Issue Brief: Legislators Should Reject Efforts to Change an Effective System

Workers’ Compensation Presumptions Jeopardize Access to Health Care 

The Issue

Workers’ compensation presumptions would reduce access to care and raise health care costs for all Californians.

Previously proposed presumptions include a variety of conditions — any infectious disease, musculoskeletal injury, cancer, PTSD, and respiratory illnesses such as asthma. If a health care worker has one of these conditions, it is presumed to have occurred on the job.

Forcing the acceptance of claims without any evidence that an injury or illness actually occurred on the job would drive up health care costs at a time when Californians are struggling to make ends meet.

Statewide, the cost of such changes is estimated at $1.4 billion annually. A presumption in workers’ compensation can result in hundreds of thousands of dollars for a single case, with zero evidence the injury occurred at work.

There is no reasonable rationale supporting these proposals. According to the California Workers’ Compensation Institute, health care employers have one of the lowest denial rates of any sector, including public safety. In 2022-23, health care employers approved about 90% of all claims — strong evidence that the system takes good care of its workers.

Hospitals prioritize employees’ well-being because without healthy team members, they could not fulfill their mission of care. Hospitals comply with strict Cal/OSHA standards to reduce hazards in the workplace, and when injuries occur, hospitals accept most claims, with a comprehensive and fair appeal process for any denials.

What’s Needed 

Legislators should reject efforts to create presumptive eligibility. These presumptions fail to recognize the current system’s effectiveness and would make health care less accessible and more expensive. At a time when hospitals are focused on caring for their patients and communities, as well as helping make health care more affordable, workers’ compensation presumptions would have the opposite effect.