California workers compensation: a 100 years old insurance program

California workers’ compensation is a situated insurance program that has been implemented for over a hundred years. The program functions under California Legal Code (see leginfo.ca.gov, for more information), which applies to all state and public employees, most full-time employees in private sectors, and even some part-time employees. At the same time, of course, California workers’ compensation does NOT apply to independent contractors (like freelance artists, for example), who are ineligible and on their own to secure disability compensation insurance.

So now that you know who is eligible, consider some of the other important specifics of California workers’ compensation:

California workers’ compensation is a no-fault system, providing benefits to those impacted by injury, illness, or disease (diagnosable) and expecting no proof that the condition is or was the “fault” of the employer. This kind of insurance, clearly, protects the employee and the employers as well, compensating the former and avoiding financial devastation for the latter.

California workers’ compensation typically covers employees who have taken ill, had an accident on the job, incurred a serious condition at and by way of employment, or who experience aggravation of a non-work-related condition.

California workers’ compensation also covers/provides benefits for, in some cases, a claim of “cumulative trauma illness”—one which has developed over a certain period of time of employment.

Covering everything from personal injury to temporary and permanent disability to death benefits, however, the California workers’ compensation system is vulnerable to fraud. For example, while California workers’ compensation benefits cover “diagnosable” disease (not by/for exposure alone), it also covers such “invisible” [my term, not a legal one] disabilities as back injury devastation [again, not a medical term but my word choice]. So ignoramuses of all walks of life will attempt to fraud the state by filing phony bad back claims. These individuals are ignorant, for they do not realize that while x-rays and other technologies may not be able to contest or refute or confirm pain/disability, insurance adjustors and investigators are able to jump in their vehicles, wield high-powered camera/telescope surveillance equipment, and bust their asses (or backs). Hell, there is even a whole reality TV series on the “condition”.

In other words, and in addition, the California workers’ compensation laws require “any insurer, self-insured employer, third-party administrator, workers' compensation administrative law judge, audit unit, attorney, or other person that believes a fraudulent claim has been made by any person or entity providing workers' compensation medical care, to report the apparent fraud to the administrative director of the Division of Workers' Compensation” (see California Legal Code, section 3823); and, more, makes it “unlawful for a medical provider to…present or cause to be presented any knowingly false or fraudulent written or oral material statement in support of, or in opposition to, any claim for compensation for the purpose of obtaining or denying any compensation (Labor Code, 3207), solicit, receive, offer, pay, or accept any rebate, refund, commission, preference, patronage, dividend, discount, or other consideration, whether in the form of money or otherwise, as compensation or inducement for soliciting or referring patients to obtain services or benefits pursuant to division four (commencing with (Labor Code, section 3200); knowingly operate or participate in a service that, for profit, refers or recommends clients or patients to obtain medical or medical-legal services or benefits pursuant to division four (commencing with Labor Code, section 3200); and/or knowingly assist, abet, solicit, or conspire with any person who engages in an unlawful act under this section…”

In other words, it is a felony to fraud the California workers’ compensation system, so don’t let anyone you know try it or get away with it.