Employers have a duty to get no-fault workers’ compensation insurance coverage for both full-time and part-time employees (California Labor Code § 3700). If a worker is hurt on the job, they can claim benefits without proving that the employer was negligent or otherwise caused their accident. Of course, that does not mean that a workers’ compensation claim will be automatically approved.
A party to a workers’ compensation claim has the right to raise a number of different defenses. There are grounds on which a workers’ compensation claim could be properly denied. In this article, our Bakersfield workers’ compensation defense lawyers highlight five of the most common defenses in workers’ compensation claims in California.
1. Time Limits (Failure to Give Notice or Statute of Limitations)
The workers’ compensation laws in California put responsibilities on both employers and employees. One of the most important responsibilities that workers have is the duty to initiate their claim in a timely manner. If they fail to do so, an employer may be able to defend a workers’ compensation claim based on those grounds. As an example:
- A worker failed to provide timely notice of the accident, injuries (30 days in most cases); or
- A worker filed for workers’ compensation benefits outside of the statute of limitations (one year).
2. Injury Was Self-Inflicted or Caused by Willful Negligence
While workers’ compensation insurance provides no-fault benefits in California, there are limits. As a general rule, an employee is not permitted to claim workers’ compensation benefits for an injured or occupational disease that was self-inflicted or caused by willful negligence on their part. An employer can defend a workers’ compensation claim based on these grounds.
3. Not a Work Injury (Outside of Course and Scope of Employment)
To qualify for workers’ compensation benefits, an employee must establish that they were injured in the workplace. In California, an injury or illness meets this condition if it occurred within the course and scope of employment. A workers’ compensation claim can be defended on the grounds that it occurred outside of the course and scope of a worker’s employment.
4. Medical Disputes: Injury Not Real, Not Severe, Pre-Existing, Etc.
A workers’ compensation claim can also be defended on medical grounds. Indeed, this is generally the most common category of workers’ compensation defenses. An employer can defend a workers’ compensation claim on the grounds that:
- An employee’s injury is not real;
- An employee’s injury is not as serious as represented;
- An employee’s injury is pre-existing; or
- An employee failed to receive treatment or attend doctor’s appointments.
Book a Confidential Appointment With a California Workers’ Compensation Defense Lawyer
At Yrulegui & Roberts, our California workers’ compensation defense law firm is devoted to superior client service and pragmatic legal representation. If you have questions about workers’ compensation defense strategies, we are more than happy to help. Contact our legal team today for a no commitment consultation. With legal offices in Fresno, Bakersfield, and Sacramento, we advocate for insurers, employers, and claims administrators throughout the wider region.