What Is Apportionment in a California Workers’ Compensation Case?

In a California workers’ compensation case, apportionment refers to the process of determining what percentage of an injured worker’s disability is caused by their workplace injury versus a pre-existing condition or prior injury. If an injury is partially work-related and partially due to a previous condition, the worker’s permanent disability benefits may be reduced based on apportionment findings.

How Does Apportionment Affect Workers’ Compensation Benefits?

If a doctor determines that a portion of a worker’s disability is caused by something other than the work injury, the workers’ compensation insurance company may reduce the benefits paid. This often happens in cases where:

• A worker had a previous injury to the same body part.
• The worker has an underlying medical condition that contributed to the disability (e.g., arthritis, degenerative disc disease).
• The doctor finds that natural aging played a role in the worker’s condition.

The amount of benefits a worker receives depends on the percentage of disability attributed to the work injury versus other causes.

Who Determines Apportionment?

Apportionment is determined by a medical evaluator, such as:

• The treating physician
• A Qualified Medical Evaluator (QME)
• An Agreed Medical Evaluator (AME) (if both sides agree on a doctor)

The doctor must provide a medical report explaining whether part of the disability is due to prior conditions. The insurance company may use this report to argue for a reduction in benefits.

Can Apportionment Be Challenged?

Yes. If an injured worker believes that apportionment is unfair or incorrect, they can dispute the findings. Common reasons to challenge apportionment include:

• The doctor did not provide clear medical reasoning for the apportionment.
• The prior injury did not contribute to the current disability.
• The worker had no symptoms or work restrictions before the job-related injury.

A workers’ compensation judge may review the case and decide whether apportionment applies.

How Can an Attorney Help With Apportionment Issues?

Apportionment can significantly reduce the amount of permanent disability benefits an injured worker receives. An experienced workers’ compensation attorney can:

• Review the medical report for errors or unfair conclusions.
• Request a second opinion from another evaluator if needed.
• Challenge the apportionment percentage before the Workers’ Compensation Appeals Board (WCAB).

If you believe apportionment is being used unfairly to lower your benefits, the Law Offices of Norman J. Homen can help. Contact us today for a free consultation.