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.</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.</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</p> Signup and view all the answers

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

    <p>Nurses</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</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</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</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</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</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.</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.</p> Signup and view all the answers

    What is considered a cumulative injury?

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

    What information is NOT typically included in an occupational history?

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

    Which of the following statements about cumulative injuries is incorrect?

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

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

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

    What is significant about the latency period in occupational diseases?

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

    When determining compensability, what evidence may a judge consider?

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

    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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    Related Documents

    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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