Workers Compensation has many legal concepts that make it different from most courts, but perhaps one of the most complex is the exclusive remedy rule. In other words, why can’t I sue my negligent employer for pain and suffering when I get injured on the job? This is something I hear quite often, a request to receive payment for pain and suffering, and occasionally punitive damages. However, these are tort remedies and not applicable to California workers compensation, which is formulated to provide “substantial justice.” That is a very vague term, but it is the law in workers compensation. It means that even though things are obviously wrong, for example the insurance carrier denying a case that is obviously a work injury, the courts will not punish that carrier if there is a plausible explanation. It is all part of the grand bargain of workers compensation.
Before California workers compensation was enacted, many employees were injured and unable to overcome their own negligence in a civil proceeding. That means they got nothing. On the other side, some were able to sue their employers for significant awards. To address the issue Labor Code 3600 was enacted. It is the exclusive remedy rule. It is broad and provides the Workers Compensation Appeals Board alone has jurisdiction over all work related injuries and deaths. It is the foundation of workers compensation and prevents litigation of torts.
The exclusive remedy rule also means the WCAB has sole jurisdiction over disputes concerning amounts to be paid doctors or other lien claimants. Efforts to circumvent the exclusive jurisdiction of the WCAB are against public policy. WCAB v. Small Claims Court (Shans), (1973) 35 CA3d 643, 38 CCC 748. However, it is clear that when the WCAB finds that no injury has occurred, physicians can file a civil suit to collect fees, but this is a unique fact pattern. It means the court found for defendants and denied the injured worker benefits entirely as the WCAB is a court of equity and will not allow unjust enrichment. It also touches on the issue of AOE/COE. Another concept that is often misunderstood by injured workers.
The phrase “arising out of” (AOE) refers to the origin or cause of the injury, while the phrase “in the course of employment”(COE) refers to the time and place of the injury. (State Comp. Ins. Fund v. Ind. Acc. Com. (1952) 38 Cal.2d 659, 661 242 P.2d 311; Argonaut Ins. Co. v. Workmen’s Comp. App. Bd. (1967) 247 Cal.App.2d 669, 676-677.)
For the exclusive remedy to apply, courts have consistently recognized the act’s two-pronged requirement: the injury must have arisen out of and occurred in the course of employment. Indeed, the California Supreme Court has described this two-pronged requirement as “the cornerstone of the workers’ compensation system.” (Maher v. Workers’ Comp. Appeals Bd. (1983) 33 Cal.3d 729, 732-733; see Vaught, supra, 157 Cal.App.4th at p. 1544.) However, it may not be so easy to apply in some circumstances, for example with a case where the employee is driving on behalf of the employer, but deviates a bit to address personal issues and gets injured, or when someone is working as an independent contractor for another contractor and gets injured on the job.
Every case is unique. The best advice I can give is to speak with a workers compensation attorney if you have questions.