California Workplace Injury Claims: 10 Conditions for Workers’ Compensation

California Workplace Injury Claims: 10 Conditions for Workers’ Compensation

Estimated reading time: 8 minutes

It’s a scenario that’s simple in theory and familiar to many (“Have you been injured at work?”), but workers’ compensation claims are often the furthest thing from employees’ and employers’ minds – until they happen. California workers’ compensation cases can be complex, with many caveats, exceptions and competing interests at play. Insurers frequently push back against claims, while plaintiffs’ attorneys often pursue additional avenues for compensation as defense lawyers seek to make workers’ compensation the only remedy.

In California, employers are generally responsible for compensating their employees or estates for any injuries or deaths that happen on the job. The law stipulates this compensation regardless of who is at fault — even if the employer’s actions didn’t lead to the injury.  However, there are certain conditions that must be met.

This is where California Labor Code Section 3600 comes in, as it dictates 10 requirements for workers’ compensation laws to apply. There are, of course, exceptions to every rule, but here’s a breakdown of what the statute says and what it typically means for employers and their employees:

Both parties must be subject to workers’ compensation laws.

This one is straightforward: The employee and employer must both have been subject to workers’ compensation laws at the time of the injury. This underscores the fundamental requirement that the employer must carry workers’ compensation insurance and the employee should be covered. 

Example: A construction worker who falls from scaffolding and injures their leg would likely be eligible for workers’ compensation, whereas a freelance graphic designer who injures their wrist while working might not.

Injury must happen in the course of employment.

When the injury happened, the employee must have been doing tasks directly related to their job and part of their responsibilities. They should also have been following the rules, safety requirements and expectations of their role.

Example: A delivery driver who gets into a car accident during their scheduled shift on their designated delivery route would likely be eligible, whereas an employee who injures their leg while jogging during their lunch break probably would not.

The employment should have caused the injury.

There must be a link – known as proximate cause – directly connecting the employee’s duties and the injury, regardless of whether the employee was negligent. Proximate causation is also a crucial factor in personal injury law, but it’s interpreted differently for workers’ compensation.

Under California tort law, causation centers around the “but for” test, meaning the injury wouldn’t have happened “but for” the defendant’s negligence. Workers’ compensation law is more lenient, as statutory policy favors awarding employee benefits under the Labor Code. In workers’ compensation law, it’s enough for employment to be a contributing cause of the injury rather than the sole cause. This means if the employment played a role in causing the injury, even if other factors were involved, the injured employee could still be entitled to workers’ compensation benefits.

Example: A drug addiction from pain medication prescribed for a work injury could be compensable, as could a new injury caused by pain and weakness from a work injury. However, an employee isn’t typically eligible if their duties merely provided a stage for the injury, if the employment was an after-the-fact-rationalization, or if the evidence shows the employment was a passive element of a condition not related to their work.

The injury should not be caused by intoxication.

If an employee’s injury happens because they were under the influence of alcohol or drugs, they likely won’t be eligible for compensation. However, it’s up to the employer to prove that the employee’s intoxication directly caused their injury – meaning they must demonstrate that alcohol or drugs were the main reason the injury happened. This can be difficult to prove, especially if there’s conflicting evidence on causation. There are some situations where an employer can’t use the intoxication defense, such as if the employer bought alcohol and shared it during the work day or if an employer provided alcohol at an off-premise work event. That said, allowing alcohol at a work event doesn’t necessarily mean an employer can’t raise intoxication as a defense.

Example: An employee injured the day after a work event where alcohol was served would likely be eligible for compensation because the employer provided the drinks, and it’s difficult to prove that alcohol consumption impaired their ability to work the next day. However, an employee who decides to go out for drinks with coworkers after their shift and is later injured in a car accident would not be eligible.

The injury shouldn’t be intentionally self-inflicted.

If an employee intentionally hurts themselves, their injury might not fall under workers’ compensation law. The key here is proving intentionality. To defend against a claim, an employer has to show that the employee meant to hurt themselves on purpose, not just that they were being careless or reckless. 

Example: If an employee hits their hand against a wall in frustration but doesn’t mean to hurt themselves, they might still be eligible for compensation if there’s no evidence they intended to cause harm.

The employee should not have willfully and deliberately caused their own death.

If an employee intentionally takes their own life, their family might not be eligible to receive benefits. However, it’s not automatically assumed that an employee has committed suicide. To defeat a claim for death benefits, the employer must prove the employee chose to end their own life and could have resisted the impulse to do so. 

Example: If an employee was under so much stress from work that they felt suicide was the only way to escape the pain, their death might still be considered compensable under workers’ compensation law. Likewise, if suicide stemmed from pain caused by a prior work injury, this could be compensable if the employee felt there was no other avenue for relief.

The employee cannot be the aggressor in an altercation.

If an employee gets hurt in a fight they started, that might not be eligible for compensation. However, the employer must prove the employee was the instigator, and using hostile words or acting in an intimidating manner isn’t enough. It’s not necessarily as simple as who struck the first blow, but the employee must be the initial physical aggressor. For the employee’s part, they must show that the injury from the altercation arose from their employment rather than personal issues unrelated to work.

Example: A worker who was beaten after grabbing an item from a shoplifter might not be considered the initial physical aggressor because they were trying to retrieve stolen property rather than harm the shoplifter. An altercation between an employee and their supervisor might arise out of their employment if it was about the way in which the supervisor relayed instructions to the employee.

The injury shouldn’t stem from a crime.

An employee can’t recover compensation for an injury caused by their commission of a felony or other crime under Section 17 subdivision (b) of the California Penal Code. However, the employee must have been convicted of the crime.

Example: An employee’s guilty plea in a vehicular manslaughter case would likely bar their injury claim. On the other hand, an employee who was accused of criminal trespass but wasn’t convicted might still be able to bring a claim if the injury was somehow within the scope of their employment.

The injury must not occur during an off-duty activity.

If an employee is hurt while voluntarily taking part in an off-duty recreational, social or athletic activity, they likely don’t have a claim. However, the activity could fall under the scope of workers’ compensation law if the worker reasonably believed their employer expected or required them to participate. Appellate courts have often used the two-pronged Ezzy test to decide whether workers’ compensation law applies.

Example: A worker injured playing basketball at work during their lunch break might be denied compensation if there was no evidence they were expected to play. However, an off-duty police officer injured while jogging might have a claim if they had to maintain a certain level of fitness to serve on the emergency team.

The claim shouldn’t be filed after a termination or layoff.

If an employee files for workers’ compensation benefits after they’ve been laid off or fired, and the injury happened before termination, they might not get compensation unless they can prove certain conditions. Those conditions include whether the employer had prior notice of the injury or if the injury occurred beforehand and medical records already existed. This condition does not generally apply to psychiatric injuries.

Example: An employee who is injured in a fall at work, immediately reports it and seeks treatment but is fired a month later would likely still be eligible for compensation. However, an employee who starts to experience severe back pain a month after being laid off might not be eligible.

Personal injury claims and workers’ compensation claims are cousins in the legal world, but their differences are distinct and vast. Not only must a work injury be directly related to the role’s responsibilities, but it must also fit within a certain set of circumstances and adhere to specific legal criteria. In California, lawyers must have a solid understanding of the 10 conditions under Labor Code Section 3600 to discern how they interact with the unique circumstances of every claim. 

For access to all of the California workers’ compensation law resources available through CEB, reach out to schedule a free demo.