What is workers’ compensation and what is a catastrophic injury?
Workers Compensation
Workers’ compensation is a system that is designed to support workers who are injured on the job and as a result are unable to support themselves financially. Workers’ compensation is actually a form of insurance that is paid for by your employer. When you are injured insurance agents, doctors, and lawyers all work together to determine how severe your injury is, how long it is expected to last, and what tasks it will prevent you from accomplishing.
There are several components to a workers’ compensation claim. The most important ones to understand are:
- Medical care: All medical treatments required to treat and recover from the injury or illness. The doctors and hospitals covered are required to be covered by your employer’s disability insurance plan in most cases.
- Temporary disability: Up to two years of wage payments that are paid out to you while you are recovering from your injury. The amount of these payments is almost never the exact amount you were making while at work. For most workers, this comes out to 2/3rds of your average weekly earnings.
- Permanent disability: If your injury results in a lifelong disability you will be eligible for lifetime payments that are based on your age, level of injury, pre-disability pay, and occupation. Determining these factors is complicated and almost always requires legal assistance.
- Retraining: Some injured employees will be eligible for a voucher than can be used to pay for educational fees at various colleges, universities, and trade schools. This is intended to allow individuals whose disability prevents them from performing one line of work to find a new line of work without the burden of paying for education.
- Consequences: Finally, if you suffer any other injuries or illnesses as a result of your workplace injury, those conditions are also eligible for compensation. A car accident while driving to medical treatments for your injury, a fall caused by a workplace injury, or other medical conditions that result from injury may all be eligible.
Always remember that workers’ compensation is a “no-fault system.” You do not need to prove that the injury was caused by another person’s error, your error, or an unsafe work environment. Any injury sustained at work, even if it was a chance accident with nobody at fault, may be eligible for workers’ compensation!
Catastrophic Injury
“Catastrophic injury” is both a medical and legal term. In the medical setting, it is used to refer to an injury that will require a prolonged hospital stay, significant rehabilitation, and may never be fully cured, repaired, or resolved. This term appears in the California state workers’ compensation laws. These laws do not directly define what types of injuries are catastrophic, only stating the following:
“[A] medical condition due to a disease, illness, catastrophic injury, or other medical problem or medical disorder that is serious in nature and persists without full cure or worsens over
90 days and requires ongoing treatment to maintain remission or prevent deterioration”
This extremely broad definition was guided by several examples provided in California Senate Bill 863, which is focused on workers’ compensation reform. The examples given in this bill are “loss of a limb, paralysis, severe burn, or a severe head injury.” This bill also specifically states that these are not the only catastrophic injuries that exist.
Having a catastrophic injury implies that you will need lifelong disability services and support. It also allows for increased benefits in the event that you experience mental health challenges as a result of your injury. These benefits can be extremely important to injured workers, which is why determining if a catastrophic injury is present is so important!
What are the most common catastrophic injuries?
Loss of a limb, paralysis, a severe head injury, and severe burns are the most common catastrophic injuries. However, it is important to understand what makes these injuries “severe” and how doctors and insurance companies define these terms.
Loss of a Limb (Amputation)
While the loss of an entire arm or leg clearly meets the legal definition of a catastrophic injury, amputation can get much more complicated. Some of the situations that will count as a catastrophic injury in some cases despite not having a complete loss of a limb are:
- Reattachment of the limb with limited functionality
- Loss of the limb at or near the elbow
- Loss of the thumb or all of the fingers on the hand
- Loss of a foot or lower leg below the knee
- Severe pain that prevents the use of a limb
Paralysis (Spinal Cord Injury)
Paralysis due to an injury to the spinal cord, brain, or a limb obviously meets the definition of catastrophic injury. However, just like the loss of a limb, there are many other cases that can meet the definition of paralysis:
- Loss of sensation that prevents effective use of an arm or leg
- Severe and constant pain in a limb that prevents the use of that limb
- Weakness that is not total paralysis, but still prevents the use of a limb
Severe Head Injury (Traumatic Brain Injury)
What makes a head injury “severe” is important for the definition of this catastrophic injury. This is one of the broadest categories and many signs and symptoms can make a head injury “severe.” Some of the most common factors that are seen in severe head injuries are:
- Loss of consciousness after the injury
- Seizure after the injury
- Bleeding in the brain, shown on a brain scan
- Any head injury that requires a hospital stay
- Paralysis, personality changes, or chronic pain after an injury
Whether or not your head injury is considered “severe” will be defined in the first definition of catastrophic injury. Will it take more than 90 days to recover and will you require ongoing treatments for continued good health?
Severe Burn
Like head injuries, burns are typically considered severe when they dramatically affect the life of the victim for 90 days or more. This is complicated as burns do much more than cause pain. Some side effects that are seen with large and severe burns are:
- Infections
- Kidney damage
- Difficulty moving the burned area
- Recovery from skin grafts
- Chronic pain
- Psychological trauma from injuries to the face or other sensitive areas
Everything Else
There are many injuries that could easily be considered catastrophic that do not fit into any of the categories above. Some of the less common catastrophic injuries include:
- Damage caused by chemicals to the lungs, kidneys, heart, or liver
- Trauma to the chest or stomach leading to organ damage
- Trauma that requires surgery
- Severe fractures to large bones such as the upper arm or leg
- Blindness
- Loss of hearing
Catastrophic Injury Legal Conversations
California Senate Bill 863 (SB 863)
SB 863 is important in the discussion of catastrophic injury as it creates a large number of reforms to the workers’ compensation system. One of the most important changes for injured workers is that mental health challenges as a result of an injury cannot be used in calculating the amount of disability that an injury has caused unless that injury was a “catastrophic injury” or the result of a “violent or threatening act.”
This is important as the depression, anxiety, fear, and stress resulting from an injury, especially a serious one, can be a significant barrier to returning to work or seeking other employment. It can also affect every aspect of your life outside of work. This is why determining if an injury is catastrophic and/or the result of a violent act is so important to those seeking workers’ compensation.
“Violent acts” is a broad category; some of the ways you can be injured that may be considered a violent act are:
- A car accident
- Assault/battery by another individual
- Injury by a machine in a factory
- Crush injuries in a warehouse
- Becoming trapped under an object
- Near drowning
- Suffocation
- Electrocution
Cases Involving Catastrophic and Violent Injuries
One of the best ways to understand complex legal topics is to look at how they apply to different court cases.
Wilson v. State of CA Cal Fire, is a case that focused on what injuries are considered catastrophic. Wilson is a firefighter who inhaled toxic smoke causing two weeks of hospitalization and ongoing disability but was denied an increase in disability for psychiatric injury as the injury was not an amputation, head injury, burn, or paralysis. This case established that the determination of whether an injury is catastrophic is based on the facts of an individual case and outlines several factors to consider:
- The intensity of the treatment required
- The outcome of treatment, and if the injury is permanent
- How the injury affects the ability to care for oneself at home
- If the injury is close to one of the injures defined as catastrophic
- If the injury is an incurable and/or progressive disease
Larsen v. Securitas established that being struck by a motor vehicle is considered a violent act, and subject to the same benefits as a catastrophic injury. Lopez v. General Wax considered the amputation of a finger by an automated machine a violent act. Sturm v. Coronado Unified School District saw Sturm lose a finger while closing a heavy gate, an injury that was also considered a violent act.
These cases illustrate that there are many injuries and situations that qualify for impairment and disability related to psychological trauma. Every case is unique and requires review by a skilled workers’ compensation lawyer. If you have been injured at work or have a medical condition that you feel may be related to your work, contact a workers’ compensation lawyer as soon as possible for a review of your case.
Catastrophic Injury Rehabilitation Care
Compassionate and skilled care for the most severe injuries
Sierra Care provides rehabilitation services in the state of California. This is especially relevant to those with catastrophic injuries which require treatment from a team of doctors, nurses, physical therapists, occupational therapists, and speech therapists. Sierra Care has experience in treating all types of catastrophic injuries, including amputations, traumatic brain injuries, spinal cord injuries, and paralysis that are outlined in the California workers’ compensation law. Choosing Sierra Care for your recovery is choosing an entire team of skilled professionals who are focused on your recovery!
Detailed and accurate medical documentation
Many workers’ compensation cases take many months of review, deliberation, and discussion. These discussions are often focused on the severity of various injuries and how they affect your life. Sierra Care’s doctors, therapists, and nurses all create detailed and organized documentation. This documentation is invaluable if your workers’ compensation benefits do not accurately reflect the severity of your injury and its effect on your life. Choosing Sierra Care for your recovery ensures that proper medical recordkeeping will present your case with the accurate picture of your needs and recovery.
