What Qualifies as a Workers’ Compensation Injury?

If you were injured at work, or during a workplace activity or event, you might be wondering whether your injury qualifies you for workers’ compensation benefits. Workers’ compensation insurance policies are policies held by employers that are used to compensate employees who are injured as a result of their jobs. Most employers are required to hold workers’ compensation policies, but the laws and regulations governing workers’ compensation vary from state to state. There are still similarities with regards to which employers, employees, and injuries will qualify for benefits.

Which employers are covered?

Most employers are required to maintain workers’ compensation policies, but there are some exceptions. Most often, the businesses that will be exempt are extremely small with only a few employees.

Which employees qualify?

Most employees are covered by workers’ compensation, although certain positions might not be covered. As stated above, certain very small employers do not have to hold workers’ compensation insurance, and thus, their employees would not be covered. Additionally, government workers are often covered by separate programs. Law enforcement agents are often excluded as well. Some agricultural workers, domestic workers, and taxi drivers may also be excluded.

What types of injuries and illnesses qualify?

Injuries sustained at work, whether through a onetime accident that causes an injury, or through a repeated work related activity that leads to the gradual development of an injury over time. Thus whether the injury is a broken leg or carpal tunnel syndrome, if the injury occurred in the course of a person’s job, it will qualify. Additionally, illnesses qualify. The classic examples of work related illnesses include black lung disease and mesothelioma, but other illnesses could also qualify if there is a provable link between the illness and the job the individual has performed. In addition, mental illnesses qualify, including depression, as long as the connection between the individual’s place of work and the development of the mental illness can be established.

What makes an injury or illness work related?

Work related illnesses and injuries are ones that occur during the course of a person’s work related duties. The injury or illness does not have to have occurred at the person’s place of work, though most injuries that happen at the individual’s place of work would in fact qualify. In addition to an injury that occurred at a person’s place of work, if an employee is injured while engaged in an errand for their job, or even on a business trip, any injuries they sustain would have the chance to qualify for workers’ compensation. This would extend in many cases to work sponsored social events.

There are cases where an employee might be injured at work and not qualify for workers’ compensation benefits. This would include cases where the employee violated the company policy and was injured, was injured while committing a crime, or was injured in a fight they started with another co-worker. Even in these cases, state laws might differ, and the case specific facts could create a question as to whether some of these injuries would be covered or not.

In addition to whether the injury is covered, the question of the injury or illness’s severity might be raised. Thus while an injury might qualify, the benefits awarded might not cover as much as the individual had hoped they would. For instance, the decision to complete certain expensive treatments might be questioned if the insurer can show a medical expert who claims the treatment did not need to be performed.

The causality question

Another issue that is of great importance in determining if an injury will be considered a workers’ compensation injury is whether there is a clear link between the injury and the individual’s job. If the insurer has the opportunity to, they will likely claim the injury or illness was a preexisting condition that occurred in a non-work related setting. Detailed medical records should always be kept in order to give as much information as possible, and witnesses might need to be contacted to support an individual’s claim.

If you suffered an injury, or developed an illness as the result of work related activities or duties, you should contact an attorney to discuss the specific facts of your case, and to develop the best course of action to pursue the benefits you need and that you are entitled to.

Contact Stern Law, PLLC for A Free Consultation

At Stern Law, PLLC, we have compassionate and caring attorneys ready to work with you in order to find the best strategy for seeking compensation for your job related injuries. Contact Stern Law, PLLC today at (844) 808-7529 for a free consolation with an experienced attorney.

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