries

Injuries sustained in areas like parking lots, restrooms, or during breaks are usually compensable under workers' compensation.

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Proximate Cause

The legal requirement that the employment plays a direct role in causing the injury or condition.

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Subjective Stress & Workers' Comp

Subjective stress alone is not enough to establish a work-related injury under workers' compensation.

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Employment as a Contributing Factor

For an injury to be compensable, the employment must be a contributing factor to the condition.

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WCJ Role in Determining Compensability

A Workers' Compensation Judge (WCJ) reviews evidence and decides if an injury occurred in the course of employment.

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Medical Evidence & WCJ Decision

Even with a strong medical connection, a WCJ could rule that an injury did not occur within the course of employment.

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Medical Opinion vs. WCJ Decision

A medical opinion about the relationship between an exposure and an injury may not be enough to establish a compensable work injury. The WCJ can still rule differently.

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Study Notes

Chapter 3: Compensability

  • Workers' compensation is a system for injured workers, providing medical treatment, income maintenance, and other benefits. It's medically driven, using medical information for key decisions, including entry into the system.
  • Physicians are crucial, evaluating injured workers and their conditions. Physicians, surgeons, psychologists, optometrists, dentists, podiatrists, and chiropractors licensed in California can act as physicians under the system.
  • Physicians' opinions are used significantly by claim administrators for benefit decisions, aiding in quick and fair resolutions for many claims. Physician reports must be detailed, accurate, and unbiased, especially the occupational history section.
  • The way words and concepts are used in the physician's language matters in workers' compensation, impacting the benefits for injured workers.
  • Occupational history is vital, especially with cumulative injuries and illnesses. It should include all employment positions held, length of each position, tasks performed, exposure to hazards, and protective equipment use.
  • Injuries can be specific (one incident) or cumulative (repetitive trauma over time).
  • "Injury," in a worker's compensation context, includes any injury or disease arising out of employment, derivative injuries caused by treatment of an employment-arising injury, and reactions to preventive health care provided by employers.
  • First aid is one-time treatment or follow-up observation for minor injuries (e.g., scratches, cuts, burns) that don't routinely require medical attention. First aid may be administered by registered professionals or physicians.
  • Occupational disease is a work-caused condition; this may include diseases that could occur without work.
  • Excluded injuries are, by state labor code, specific: those due to alcohol or drug use, self-inflicted wounds, and committing a felony, and those occurring during off-duty recreational activities that aren't part of the employee's work.
  • A compensable injury meets four criteria: must be an injury, have an employment relationship, caused by the job, and occur during the course of employment.

What is a Compensable Injury?

  • A physiological or psychological harm is required
  • Employment relationship, or some connection with an employer
  • Connection between the harm and employment, "arising out of employment"
  • Harm occurring during the job's duration, "course of employment"

What is the "Date of Injury"?

  • Date of incident (specific injury)
  • Date of disability, with awareness of employment's role (cumulative injury/illness)
  • Injury must be proven work-related by preponderance, not sole cause for injury
  • "Arise out of employment" (AOE): Work activities contribute to injury, not just sole cause
  • "Occur in the course of employment" (COE): Injury happens during work or a work-related task
  • Psychiatric injuries have differing standards

Causation for Psychiatric Injuries and Illnesses

  • Thresholds for psychiatric injury causation are more strict, requiring the "predominant cause" of the injury to be employment-related
  • Psychiatric injuries are only seen as compensable if there substantial evidence of an employment connection

Perception Is Not Disability

  • Claims are subjective and take into consideration how individual workers uniquely respond to work environments. The focus is the proximate cause; did work environments/exposures contribute
  • Additional records and data are needed in psychiatric injury claims due to their complexities and varying nature.

What Happens If a Claim is Filed After Notice of Termination or Layoff?

  • Psychiatric injuries resulting from termination or layoff typically aren't compensable unless employment was predominant cause, or certain specific notice conditions are met.

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Chapter 3 Compensability PDF

Description

Explore key concepts in Chapter 3 of Workers' Compensation, focusing on the role of physicians in evaluating injured workers. Understand how their reports influence benefit decisions and the importance of accurate occupational history in claims. This quiz will test your knowledge on the intricacies of compensability in the workers' compensation system.

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