Apportionment in workers’ compensation is when an insurance company tries to blame at least part of your injuries on something other than a workplace incident, for example, a pre-existing condition. If they are successful, you could receive fewer workers’ compensation benefits than you deserve.
How Apportionment in Workers’ Compensation Works
LAB § 4663(a) states that, when it comes to workplace accidents, “apportionment of permanent disability shall be based on causation.” In practical terms, this means:
- A doctor (and possibly multiple doctors) will examine you and your medical history to diagnose the root cause of your injuries
- If the doctor decides your injuries are 100 percent the result of a workplace accident, you could receive full workers’ comp benefits
- If the doctor decides your injuries were partly caused by a non-work-related incident, your workers’ comp benefits could be reduced accordingly
If your employer’s insurer says they are going to look into apportioning blame for your accident injury, it would benefit you to seek legal assistance as soon as possible. Understanding what apportionment is in workers’ compensation could help you recover every penny of compensation you deserve and prevent the insurer from unfairly docking your benefits.
Why Does Apportionment in Workers’ Compensation Exist?
As the law states, a worker is only entitled to the full amount of workers’ compensation benefits if their injury is job-related. Your employer has no obligation to pay you for injuries that occur outside of the workplace. They may therefore look for reasons to blame your injuries on outside factors. For example:
- You are a smoker who developed lung cancer due to chemical exposure in the workplace. Your doctor may conclude that your smoking contributed to the cancer just as much as the chemicals.
- You break your leg on the job. It is the same leg that you previously injured in a non-work-related accident. Your doctor may say the previous injury weakened the leg, making it more prone to subsequent injury.
- You type a lot at work and are diagnosed with carpal tunnel syndrome. You also type a lot at home on non-work-related materials. Your doctor may state that the typing you do on your off-hours contributed to your diagnosis.
The Insurance Company May Review Your History and Documentation
To determine if they must pay you workers’ compensation benefits—and how much they must pay—the insurer could:
- Ask you to visit one or more doctors of their choosing
- Review the doctors’ reports regarding your injury and any paperwork you have filled out regarding your claim
- Request additional evidence, such as your medical history
Unfortunately, some insurers may take advantage of apportionment to incorrectly claim that your injuries are non-work-related and save themselves money.
To make sure this does not happen, it is a good idea to hire a workers’ compensation lawyer as soon as you can. A legal representative can review the insurer’s requests and conclusions to make sure they treat you fairly throughout the entire process.
Injuries that Entitle You to Workers’ Compensation
An on-the-job injury is one that takes place when an individual:
- Works for a company as an employee, as opposed to a contractor
- Suffers an injury while performing their regular job duties
- Is injured while following their employer’s rules and not engaging in banned, illegal, or blatantly reckless behavior
Such an injury could take many forms, including:
- Acute, one-time injuries resulting from a fall or another violent accident
- Injuries caused by repetitive motions performed over time
- Occupational illnesses
You Have Responsibilities After Suffering an On-the-Job Injury
To seek benefits for such an injury, you should complete your obligations as an injured worker, such as reporting your injury to your employer as soon as possible. You may seek all necessary medical care with your employer’s approved physician, and make sure your employer files a claim with their insurer.
It is up to your employer’s workers’ compensation insurer to decide whether or not your injury counts as a workplace injury. You can help them come to the right decision by complying with requests for information and being open and truthful about your experience.
The Workers’ Compensation Benefits at Stake in Apportionment
Injured employees are entitled to compensation for:
- Medical expenses, including emergency care, prescriptions, assistive devices (e.g., prosthetic limbs), long-term and follow-up care, and more
- Certain travel expenses related to seeking appropriate medical care (e.g., the cost of gasoline used when traveling to and from appointments)
- Partial loss of income—the exact amount you receive will depend on how much you usually made and whether your injuries are temporary or permanent
- Any training or education you have to undergo in order to qualify for a new position that better accommodates your permanent disabilities
If the insurer decides your injury was not work-related, you could be left with huge bills and no way to earn money to pay them. You can guard your rights by having a workers’ comp attorney represent you to the insurance company.
What to Do if the Insurer Apportions Blame for Your Injury
You may feel frustrated or nervous if the insurance company indicates they want you to undergo additional examinations before awarding any compensation. It may help to remember that you have rights and that a workers’ compensation lawyer can protect you against infringement of those rights.
If you have not already hired an attorney by the time the subject of apportionment comes up, consider doing so. They can:
- Answer questions you have about the claims process, apportionment in workers’ compensation, your case’s worth, and other legal topics
- Communicate directly with the insurance company to discuss their course of action and even negotiate for a fair amount of compensation
- Help you figure out how to respond to the insurer’s various questions and requests
- Collect evidence that proves your injury is work-related
- Calculate how much compensation you need to cover present and future losses
Do Not Let Apportionment Rob You of Workers’ Compensation
Call KJT Law Group at (818) 507-8525 to request a free case review with a member of our team. We can explain what apportionment is in workers’ compensation in greater detail. Our team wants to make sure that everyone receives fair reimbursement for their injuries, and that insurers do not take advantage of you during a vulnerable time. Contact us today for more details.