What types of injuries are covered by workers’ compensation?

Workers’ compensation laws establish specific benefits available to employees who suffer workplace injuries. Generally speaking, they are designed to make the recovery process more efficient and expedite payment for damages to the employee. They transfer the burden of covering a work-related injury from the employer, directly, to a pool of employers and their insurers. Workers’ compensation claims are decided and paid via the workers’ compensation system rather than through the civil courts.

One of the primary reasons for this unique treatment of workplace injuries is to ensure a timely monetary recovery for employees. Workers’ compensation systems also protect the employers by prohibiting an injured worker from suing the employer if a claim is filed and benefits are accepted. Negligence on the part of the employee is not generally considered. Instead, workers are simply entitled to recover benefits as long as the injuries were related to their employment.

Generally speaking, there are three requirements for a valid workers’ compensation claim:

• The injured party must be an employee as opposed to an independent contractor.
• The employer is required by state law to either have workers’ compensation insurance coverage or to self-insure.
• The injury or illness was work related.

Injuries Related to Employment

Many workers’ compensation cases depend on whether or not the injury occurred on the job. Injuries related to employment are covered by the workers’ compensation system; unrelated injuries are not. Laws vary from state to state, but if the injury was caused by an activity that was performed for the benefit of the employer, workers’ compensation is likely to apply.

For example, an employee who sustains an injury while loading boxes into a truck as part of a job at a warehouse will likely be entitled to workers’ compensation benefits. An employee who is injured during his or her lunch break while away from work, on the other hand, will likely not be covered.

Workers’ compensation claims are not always simple, however. In cases where the injury occurred away from work but was somehow connected to the job, the analysis may be more complicated. If the employee was buying lunch for the office on orders from the boss, for example, he or she may have a valid claim even if the injury occurred during the lunch break and away from work. An employee who is in a car accident while commuting to work in a company vehicle may be entitled to compensation, as may an employee who sprained his ankle while playing for the company softball team.

Types of Injuries Covered

Workers may be entitled to benefits for the following types of injuries or occupational illnesses, among others:

• Diseases like lung cancer, if they were caused by workplace exposure to carcinogens or other toxins.
• Repetitive stress injuries like carpal tunnel syndrome, if they developed in whole or in part due to workplace conditions or requirements.
• Injuries that occurred during break times, lunch hours or activities outside the workplace, if the activities were related to work. This may include company picnics or other events. Work injuries caused by company equipment, like a table or coffee maker in the break room, may also be covered.
• Injuries that occurred as a result of the physical or mental strain of increased duties or responsibility at work. Individuals in some states may be able to pursue a workers’ compensation claim if they have developed a mental condition due to supervisor harassment on the job.
• Injuries that were preexisting but were accelerated or aggravated due to workplace conditions. For example, an employee might be entitled to benefits if he or she had a preexisting back injury but did not notice the pain from the injury until it was exacerbated by work.

Exceptions for Certain Classes of Workers

Some workers are not eligible to recover through the workers’ compensation system. Independent contractors do not qualify as employees for the workers’ compensation analysis and are thus not eligible for workers’ compensation. Whether a person is an employee or an independent contractor depends on a variety of factors.

Some states do not include domestic workers, like housekeepers and babysitters, in the workers’ compensation system. Farm workers are also excluded from the workers’ compensation system in many states.

State laws vary with regard to loaned workers. A person who is employed by an agency and then hired out to a different employer is likely to be covered, but the states are divided regarding which company, the employer or the agency, is responsible to provide coverage. Seasonal workers or others who work only sporadically or intermittently may or may not be covered by workers’ compensation, depending on the laws of the relevant state.

The laws of some states, including California, New York, Florida, Arizona and Texas, provide workers’ compensation coverage for undocumented workers. In other states, Wyoming and Idaho among them, undocumented workers are explicitly excluded from the workers’ compensation system.