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What counts as a compensable consequence
Overuse of the opposite side. A right shoulder injury means everything gets done left-handed. A leg injury means the other leg carries the load. This is predictable, it is documented in the medical literature, and it is compensable.
The joint above or below. A knee injury changes your gait and the hip and low back absorb it. An ankle injury does the same.
A fall caused by the injury. If your knee gives out and you fall and break a wrist, the wrist is industrial.
Complications of treatment. Infection, a failed surgery, hardware failure, nerve injury during a procedure, complex regional pain syndrome. Under Hikida v. WCABWCAB Workers’ Compensation Appeals Board. The court system that decides these cases. 23 district offices statewide., where industrial medical treatment causes disability, that disability is industrial — and not apportionable to the underlying condition. But Hikida was narrowed. County of Santa Clara v. WCAB (Justice) (2020) 49 Cal.App.5th 605 [85 Cal.Comp.Cases 467] holds that it “precludes apportionmentApportionment Dividing permanent disability between industrial and non-industrial causes. It is to disability, not to findings on an image. only where the industrial medical treatment is the sole cause of the permanent disabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week..” Where pre-existing pathology also contributes, §§ 4663 and 4664 apportionment still applies.
Medication side effects. Gastrointestinal injury from long-term anti-inflammatories. Dependence on prescribed opioids. Organ damage.
Sleep disorder, and psychiatric injury. Both are subject to § 4660.1(c)(1) for injuries on or after January 1, 2013 — which bars increasing the rating for sleep dysfunction, sexual dysfunction, or psychiatric disorder. The exception in § 4660.1(c)(2) — the injury was catastrophic, or you were the victim of a violent act — applies only to the psychiatric disorder, not to sleep or sexual dysfunction. How that exception works.
And in an amputation case, the contralateral limb and the shoulders — from crutch and wheelchair use — are the classic example. Amputation claims.
Why it gets missed
Because nobody adds body parts to a claim on their own initiative.
The original claim form lists a body part. The treating physician treats that body part. The medical-legal evaluator is asked about that body part. The permanent and stationaryP&S / MMI Permanent and Stationary / Maximum Medical Improvement. Your condition has plateaued — not that you are healed. Temporary disability ends here. report addresses that body part — and the rating covers that body part.
The second one, if nobody said anything, contributes nothing.
And the timing is unforgiving. Discovery closes at the mandatory settlement conferenceMSC Mandatory Settlement Conference. Where most cases end — and where discovery closes., and evidence not disclosed there is generally inadmissible. A body part raised after the case is set for trial is usually too late.
What to do
Tell your treating doctor, at the next visit, and make sure it goes in the note. “Patient reports left shoulder pain from overuse since the right shoulder injury” is the sentence that starts this.
Report it to the claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer. in writing. Dated, specific, kept.
Ask that it be addressed in the medical-legal report — the evaluator has to be asked about it, in the letter that goes to them, before the examination.
Do it early. Not at the settlement conference.
Specific injuries
Where the body part changes the answer.
Sources
§ 5502(d)(3)
General information about California law, not legal advice about your case.
Reviewed by Jamey Teitell, Partner & Trial Attorney · Last reviewed
Law Offices of Solov & Teitell, APC · (213) 380-9310
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