California Worker’s Compensation: What is the difference between a Specific Injury and Cumulative Trauma?
Workers’ compensation claims can arise from a wide variety of circumstances. And there are several ways that injuries can be classified, or categorized, based on the details of the injury.
One of the simplest and most common ways is to sort broadly by injury type. Though there are many different injuries an employee can experience in the workplace, they can all be sorted into two large categories: Specific Injuries or Cumulative Trauma.
It is important to understand the difference between Specific and Cumulative injuries because an effective claims strategy will use different tools and procedures for each. In this article, we will give you the knowledge to differentiate between these two main types of injuries, so you will be equipped to implement proper strategies for both.
Specific Injuries are the most common (and more straightforward) of the two. Injuries classified as Specific have a single and definite time and place of occurrence.
For example, an employee of a roofing company falls off a roof on a job site and breaks his leg. The injury happened at one Specific time and place – and to Specific body part(s).
Another example would be if an employee of the same roofing company had cut their finger on a loose nail. Again, a Specific injury, because it happened at one definite and Specific place and one moment in time.
Unlike Cumulative Injuries, which are significantly more likely to raise red flags, Specific injuries (at least those that are witnessed or visible) are less likely to be questioned.
In the event of a Specific injury, you will need to make sure that you have the right protocols in place. A top-tier strategy would include injury technician dispatch – to get your employee faster and more personal care, right at the place of injury – along with much more.
If you would like to learn more about how to create an airtight injury protocol that gives your employees better care and minimizes the cost of each claim, explore Whiteboard’s injury response process.
Under California law, Cumulative Trauma is defined as an injury that develops over time through physical repetition or exposure. So, while Specific injuries are those that occur at a single time and place, Cumulative Trauma injuries develop over an extended period and (potentially) multiple places.
Some common examples of Cumulative Trauma are Carpel Tunnel syndrome, Tendonitis, Muscle Strain, Vision or Hearing damage, and Back Pain. You may hear Cumulative Trauma used interchangeably with another name: Repetitive Motion. Like Cumulative Trauma, Repetitive Motion claims happen over an extended period of time.
The best way to minimize the impact that Cumulative Trauma claims will have on your bottom line is to create a pro-active case against any questionable claims through your regular workplace injury protocols. Whiteboard can help you establish thorough protocols that get your employees better and faster care, provide documentation for each step of the process, and help you put forth a strong defense if any employees do try to take advantage of the system with a Cumulative Trauma claim.
Another form of Cumulative Trauma: Mental/Psychological Stress or Abuse
In addition to physical injury, like in the examples listed above, Mental Health (or Psychological Stress) claims are often considered a type of Cumulative Trauma as well. This may not come as a surprise to some of you, but the frequency of Mental Stress claims are on the rise in recent years.
Psychological complaints of injury come with their own new set of problems for employers. With the added emphasis on mental health in the United States, there has become more leniency towards employees who claim mental trauma from their workplace. In fact, California categorizes this kind of trauma as a “psychiatric injury” in its workers’ compensation system.
To receive benefits from California, you must prove that you have a mental disorder resulting from “actual events of employment” – and it is required that you must have worked for your employer for at least six months before making such a claim.
The best way to make sure you are protected against Mental Health claims is to make sure all employees know how to report a claim and are given the training and opportunities to do so. If you document this, you can ensure employees are responsible to report all injuries in a timely manner and create a pro-active defense for yourself against those that make these types of claims when they become disgruntled.
For the employees who are suffering from psychological troubles due to work, this requirement for employees to report these injuries right away will allow you to get them care quicker – hopefully before their distress spirals into something worse.
Cumulative Trauma? Or is this just what it feels like to get old?
As you can imagine, Cumulative Trauma claims often come with several red flags – for employers and adjusters, alike. If you have experienced this type of claim before, you have been left wondering: how do I know his back hurts from work and not from picking up his kids? How do I know his knees are bad from his employment and not from hiking every weekend?
In California, the injury only must be found to be 1% related to employment to be an accepted Worker’s Comp claim. Cumulative Trauma claims (almost) always come from employees that are represented by an attorney and are trying to get as much out of a settlement as they can.
While it is unlikely you will find a doctor that will not find most injuries at least 1% related to work, there are steps that you can take to defend yourself against these often-outrageous settlements. To be successful here, you will want to incorporate proactive documentation, have fraud prevention measures built into your workplace injury procedures, and ensure that you have someone providing medical oversight on behalf of your company. At Whiteboard, we do all of this and more.
You are now equipped with the understanding of how insurance professionals split claims into the two major categories: Specific vs. Cumulative.
To be prepared for every variety of claims, learn more about how to build a comprehensive Claims Management strategy.