In California, most people who sustain an injury at work and also have a preexisting condition often face trouble receiving their California workers’ comp benefits. If you are one of those people, then a work injury lawyer Bay Area can help you.
What is Apportionment?
The term apportionment applies when an employee has multiple injuries, and some of these injuries may be pre-existing or not related to a workplace injury in California. In this case, a panel of board members is responsible for determining which of the injuries your California employer might be responsible for. Apportionment in California workers’ comp is the process used to determine the specific portion or percentage of your injuries that are deemed either work related or non-work related. In simple words, apportionment separates an injured employee’s work permanent disability because of work from a disability that arises from a source outside of work.
Unfortunately, when an injured employee applies to the California workers comp carrier, the claim is quickly denied. It is worth noting that this may happen when a preexisting medical condition to the same part of the body exists due to any kind of prior accident, such as a slip and fall. It can be a prior workplace injury or perhaps an injury from an earlier slip and fall or auto accident at the employee’s home. So, apportionment in regards to California workers’ comp tends to split up the specific causes of an injured employee’s permanent disability.
Note that apportionment will reduce a California injured employee’s permanent work disability, which, in turn, reduces the monetary value of her or his claim. However, keep in mind that only under specific situations, your employer is allowed to “apportion” workers’ compensation benefits from your existing injury to a past injury. This is why to protect your rights, you should hire a workers’ comp attorney San Francisco as they are familiar with these issues.
A pre-existing condition may be a:
- non-work-related injury
- non-work-related medical condition
- previous work injury
It is worth noting that successive injuries often pose a number of different problems under California workers’ compensation as any 2 disabilities combined typically result in a more severe disability classification for a worker than if each disability were separately classified and the employee received comp benefits for each injury individually.
Successive injuries, in other words, have synergetic effects on California workers’ compensation benefits. For instance, a lost eye will often result in a partial permanent disability classification with an accompanying award.
Keep in mind that for a disabled employee who is already missing their eye (i.e., suffering from a preexisting medical condition), however, the loss of the second eye (called the second injury) will usually lead to a total disability classification with a considerably higher award compared to either the preexisting medical condition or the second work injury by itself.
Note that there’s also apportionment when an injured employee has two or more than two workplace injuries at the same time. In this case, each injury you sustain is usually given a separate percentage value. And this often has a lower monetary value than if your injuries are combined.
Role of Medical Experts in Determination
Deciding the specific percentage or portion to apportion against a prior medical condition is often a medical issue. It is worth noting that the insurance carriers in San Francisco usually hire independent medical consultants in order to review extensive medical evidence and records and provide formal opinions, dividing monetary liability between multiple accidents, incidents, or medical conditions. Their main aim is to lower the amount you will receive.
It is important to stress that medical evidence and records are an important factor when it comes to determining apportionment in California, just like any other state. A doctor’s ability to compare and analyze medical records from various time periods is likely to show changes in a particular medical condition, such as carpal tunnel syndrome. For example, the comparison of diagnostic tests, such as MRIs, over time may help determine apportionment.
Note that any doctor or medical expert who issues a medical report about permanent disability has to address the main cause of the disability. And part of causation involves determining apportionment.
Also, the doctor has to:
- state that she or he is familiar with apportionment in California workers’ comp
- describe the precise nature of the apportionment, and
- present a valid basis for an opinion
In addition, the doctor has to answer the following questions:
- What percentage or portion of the injury was caused due to work?
- What percentage or portion of the injury was caused by various other factors after or before the workplace injury?
Insurance carriers in California will often try to raise apportionment even in case your prior medical condition was comparatively minor. This is why you should have a San Francisco workers compensation attorney by your side.
Pre-existing Conditions that aren’t Apportioned
Apportionment is often a very complex concept in California workers’ comp law, and so it usually leaves many individuals confused about the payments and benefits they might be able to receive under the law. Note that a worker may experience lighting up of a pre-existing medical condition that won’t have any apportionment under the law if it wasn’t disabling.
For example, an employer hires a worker in her or his current condition. Note that if a worker is more fragile, then their employer is still responsible for any work injury. And it’s not a valid defense to claim that it wouldn’t happen to a healthier or stronger employee. If you suspect that your employer may use this tactic, you should get in touch with a San Francisco workers compensation lawyer right away to fight for your rights and help you receive the compensation you need and deserve.
However, it is worth noting that the employer isn’t held liable for the natural progression of your pre-existing medical condition.
Apportionment and Future Medical Care
This is another important issue. Note that even if there’s apportionment pertaining to a non-workplace-related condition, there’s no apportionment of the medical care. It is important that you should know your rights. The insurance company or your employer has to pay for all medical care that is necessary to treat your injury. However, injured workers do not have any deductibles or co-pays. The good news is that if you are an injured employee and need significant medical treatment, you can get it through California workers’ compensation even if the majority of your injury isn’t work-related.
Know Your Rights
Many workers’ compensation insurance companies in California usually deny compensation claims where preexisting injuries or conditions exist. Keep in mind that when these comp claims aren’t denied, the insurance provider will claim that your injury was mainly because of your preexisting condition and may tell you that your claim is worth very little. This is why you should hire Bay Area workers compensation attorneys to protect your rights.
And at other times, the insurance company’s doctor may quickly apportion your entire injury to a preexisting condition on your first visit to the clinic even when a fair and reasonable medical evaluation would find some fair apportionment to your current workplace injury. It is a common practice. In these cases, it is vital that the injured employee not be fooled and short-changed on his or her benefits by this kind of behavior by the employer’s insurance carrier. Bay Area workers’ compensation attorneys are well versed with these tactics and will help you mount a solid claim to get the benefits you need and deserve.
You should seek the competent advice of a worker’s comp lawyer in San Francisco. You should get the advice you need from Farnsworth Law Firm to know all your rights and how to recover from your legitimate workplace injury, regardless of any preexisting condition(s) to the same body part or parts.
California Workers’ Compensation – Importance of Apportionment
Keep in mind that apportionment could have a considerable impact on the value of your case. This is why an insurance company in California that isn’t able to dispute your injury will often spend a considerable period of time and resources looking for apportionment of permanent disability in order to reduce the monetary value of your claim.
Call Farnsworth Law Firm
Attorney Arjuna H. Farnsworth knows all about apportionment and various apportionment issues and the way California workers’ compensation law applies to different cases. This is why when you hire Farnsworth Law Firm, you’ll no longer be hassled or pushed around by insurance agents who care little about you or your work injury. Instead, you’ll have a competent lawyer by your side that will fight for all of the workers’ compensation benefits in California to which you’re entitled. Our firm helps firefighters, police officers, and other workers get adequate compensation for their work-related injuries in California. An experienced and competent lawyer can assist you with gathering and presenting the relevant medical evidence in a helpful light.
Call us at 415 -250-1044 for a free consultation, or you can fill out your claim evaluation form at Farnsworth Law Firmand Attorney Arjuna H. Farnsworth will call you within 24 hours in order to discuss the case for free.