Work-related injuries may occur due to accidents or to repetitive job duties. Cumulative trauma is defined as a work-related medical impairment caused by “repetitive mentally or physically traumatic activities extending over a period of time” [1]. Unlike a specific injury that occurs due to accident or event, cumulative trauma develops over an extended period. Lifting 20-pound boxes daily for several months can lead to a cumulative trauma injury, whereas a slip and fall is a specific injury. Cumulative trauma injuries do not have a clear starting point. Exposure can occur over the course of years or even decades. State policy is clear that this type of injury can be just as debilitating as a sudden traumatic injury and can be the basis of a Workers’ Compensation claim.
Roughly 70% of all cumulative trauma injury claims filed in California are Orthopaedic in nature, with the most reported claims involving soft tissue disorders (27% of all claims) [2]. In California, an injury is considered to have industrial causation if the job is only 1% of an applicant’s disability in order to be compensable. This means that only 1% of the injury needs to have been caused by work for treatment to be covered under Workers’ Compensation. Medical evidence must support the claimed causal connection with reasonable medical probability. Cumulative trauma injuries are typically more difficult to diagnose as they often develop gradually over a period of weeks, months or even years.
Since 2008, cumulative trauma claim rates have grown by 50% in California [3]. This growth is predominantly seen in the Los Angeles and San Diego regions, which now generate 75% of all cumulative trauma claims. While this growth is spread across many industries in the LA region, the manufacturing and hospitality sections have experienced the most significant growth rates, with most claims concentrated in lower wage workers.
Filing a Cumulative Trauma Injury Claim
Since these injuries develop over time, it can be challenging to pinpoint an exact date of occurrence. The law adjusts for this by allowing the time limit to begin when:
- A disability arises.
- The employee knew or should have reasonably known that work activities caused the injury.
If a worker discovers their cumulative trauma injury after they stop working, they can still file a claim within a year of realizing the injury was work-related. According to Labor Code §5500.5, liability for a cumulative trauma injury is limited to employers who employed the worker during the one-year period immediately preceding the date of injury or the last date of injurious exposure, whichever occurs first. For this reason, these claims are typically filed for the final one-year time period of employment, though this is effectively shorthand for the entire length of employment.
Evaluating Cumulative Trauma as a QME
The QME should take a thorough history of job duties that may have led to injurious exposure. These may be compared to a formal job description or job analysis.
Apportionment of permanent disability must be addressed when an injury is at maximal medical improvement. As with any injury, prior and subsequent injuries may be apportionable according to Labor Code §4663. In addition, pre-existing medical conditions may be determined also to contribute [4]. A QME is required to consider all of these in the discussion of a report.
QMEs are expected to provide a thorough and balanced assessment of cumulative trauma claims, ensuring that all relevant factors are evaluated to determine the appropriate course of action.
References
- “Labor Code.” California Legislative Information . Accessed June 26, 2024. https://leginfo.legislature.ca.gov/faces/codesTOCSelected.xhtml?tocCode=LAB&tocTitle=%2BLabor%2BCode%2B-%2BLAB.
- “Medical Characteristics of Cumulative Trauma Claims.” WCIRB California. Accessed July 3, 2024. https://www.wcirb.com/
- “The Workers’ Compensation Insurance Rating Bureau of California Report on California’s Workers’ Compensation System.” WCIRB California. Accessed July 2, 2024. https://www.wcirb.com/
- City of Petaluma et al. v. W.C.A.B (Lindh) (2018) Cal. App. 5th 1175.