Are You Covered By Workers' Compensation?

Most injuries that happen in the "course of employment" are covered -- if you are an employee.

If you are injured at work or develop an illness as a result of your work-related activities, you are probably wondering if you are covered by workers’ compensation. Workers’ compensation laws vary in each state, but every state has a workers’ compensation system that provides benefits to employees involved in workplace injuries or that develop a condition or illness directly related to their employment.

Covered Employment

Employees, those that receive regular wages for a specific employer doing a regular job, are almost always covered by workers’ compensation in the employee’s state. However, not all workers are considered employees. Independent contractors are not covered by workers’ compensation. In many states, partners or owners of a business are not covered employees for purposes of workers’ compensation.

Volunteers do not receive wages, and thus are not employees. For that reason, volunteers are not covered by workers’ compensation if they are injured while volunteering. Such an individual may still be covered by personal health insurance for injuries sustained while volunteering.

Covered Injuries  

Work-related injuries, often called industrial injuries, that occur as a result of an accident or event may amount to a workers’ compensation claim.   Typically you can file a workers’ compensation claim if you are injured while on the job and you require medical treatment beyond simple first aid. Thus, if you fall at work but are not injured, you do not have a workers’ compensation claim, because you sustained no injuries.  

An incident must have occurred within the “course and scope” of employment. This means that accidents that happened while commuting, or during non-work-related activities, will not likely amount to a workers’ compensation claim. On the other hand, accidents that occurred during lunch breaks or while driving for work may be grounds for a workers’ compensation claim. Injuries that are caused by, or contributed to by, fighting or horseplay at work may or may not be covered by workers' comp, depending on the specific circumstances.

Similarly, injuries due to alcohol use may be covered if the injury happened during a company party where alcohol was sanctioned, but are not usually covered if the alcohol use was illicit.   If you have questions about whether the circumstances of your injury may be a workers’ compensation claim, you should talk to an experienced workers’ compensation attorney in your area.  

Occupational Diseases  

A workers’ compensation claim is not exclusive to accidents and sudden injuries. Toxic exposure or repetitive work activities over time can also lead to workers’ compensation claims. If your condition or illness arose as a result of your work activities, you may have what some states call an "occupational disease," and thus you may have a workers’ compensation claim. Other states call injuries from repetitive work "cumulative trauma" or "repetitive stress" injuries. Pulmonary conditions, hearing loss, and carpal tunnel syndrome are common occupational diseases.   Again, the occupational disease or cumulative trauma disorder must have arisen primarily due to your workplace activities, not non-work-related activities.

Psychiatric Conditions and Stress-Related Conditions

Psychiatric conditions, if they are the direct result of a traumatic workplace injury or otherwise arose due to work-related activities, may give rise to a workers’ compensation claim. Sometimes, mental health conditions begin in tandem with physical injuries from a workplace injury. Most states require certain evidence to establish a correlation between work and the mental health condition in order to consider the condition compensable under workers’ compensation.

Most states also limit compensability of stress-related conditions. Typically, a stress-related condition will be covered only if the injury occurred during an unusually stressful situation, not as a result of continual stress over a long period of time. For instance, an EMT responding to a gruesome accident scene may being to suffer from post-traumatic stress disorder.  If you think you have a workers' compensation claim for stress, you should talk to a workers' comp attorney, as these cases are very hard to get accepted.

How to File a Workers’ Compensation Claim  

If you think you have a workers’ compensation claim, you should report your injury, condition, or illness to your employer as soon as possible. Many states have strict timelines for reporting, and you risk losing workers’ compensation benefits if you do not timely report to your employer. In many states, you may also report a possible industrial injury or occupational disease to your doctor. However, you should not rely on this notification; it is best to report the possible workers’ compensation claim to your employer.  Your employer will then provide you with the forms necessary in your state to file a workers’ compensation claim. Make sure you fill out the forms completely and accurately.

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