Quick Take
- Understand that allostatic load—the cumulative effects of chronic stress—may be raised to connect a focused workplace injury with broader medical conditions.
- Watch for claims that expand beyond the initial injury into psychiatric allegations or multiple body systems.
- Document the incident, job duties, schedules, witnesses, video, and relevant employee communications as early as possible.
- Share new information and relevant employment records promptly with the adjuster and claims team.
- Ask what medical evidence supports any expansion of the claim and keep the claims administrator involved throughout the case.
Allostatic load is beginning to show up in conversations around California workers’ compensation, and it is a development employers should understand.
The basic idea is that prolonged stress can create wear and tear across multiple systems in the body. In a workers’ comp claim, that can become important when an injury that initially appears limited to one condition starts expanding into allegations involving several body systems.
From a claims standpoint, that can change the complexity, cost, and potential value of the case considerably.
What is allostatic load?
Allostatic load describes the cumulative physical effects of chronic stress.
When the body experiences short-term stress, it releases hormones such as cortisol and adrenaline to help it respond. When that stress continues over a long period, researchers have associated it with changes involving cardiovascular, metabolic, immune, and nervous systems.
Where this becomes relevant to workers’ comp is causation.
An applicant may argue that a workplace injury or cumulative trauma created or contributed to a prolonged stress response, which in turn affected other parts of the body.
That can take what looked like a relatively focused injury and make the medical and legal questions considerably broader.
Why does that matter to an employer?
One of the things we see in claims is that once additional body systems and medical specialties become involved, the claim can get more complicated very quickly.
That can mean:
- Additional medical-legal evaluations.
- More questions about what was caused by work and what may have other causes.
- Higher potential permanent disability exposure.
- More litigation over medical causation and apportionment.
- Greater expense before the parties even get to a point where the claim can be resolved.
The important point for an employer is that these questions do not get decided simply because one side advances a theory. The medical evidence still matters.
It has to be more than a theory
This is where I think employers sometimes need some perspective on how the claims process works.
A medical theory may sound persuasive. A claim may also expand in a way that does not seem right based on what the employer knows about the injury or the employee.
But it has to be more than a feeling on either side.
The physicians involved need to address whether the medical evidence actually supports a connection between the workplace injury and the additional conditions being claimed.
They may also need to consider other contributing factors, including prior medical history, non-work stressors, lifestyle factors, aging, or other conditions.
Those questions can become particularly important when a claim involves psychiatric allegations or several different body systems.
Every case is different. The goal is to make sure the claim is evaluated on the evidence rather than allowing the scope of the claim to expand without examining the medical basis for it.
What can restaurant operators do?
Most restaurant owners and managers are not going to be the ones deciding medical causation or legal apportionment. Those issues belong with the claims and medical teams.
There are still things the employer can do that may become important later.
- Document the injury when it happens. Preserve the incident report, available video, witness information, job duties, scheduling information, and relevant employee communications.
- Communicate changes or new information. If something comes to light during the life of the claim that may be relevant, get it to the claims team. Information that seems minor today can become important months later.
- Provide relevant employment records. Job duties, disciplinary history, attendance records, prior reported injuries, and other employment information may help the claims team understand the circumstances surrounding the claim.
- Ask questions. If the claim begins expanding beyond the injury you originally understood, ask the adjuster what is driving that change and what evidence is being evaluated.
Consider your claims administrator part of your team. The more complete the information we have, the better positioned we are to evaluate what is actually happening.
What I’m watching
It remains to be seen how significant allostatic load will become in California workers’ compensation.
What makes it worth watching is the possibility that it gives parties another framework for connecting a relatively narrow workplace injury to much broader medical allegations.
I have seen enough changes in California workers’ comp over the years to know that emerging medical and legal theories can develop quickly once they begin appearing repeatedly in claims.
For restaurant operators, the practical response is fairly simple: document early, communicate throughout the claim, and make sure the claims team has the information it needs to evaluate the evidence as the case develops.
Not yet a member?
Talk with CRMBC about how a self-insured group can support your restaurant’s workers’ compensation program.
Randy Bugg is Senior Vice President at Pacific Claims Management (PCM), a third-party administrator specializing in workers’ compensation claims management. With more than 34 years of experience in the workers’ compensation industry, Mr. Bugg brings extensive expertise in claims administration, investigation, cost containment, and strategies designed to achieve timely and effective claim resolution.
Throughout his career, Mr. Bugg has worked closely with employers and self-insured organizations to improve claims outcomes and manage the financial impact of workplace injuries. At Pacific Claims Management, he emphasizes proactive claims handling, early reporting, thorough documentation, and individualized service. He also works closely with CRMBC and its members, providing guidance on claims management, return-to-work strategies, settlement practices, and the advantages of effective self-insurance programs.
