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Denied Workers Compensation Claims Always Deserve a Second Opinion

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Los Angeles, CAIt is not unusual for an insurance company to deny a worker compensation claim. However, the words “claim denied” are not always the final outcome and it’s well worth asking a few more questions before accepting that decision.

Attorney Jeff Stern from the firm of Mallery & Stern in Los Angeles is a workers compensation lawyer whose business is helping people with workers compensation claims in California. He works with many first responders and frontline workers who are identified by California labor legislation as “sworn officers”. They are firefighters, or prison guards, forestry workers, or highway patrol officers – men and women that go to work every day knowing their life could be on the line.

Not that long ago, a corrections officer recommended a colleague in his late fifties see Jeff Stern about a workers compensation claim that had been stamped “denied”.

Prison situations frequently demand that guards use tear gas to control violent prisoners in dangerous situations. Prison staff regularly undergo training exercises to prepare for those kinds of situations.

In this case, the prison guard’s protective face mask slipped slightly during a pretend highly physical altercation involving flailing batons and tear gas. The guard accidentally inhaled a substantial amount of tear gas and suffered a heart attack on the spot.

“He was rushed by ambulance from the training exercise to the hospital but the insurance company denied him workers compensation saying that it was not a work related heart attack,” says Stern.

“The heart attack was caused by the tear gas exposure and the altercation,” says Stern. “Not only that, but California law allows for that presumption because he is a correctional officer.”

The California Labor Code, Section 3212, provides that state workers who work a job considered hazardous to their health the right to claim compensation without going through a complicated legal process. Prison guards are among that group.

“If he had listened to the insurance company he would never have been able to claim benefits. The insurers decision was totally contrary to the way the law is written and intended to be used.

“Usually when we file claims on behalf of state workers who’ve had heart attacks in these kinds of jobs it is more likely that the heart attack was brought on by the long-term stress of the job. This is the only time we have ever filed a claim as a result of a specific event.

“It doesn’t really matter whether it is a specific event that causes the heart attack or the repetitive nature of the situation – the fact that they are in these types of stressful, frontline jobs means they have a lot of protection for injuries suffered under the presumptions clause in the labor code.

“The California Labor Code presumptions deal not only with heart attacks but also hernias, pneumonias, tuberculosis, low back issues, and mrsa (an antibiotic resistant type of staph infection), or stress accumulated on the job that leads to a stroke or clot,” says Stern. “It deals with all these types of medical issues and more, but the unifying force in these kinds of claims is the illness they developed is connected to the job.”

The prison guard’s heart attack was a career ending injury. Fortunately, Stern was able to show that indeed the man was entitled to compensation.

Good thing the guard’s co-worker suggested he get a second opinion.

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READER COMMENTS

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Mr. Stern appeared before me frequently when I was on the bench, and I always found him to be a knowledgeable and well prepared advocate.

Obviously, Mr. Stern knows more about the Labor Code presumptions than the claims examiner handling this case, which is clearly compensable.

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