Attorneys Explain Workers Comp Terms:
Direct Injuries vs. Compensable Consequences
If you have applied for workers compensation and you have been denied, you may have heard or read the terms “direct injury” or “compensable consequences.” It is important to understand these terms and how they apply to your case, because a “direct injury” typically qualifies for more compensation than “compensable consequences.”
A direct injury – for purposes of workers’ compensation is pretty straightforward. If a forklift falls on you and crushes your leg – that is a “direct Injury”. The cause of the injury was “direct” and therefore typically cannot be disputed.
But what if you develop PTSD or sexual dysfunction issues down the road, as a result of the forklift accident? Those secondary effects would likely fall under the category of “compensable consequences”. For purposes of collecting workers compensation, “compensable consequences” are usually secondary effects of the accident, injury or exposure that caused the direct injury.
History of Workers’ Comp for Compensable Consequences
Workers injured prior to January 1, 2013, were entitled to full workers’ compensation benefits for injuries to any body part. And it did not matter if the illness or injury was a “direct industrial injury” or a “compensable consequence of a direct industrial injury.”
However, while employees injured on or after January 1, 2013, are still entitled to all workers’ comp benefits for injuries resulting from direct industrial injuries, changes to the law means they may no longer be entitled to certain benefits for “compensable consequences.”
Whole Person Impairment Increase for Sleep, Sex or Psychological Injuries
Previously a workers “whole person impairment (WPI) rating” could be increased because of compensable consequences – such as sleep dysfunction, sexual dysfunction, or psychiatric disorders that were deemed to be a consequence of a direct industrial injury.
Now, Labor Code § 4660.1(c)(1) provides that:
“There shall be no increases in impairment ratings for sleep dysfunction, sexual dysfunction, or psychiatric disorder, or any combination thereof, arising out of a compensable physical injury.”
However it is important to note that the injured worker can still obtain treatment for sleep dysfunction, sexual dysfunction or psychiatric disorders that are a consequence of an industrial injury.
In other words, although no permanent disability may be awarded for compensable consequences, the injured worker is still entitled to medical treatment for these injuries under workers compensation.
Additionally, the revised law also allows certain exceptions for some psychiatric compensable consequences when the employee was the victim of a violent act or catastrophic injury.
Distinction Between Direct Injury & Compensable Consequence
Understanding the distinction between direct injuries and a compensable consequence of a direct injury can be complicated, as demonstrated by the following example:
If a machine operator witnessed his supervisor being shot to death by a disgruntled employee, she could have direct injury to her psychological state – and would NOT be barred from claiming an increase in their Whole Person Impairment. However, if a worker suffered lung cancer due to chemical exposure – and then began to experience sleep problems or sexual dysfunction, these would likely be considered “indirect” injuries and may or may not be “compensable consequences.”
The Bottom Line for Workers Comp
The line between a Direct Injury and a Compensable Consequence is often blurry. And the employer and workers comp insurer may try to block an injured employee from collecting permanent disability claiming that the injuries are not “direct”.
Therefore, it is important to discuss your case for compensable consequences with an experienced workers’ comp attorney. Our attorneys can explain how this “fuzzy’ area of the law will likely apply to your specific situation.
In many instances, an experienced workers comp attorney can even include these Compensable Consequences in a negotiated settlement through a Stipulation with a Request for Award. This can enable you to obtain ongoing medical treatment for these Compensable Consequences, even though they may not entitled you to permanent disability.
Our Long Beach Attorneys Fight for Workers Comp
If you applied for and were denied Workers Comp for compensable injuries, contact our experienced Workers Comp attorneys for a free consultation. Our Long Beach Workers Comp attorneys have obtained millions of dollars for injured workers. We will help you understand how the law applies to your injury or illness. And we will fight to obtain the maximum workers comp for which you qualify.