Workplace injuries can be devastating both in the short-term and in the long-term. In some cases, people who get hurt at work develop complications from their injuries or illnesses years later. That’s where the 5-year rule comes in. Anyone who has been injured at work and is suffering lingering pain or recurring complications can benefit from the California workers’ compensation 5-year rule explained.
Introducing the 5-Year Rule
Most people, even those who have been injured at work, aren’t aware of the 5-year rule. They assume that if their injuries heal initially and they can return to work, it’s irrelevant what happens later down the line. Thankfully, that’s not the case. Workers’ compensation laws in California allow injured or ill employees to reopen their cases and request modifications to their benefits for up to five years following the initial incident report if their condition changes.
The purpose of the 5-year rule is to ensure that workers aren’t left with no options if their injuries worsen over time. Let’s look at an example.
Assume a construction worker has fallen from a height and sustained a back injury. The worker receives medical attention and spends several months healing from the injury, returning to work after receiving temporary disability benefits for three months. If the same injury flares up again two years later, the injured worker is entitled under the 5-year rule to reopen their original workers’ compensation case.
Why the 5-Year Rule Exists
In 2023, 94,386 workers filed initial incident reports regarding injuries or illnesses sustained because of their work. Of those, 48,404 were medical-only claims. The rest were claims for both medical expenses and lost wages. Overall, the rate of initial claims opened by employees amounts to 4.03 claims per 100 workers.
There are no statistics regarding how many claims are reopened each year, but a non-negligible number of people injured at work suffer additional flare-ups or worsening of their injuries or illnesses, often years down the line. An injury that seems like a minor strain could develop into a chronic condition over time that requires extended treatment. The injured worker shouldn’t have to pay for those expenses out of pocket since the original injury was sustained at work.
The 5-year rule comes into play in workers’ compensation cases where:
- The initial settlement did not cover the employee’s future medical needs.
- The employee’s disability has increased in severity.
- There is new evidence that reveals an injury has long-term impacts on the employee’s ability to perform their job.
Unforeseeable medical complications can arise. When they do, workers are covered under the 5-year rule.
How to Reopen a Claim
You may be wondering how to reopen a claim under the 5-year rule. The process is not automatic. It requires workers to file a Petition to Reopen with the Workers’ Compensation Appeals Board. The petition needs to demonstrate that additional benefits are required due to the injured worker’s worsening condition.
To file a claim successfully, you’ll need to gather medical evidence that documents the worsening condition and file the petition on time. Reopening a case can be challenging, so it’s also a good idea to have a California workers’ compensation attorney help you with the process.
Potential Complications
Insurance companies often resist reopening old cases. Sometimes, they will cite insufficient evidence. In other cases, they’ll dispute the link between the original injury and the newly emergent issues. The process also comes with strict timelines. If you don’t file within the five-year window, you’ll lose the right to reopen your claim, even if your condition has worsened severely.
Exceptions and Alternatives
While the 5-year rule provides a straightforward pathway for most residents of the Golden State to reopen their claims, there are some alternative options and exceptions to the rule. They include:
- Future medical awards. If your original settlement included provisions for future medical care, the 5-year rule will not apply.
- Cumulative trauma claims. If your injury was cumulative, the 5-year rule takes effect based on the last day of exposure, not the day of the first incident.
FAQs
What Is the 5-Year Rule for Workers’ Comp in California?
The 5-year rule for workers’ comp in California refers to a rule that allows injured workers to reopen claims, request modifications to their benefits, or seek additional benefits for up to five years following their original injury date if their condition gets worse. They can receive up to 104 weeks of temporary disability within this five-year window, or up to 240 weeks for severe injuries.
How Long Can You Stay on Workers’ Compensation in California?
You can stay on workers’ compensation in California for up to 104 weeks for most temporary disability benefits, or up to 240 weeks for severe injuries. If your condition becomes permanent, you can be transitioned over to permanent disability benefits. There is no cap on how long you can receive permanent disability benefits, with some recipients getting monthly checks for life.
What Is the New Workers’ Comp Law in California?
The new workers’ comp law in California requires employers to post notices about employees’ rights to counsel and emergency treatment in the workplace. It also increased weekly disability payments for many workers. There’s also a second recently passed law in place now that requires some contractors to carry workers’ comp insurance if they don’t have employees.
Can an Employee on Workers’ Compensation Be Terminated in California?
An employee on workers’ compensation can be terminated in California, but only if it is for a non-discriminatory reason. Employers can’t fire employees because they filed claims. They can, however, terminate their employment for legitimate reasons, such as company-wide layoffs or documented poor performance that was unrelated to the injury.
Hire a Workers’ Compensation Lawyer
If you’ve been injured on the job, you should hire a workers’ compensation lawyer right away. The team at English Lloyd & Armenta has three decades of experience practicing workers’ compensation law. We’ll have no problem providing you with the California workers’ compensation 5-year rule explained, or any other information you might need. Contact us to schedule an initial consultation today.
