CA Workers’ Comp and The Great Compromise
California Workers’ Compensation is Based On “The Great Compromise”
Did you know that the California workers’ compensation (“WC”) system is a “no-fault” system? This means that even if you are 100% at fault for causing your work injury(ies), you may potentially be entitled to claim WC benefits from your employer or WC insurance carrier.
Since workers’ compensation is a no-fault system, the employer or WC insurance carrier is very limited in the bars it can raise to your recovery for WC benefits. You may be barred from workers’ compensation benefits if your employer or the WC insurance carrier can prove that your work injury(ies) is due to your engaging in activity prohibited by your employer, illegal conduct, horseplay, and/or intoxication. Assuming none of these bars to recovery apply, then you may be able to claim WC benefits even if you are at fault in your injury by e.g., accidentally cutting yourself at work with a saw; missing a step causing you to trip and fall, or by not braking your work truck in time resulting in a car accident with you rear-ending a car.
Our no-fault California WC system is often referred to as “The Great Compromise” or “grand compensation bargain”. This no-fault system was created during the early 1900s “Progressive Era”. In 1913, the California State Assembly in the legislature passed the Boynton Act, establishing the California workers’ compensation no-fault system. The Boynton Act became effective on January 1, 1914. In exchange for employees giving up the right to sue their employers for damages in the tort or civil law system, the employers would cover employees for their injuries within an administrative law system of limited benefits. This compromise grew out of concerns by reformers in labor about the high number of disabling injuries to workers; inadequate compensation for workers; the lifelong need for medical care for work injuries; difficulties, exorbitant costs, inefficiencies, and many legal barriers to an employee suing their employer in civil court for damages (monetary recovery). On the employers’ side there were many concerns about uncertainties of cost to employers for the injuries; the burden of defending against an increasing number of civil lawsuits; and high expenses to employers for ongoing, protracted civil litigation.
It is Very Easy For An Injured Worker To File a Workers’ Compensation Claim
The result of the no-fault system is that workers’ compensation is the exclusive remedy for workers injured on the job. This means that unless the employer is engaged in illegal conduct such as harassment, discrimination, is illegally uninsured, etc., workers typically may NOT sue their employer in civil court for e.g., monetary damages. Workers must pursue their right to recovery through the WC system. In certain situations, there may be an at-fault third party. A third party is someone at fault other than you, your employer, or an employee of the employer. If there is a third party, then you may potentially have a civil claim(s) against the third party in addition to your workers’ compensation claim(s) against the employer or WC insurance carrier.
It is very easy for an injured worker to file a WC claim(s). WC is liberally construed in favor of the injured worker. The WC system is meant to be an expeditious benefits delivery system where a worker is quickly provided with medical care and monetary benefits for their injury(ies). Most WC cases settle, resulting in some monetary recovery and medical care for an injured worker. The flip side of this compromise is that the WC benefits are strictly limited to five main benefits set by the California legislature. Treatment within the WC system may be required with certain doctor(s)/medical provider(s) within the employer or WC insurance carrier’s Medical Provider Network (“MPN”). The monetary benefits in WC have caps on the maximum/minimum amount of benefits allowed pursuant to statutes enacted by the California legislature. The money in WC is usually lower than the monetary recovery of a civil case. Unlike a civil case, in WC there are no punitive damages and/or pain and suffering damages. WC is not considered a “lawsuit”. You are not suing your employer in the WC system. In WC, you are making an application for a claim of benefits against an employer or WC insurance carrier in the WC administrative law system.
The five main benefits in WC for a WC injury(ies) are:
- Lifetime medical care for the industrial body parts/medical conditions found to be work-related by a WC doctor(s)
- Temporary disability (“TD”) payments for periods where you are off work due to your work injury(ies)
- Permanent disability (“PD”) payments based on findings by a WC doctor for permanent impairment to a body part/medical condition in your worker injury(ies)
- A Supplemental Job Displacement Benefit Vouch (“SJDBV”) for job retraining if you are unable to return to your pre-injury job, as well as a potential Return-to-Work Supplement payment for $5,000 if you receive the SJDBV
- Death benefits for your financial dependents if you pass away due to a work-related injury(ies) including aggravation by your work to a pre-existing medical condition
- WC is intended to be an efficient system where workers receive medical care and monetary benefits related to their work injury(ies)
The biggest threat to the WC system are employers and WC insurance carriers improperly delaying WC benefits and denying WC claim(s). Whenever employers and insurance carriers talk about “reforms” to the WC system making it harder or slower for workers to collect WC benefits, what they are really talking about is undoing the no-fault system. We must be vigilant advocates for our rights in the WC system. It is very important that we vote for candidates who are champions for workers’ rights and who are fighting for workers’ dignity, medical care, and benefits!
Ford & Wallach offers a free case evaluation. Contact us by email or call 213.380.3140.