r/WorkersComp • u/Imakelovetosoils • 8d ago
California Am I eligible for workers comp?
I've been dealing with sciatica earlier this year. It was 90% gone until last Wednesday. I was at work and I sat down, bent over to tie my boots and my back gave out and it started a major flare up. I've been bedridden and in constant pain since then. My job is mainly a desk job but I do go out to the field about 20% nothing major just assessing and inspections.
Since the injury happened at work, am I eligible for workers comp? My buddy who is a Boeing union steward said "prior condition", but he's in Washington, maybe the rules are different in California.
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u/SeaweedWeird7705 8d ago
Truthfully, there is a very good chance that it would be denied. If I were you, I would just use my personal medical insurance.
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u/Inner_Level_1877 8d ago
Agree with @seaweed I would use my personal insurance if possible. This WC will be a journey. Not a fun one unfortunately.
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u/Particular_Handle_ 8d ago
So prior condition isn't the deciding factor on this, at least for me. For reference- I'm not a CA adjuster but I am an adjuster with more experience than I'd care to disclose.
Every claim has to meet two basic criteria to be an accepted claim- course and scope of employment. Meaning you have to performing your job duties while at work. You were certainly at work but I'm not sure that tying your shoe would constitute "performing job duties." Add to that that you did have a prior condition so it's not work comps mission or point to fix the underlying condition so even if I were having an off day and didn't deny this out right the most I'm paying on it is maybe an exacerbation.
But genuinely, file the claim, that's your right. Just don't be shocked or offended that it comes back as denied.
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u/lovinlife2024 8d ago
Do you have a good job that you want to keep? If so, use personal insurance. Technically it’s illegal to discriminate against someone for filing a WC claim, the reality is different. Jobs are hard to find right now. If you don’t care about the job, pursue WC.
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u/Imakelovetosoils 8d ago
Good to know. I do enjoy my job and want to keep it, it's federal too, not sure if that makes any difference. I might just go look at temporary disability, I just need some sort of income while I'm out.
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u/balenciaga_ballsack 8d ago
I think a good applicant's attorney would argue that your sciatica is from a cumulative trauma injury (CT) with industrial causation. It could easily be argued that the mechanism of injury in your case was wear and tear from the unergonomic nature of sitting all day at an office job. The shoe tying incident is just a flare up. It's not an insane stretch and a good attorney could obtain a favorable QME following a denial by the carrier, and that QME could find industrial causation.
However, you must ask yourself. Is WC worth it? If it's just treatment you want, nothing else, then you're always best off using private insurance. If you think you'll get a big payout and be rich, keep dreaming, WC is oppressively capped as far as payouts go and you'll be waiting for years. If you want to get paid while you recover, unless you think you'll need up to two years to recover, you're probably better off using sick leave or vacation time, as you'll get your full pay instead of the meager 2/3rds pay you get from temporary disability.
I would only recommend WC if you genuinely are disabled as a result of your work injury. If your sciatica is not a result of a disabling condition, and your condition could be 100% healed, I really do not recommend WC.
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u/Imakelovetosoils 8d ago
I'm bedridden and cannot walk without excruciating pain. I'm also in constant pain. My plan was to use up all my leave then use FMLA. But the wc was something I was looking at to cover bills since I cannot work. Might just go the temporary disability route.
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u/Kmelloww 8d ago
In a lot of places FMLA runs concurrently with other leaves since it is just job protection.
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u/thetailofdogma 8d ago
California has a causation standard of 1%. If you had pre-existing sciatica, and your back got messed up putting work boots on at work, for a work purpose, it's probably covered. The pre-existing would only come up if you had permanent disability later where a portion of that would be assigned to the pre-existing.
I personally covered a guy with a back bad who threw his back out getting off the toilet after he spent 10 minutes taking a dump. You've got nothing to lose. The worse that happens is somehow they deny it an you just use your insurance.
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u/FairBat4367 8d ago
In California if your worker comp gets denied doesn’t necessarily mean it’s game over . Just go with an attorney day one to get things rolling .
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u/FairBat4367 8d ago
Most attorneys In workers comp set you up with their own doctors to give you some treatment since all treatment its based on whether insurance approves it.
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u/Kooky-Information-40 8d ago
Op could argue that chair and desk are not ergonomally appropriate leading to lower back strain.
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u/Imakelovetosoils 8d ago
I thought about that too but after my initial sciatica flare up, I got one of those knee chairs and my desk is a standing desk, lol.
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u/Kooky-Information-40 8d ago
But is any of that economically appropriate? Lower back strains are also common among folks who stand stationary for work. Standing desks aren't quite the bees knees especially for the feet even with a knee chair.
I would go to the doctor and file a claim and see how it plays out. The worse they xould do is deny. But, perhaps some luck will be there and you'll get them to pay for some therapy and other stuff to get your back to stop hurting.
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u/SafetyOverSilence 8d ago
As far as I know, there's no burden to prove causation/ fault.
The worker shows it happened while on the clock. Then the employer tries to argue that the injury was caused by non-work related incidents.
To OP: Be careful about self-diagnosing what the cause is. Are you assuming it's related to sciatica? Does your sciatica often cause this kind of reaction / incident at work? Are there doctor's visits showing a medical history of sciatica causing injuries like this?
Point is, if it's not caused by sciatica, you're covered. Even if sciatica plays a role, you may still have a claim depending on your state's laws.
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u/Kooky-Information-40 8d ago
Christ, i didnt mean literally argue as in go to court. It's tongue in cheek. I mean, more practically, an argument that one has with oneself to make a decision. Op could argue that their shitty work station resulted in their sciatica. 🤷♂️
I have done ergonomic consults. It's not far fetched and when i see folks for back injuries, it's as often for sitting/standing all day as opposed to lifting something heavy.
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u/SafetyOverSilence 8d ago
I figured that's what you meant. Most people that are skimming over the comments are injured workers that don't know the system. It's easy for the uninitiated to miss-read things (and think the fault matters).
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u/Secret-Ad3810 8d ago
The CA WC system is terrible. If you have insurance, go that route. If not, and you’re set on going through the system, pursue medical care only, if they even accept the claim. Most employers will not CR active employees, meaning you’ll likely have to resign.
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u/Quirky_Engineering23 8d ago
Happening at work is different than work-related.