What Injuries does Workers’ Comp Cover?
Knowing what types of injuries and illnesses are covered by workers’ compensation is something every employee and employer should be aware of. So what injuries does workers’ comp cover?
In general, most injuries or illnesses caused as a direct result of your workplace duties will be covered by workers’ comp insurance. This includes physical injuries such as a back injury from slipping and falling as well as metal distress like PTSD or anxiety.
However, there are some exceptions that will keep employees from getting workers’ comp benefits. Keep reading to learn more about which workplace injuries are covered and which ones are not.
What is Considered a Workers’ Comp Injury?
Work-relate injuries covered by workers’ compensation are known as “compensable injuries” and will qualify an employee to benefits. These benefits are intended for medical care, lost wages, and the cost of rehabilitation. What benefits are awarded and for how long depends on the severity of the injury or illness in question.
While the guidelines of what is considered to be a workers’ comp injury can vary from state to state, some requirements include:
- You must be an employee and not a contractor
- The injury must have happened during working hours
- The injury must lead impairment to one extent or another and/or the loss of wages
If the injury is fatal, surviving family members can also claim funeral expenses under workers’ compensation.
Often, employers or their workers’ comp insurance company will deny a claim for benefits, saying that it is not covered. If this has happened to you or a family member, the best course of action is to talk to a qualified attorney about your case.
Types of Workers’ Comp Injuries
Sometimes, employees will not realize that they are eligible for workers’ comp benefits either because they are not aware that their injury or illness is covered or because it is not physical.
Some of the injuries and illnesses covered by workers’ comp include:
- Impairing physical injuries that happen during work activity
- Injuries caused by repetitive actions such as carpal tunnel syndrome
- Illnesses caused by from extensive exposure to toxic chemicals or other substances
- Injuries or illnesses caused by excessive physical or mental stress
Even if an injury or illness is obviously a result or work-related activities, it is not always certain that a workers’ comp claim will be approved. There are various reasons that an insurance company can use to deny benefits. When in doubt, it is a good idea to seek professional advice from a lawyer who specializes in these cases.
What Injuries are not Covered by Workers’ Compensation?
As we mentioned above, even though most work-related injuries entitle employees to workers’ comp benefits, some do not.
Injuries that are not covered by workers’ comp include those that occur while employees engage in banned activities, illegal activities, and activities outside of working hours.
Let’s have a closer look.
Unfortunately, some employees do not take their jobs as seriously as most. For example, some workers might engage in horseplay during working hours. If such behavior leads to an injury, a workers’ comp claim will be denied.
It should go without saying that employees should refrain from any illegal activities at work. However, some choose to take drugs or alcohol at their jobs or before clocking in to work.
Any injuries sustained while under the influence of drugs or alcohol will keep the injured party from receiving workers’ comp benefits.
Injuries Outside of Working Hours
It is not uncommon for workers to claim benefits from injuries they got outside of working hours. This is fraudulent and will lead the workers’ comp insurance company to turn down a claim.
What to Do after an Accident at Work
Employers have the responsibility of providing a safe environment for workers. However, even when this is the case, accidents can happen and workers can sustain injuries.
If you suffer a work-related injury, the first thing you should do is seek medical attention. It is important to note that you should go to an authorized clinic or hospital. You can go to an unauthorized medical center if the situation is an emergency.
Once you have gotten proper medical attention, you should contact your employer immediately to let them know what has happened. Failure to do this can lead to problems with your workers’ comp claim.
Your employer will have you fill the appropriate paperwork to send it to the insurance company and begin the process of getting you the workers’ comp benefits you deserve.
Ideally, your claim will be approved right away and you will begin to get benefits. If your claim is turned down you can dispute the decision. The best way to go about this is with legal representation to obtain the best possible results depending on the facts of your case.
Do I Need a Lawyer?
Since you can dispute an insurance company’s decision about workers’ comp benefits on your own, you might be wondering whether you really need a lawyer or not.
An attorney with experience fighting workers’ compensation cases knows how to deal with insurance companies effectively. You will obtain much better results with proper legal representation than without it.
Remember that insurance companies are for-profit businesses and it is not in their best interest to hand over any money. To this end, they employ high-powered attorneys so you should not face them without a lawyer yourself.
It is also important to know that workers’ comp laws vary from state to state. Your attorney will be able to explain the best course of action depending on the specific circumstances of your case.
Workers compensation covers most injuries that occur at the workplace, but there are exceptions as noted above.
If you have suffered a work-related accident that resulted in injuries and lost wages, the best thing to do is speak to workers’ comp lawyer. An attorney will be happy to grant you a free consultation and explain what the best course of action is depending on the facts of your particular case.
Types of Workers’ Compensation Injuries (discipiolaw.com)
What Injuries Are Covered by Workers’ Comp? | Workers’ Comp 101 (pieinsurance.com)
Call us at the Law Office of Robert E Frawley at (617) 523-2929 today.