Legal Disclaimer: This blog post is intended for informational purposes only and does not constitute legal advice. Every worker’s compensation claim is unique, and specific legal questions should be directed to a qualified attorney. The information provided here is based on general principles of California workers’ compensation law and may not apply to your particular situation.
Introduction
If you’ve been injured on the job in California, you may already be familiar with the basic concepts of workers’ compensation: it generally covers medical treatment, temporary disability benefits, permanent disability benefits, and more. One aspect of workers’ compensation that can come as a surprise, however, is apportionment. Apportionment can significantly impact the amount of permanent disability benefits an injured worker ultimately receives.
What is Apportionment?
In California workers’ compensation, apportionment refers to the process of determining whether any portion of an injured worker’s permanent disability is attributable to causes other than the current work-related injury. Under California Labor Code Sections 4663 and 4664, a Qualified Medical Evaluator (QME) or a treating physician will assess the percentage of a worker’s permanent disability that results from:
- Pre-existing Conditions or Injuries – For example, if you have had a previous injury or a degenerative condition affecting the same part of the body.
- Non-industrial Factors – Age-related degeneration, congenital conditions, or other causes that are not work-related.
Once the physician identifies the causes and percentages of disability, the insurance company (and ultimately a judge, if the case goes to trial) can “apportion” or allocate the permanent disability award. This means a worker may only receive compensation for the percentage of permanent disability that is directly related to the industrial injury.
Why Does Apportionment Matter?
- Impact on Compensation: The most significant effect of apportionment is on the overall permanent disability award. If a doctor or QME finds that 30% of your permanent disability is due to a prior injury or underlying condition, then your workers’ compensation award might be reduced accordingly.
- Disputed Apportionment: Employers and insurance carriers often argue for higher percentages of apportionment to non-work-related causes, potentially lowering the compensation owed. Injured workers (and their representatives) may, in turn, challenge these findings if they believe the apportionment is unfounded or excessive.
Common Scenarios Involving Apportionment
- Pre-existing Injuries: If you had a back injury from a car accident years before your work injury, and your new on-the-job injury aggravated that old condition, a doctor may apportion some of your current disability to the prior injury.
- Degenerative Conditions: Many older workers have some form of natural degenerative changes in their spine or joints. Doctors may try to apportion a percentage of disability to those non-industrial degenerative issues.
- Cumulative Trauma: In cases where you’ve worked a physically demanding job for many years, it can be challenging to determine exactly which employment period or which specific injury is responsible for a permanent disability. Apportionment may come into play to identify how much of the disability occurred before the most recent injury date.
How to Protect Your Rights
- Accurate Medical Records: Ensure that your physician has a complete and accurate medical history. Any misstatements or incomplete information can lead to incorrect apportionment conclusions.
- Seek a Second Opinion: If you disagree with your treating doctor’s apportionment findings, you may have the option to obtain a second opinion or be evaluated by a Qualified Medical Evaluator.
- Legal Representation: An experienced workers’ compensation attorney can help you gather the necessary evidence, negotiate with insurance companies, and, if needed, represent you in front of the Workers’ Compensation Appeals Board (WCAB).
Final Thoughts
Apportionment is a complex aspect of California workers’ compensation law that can significantly affect an injured worker’s benefits. It highlights the importance of comprehensive and accurate medical evaluations. If you suspect apportionment may play a role in your claim—or you disagree with an apportionment determination—consider consulting a lawyer who specializes in California workers’ compensation. The right guidance can help ensure you receive the full benefits you deserve.
