In some cases, an injury can make a person vulnerable to other medical complications. Under California’s workers’ compensation laws, this type of new health problem may be considered a compensable consequence. In California, a compensable consequence is an injury or health condition that arises directly out of an industrial injury.
This raises an important question: What qualifies as a compensable consequence under California law? Here, our Fresno workers’ compensation defense attorneys answer the question by explaining the key things that insurers and employers should know about California’s compensable consequence doctrine.
Compensable Consequence Defined
A compensable consequence is a health problem that developed directly because of a proper workplace injury or workplace illness. Under California state law (Lab. Code § 3208.1), workers’ compensation benefits may be available for both:
- Specific injuries that occur in a ‘one-time’ incident; and
- Cumulative injuries that occur as a result of repeated stress or trauma.
The state’s labor code does not define the parameters for the term compensable consequence. Instead, the definition is found in case law. In the 1994 case of Rodriguez v. Workers’ Comp. Appeals Bd, a California’s appeals court offers an instructive definition of a compensable consequence, “a secondary incident which, although perhaps a new and distinct injury, is not a new and independent injury but rather the direct and natural consequence of the primary incident.”
Unpacking that definition, the key thing to understand about compensable consequence claims is that the new health problem must be directly related to the initial workplace injury or illness. If the new injury is independent, then it is not covered by workers’ compensation as a compensable condition.
Case Example: Compensable Consequence Claim Remanded for Lack of Evidence of Causation
To best understand the standards that California courts use to assess compensable consequence claims, it is useful to consider a real world example. In the 2013 case of Bates v. Serologicals Corp, a laboratory technician filed a compensable consequence workers’ compensation claim for a secondary injury.
The lab technician, who was employed at a facility in Riverside County, developed a repetitive stress injury (carpal tunnel) while on the job. Eventually, he was able to return to work, but he did not make a full recovery and continued to deal with ongoing physical limitations in his right arm.
Later on, the employee developed a knee injury. A compensable consequence claim was filed on the grounds that the knee injury, despite being a new injury, arose directly out of his previous arm injury. In adjudicating the issue, the California court remanded the matter on the grounds that a medical determination must be made on the matter of causation. This is the key thing that insurance providers, administrators, and employers should know about compensable consequence disputes: Courts will carefully review the medical evidence. If the new health problem cannot be linked directly to the initial workplace injury, it will not be covered as a compensable consequence.