California’s no-fault workers’ compensation system benefits both employers and employees. While employees cannot sue their employers in a court of law, employees don’t need to prove that their employer was at fault for an injury. They only need to prove that their injury occurred at their workplace. Furthermore, employers pay for the workers’ compensation system in California to provide benefits for injured employees.

The Rights and Entitlements of California’s Workers

The state workers’ compensation benefits system provides tax-exempt payments and non-cash benefits for injured workers, unlike other benefits like unemployment benefits, which are not tax-exempt. Under this system, a number of benefits are available for eligible workers who were injured while performing their job duties. The premium benefits provided to injured workers through the system are listed below.

  • Costs of medical treatments
  • Costs of vocational retraining
  • Death benefits
  • Life payments for pensions
  • Payments for temporary disability
  • Payments for permanent disability

There are additional potential benefits available to workers who suffered from a workplace injury as well, such as state disability insurance (SDI), Social Security disability (SSD), legal claims, or settlements from court judgments against third parties.

What must the injured employee prove for an injury to be compensable under worker's compensation?

What Are the State Requirements for Workers’ Compensation for Work-Related Injuries

California does have some of the most generous workers’ compensation benefits and programs in the country. Thus, it makes sense that, to receive benefits for a work-related injury, the worker must show proof that their injury was, in fact, work-related and constitutes a compensable injury under state law. The following conditions are requirements for workers’ compensation eligibility:

  • There must be a work relationship.
  • There must be a medical injury.
  • The injury must occur during the period of employment.
  • The injury must be a result of employment.

A key factor in a legitimate workers’ compensation claim is establishing that an injury occurred and how it occurred, as related to employment. The examining physician provides crucial input on this component. However, the physician can also disqualify the worker from being able to receive benefits, as they can determine if the worker’s injury is excluded from benefits according to the requirements for exclusion. The following circumstances make an injury non-compensable:

  • The injured employee was intoxicated by illegal drugs, a controlled substance, or alcohol at the time of the incident.
  • The injury was self-inflicted and intentional.
  • The injured purposely and willfully caused their own death.
  • The injury was caused due to an altercation initiated by the employee, who was the aggressor in the altercation.
  • The injury occurred while committing a felony.
  • The injury was caused during participation in off-duty recreational activities that were not part of the injured employee’s job duties.
  • The claim was filed after the injured party was laid off or fired unless:
    • The employee notified them of the injury prior to the termination of employment.
    • Medical records exist that prove that the injury occurred before the termination of employment.
    • The injury was dated before the termination of employment.
    • A cumulative injury is discovered after the termination of employment.

If you are still unsure whether your injury is compensable, discussing your case with a qualified workers’ compensation attorney can help clear up any confusion regarding compensable and non-compensable injuries.

Date of Injury

For all workers’ compensation claims in California, the date of injury must be established to receive benefits. If the injury was a one-time occurrence, the date that the injury occurred is the date of injury according to state law. If the injury is cumulative or an occupational illness, the date of injury is the first date that the employee suffered from the injury or the date the employee realized that the injury was a result of their job duties. This is an important part of a workers’ compensation case because it determines the:

  • Statute of limitations
  • Regulations that are applicable to the claim
  • Employee benefits compensation rate

It also identifies the liable employer.


Q: What Is Considered a Compensable Consequence Under Workers’ Compensation?

A: State law does not have any specific statutes concerning compensable consequences and their attribution to workers’ compensation claims. Nevertheless, if a worker suffers from an injury or condition that arose directly from a workplace injury, it may be a secondary injury that is a direct result of a primary injury. Precedent verdicts establish that the injured employee can be eligible for workers’ compensation benefits as long as it meets other required criteria.

Q: If I Smoke, Can I Be Denied Workers’ Compensation for a Work-Related Injury That May Have Been Exacerbated by My Smoking?

A: Yes, smokers are still eligible for workers’ compensation benefits. In fact, workers only need to show that the injury is partially work-related. Work does not have to be the only contributing factor to the injury or even the primary cause. Proving that the employment contributed to some degree to an injury is enough.

Q: What Are the Two Main Criteria the Injury Must Meet to Trigger Protection Under Workers’ Compensation Laws?

A: The two main criteria a work-related injury must meet to be covered under workers’ compensation is that the injury was an accident and it occurred during employment. Another secondary criterion is that the injury must be an actual medical injury and not one for which simple first-aid treatment will suffice.

Q: What Is Alternative Work?

A: Alternative work is employment offered to injured employees who are returning to work with limited abilities to perform their original job duties due to their workplace injury. The alternative job must provide 85% of the compensation and wages the original job paid at the time of the injury. It must also be located within a reasonable distance from the residence of the employee. Failure to adhere to these guidelines could constitute discriminatory charges against an employer.

Contact English Lloyd & Armenta

If you’re having a hard time proving your employers’ liability in your workers’ compensation case, it is critical to hire a professional workers’ compensation attorney. They can facilitate a case strategy that no one can refute. An attorney can help you learn more about the options you have and what opportunities are available to provide restitution for your workplace injury. Contact English Lloyd & Armenta today.