What Types of Injuries Are Covered by Workers’ Compensation?

You’re driving to meet a client for a business lunch when another car hits you. You probably know you can file a personal injury claim against the other driver. But because the crash happened while you were working, you should also consider filing a workers’ compensation claim. 

We answer common questions about work-related injuries. However, workers’ compensation injuries can raise complicated legal questions. Talk to a workers’ compensation lawyer near you after reading this article. 

What Is Workers’ Compensation?

Workers’ compensation pays people affected by on-the-job injuries. Employers pay workers’ compensation insurance premiums that cover these costs. Unlike personal injury lawsuits, workers’ compensation claims don’t require proof of fault. The no-fault approach makes the workers’ compensation process more efficient than traditional litigation. 

With the exception of certain federal employees, state law governs workers comp claims. This means workers’ compensation benefits and eligibility vary from state to state. However, in most states, workers’ comp offers: 

• Payments for lost wages 
• Reimbursement for medical costs, including rehabilitation and occupational therapy
• Vocational and educational training for injured employees whose permanent disabilities prevent them from performing their pre-injury job duties 
• Death benefits to the dependents of those who suffer fatal work injuries

Which Injuries Qualify for Worker’s Compensation? 

Workers’ compensation insurance covers most—but not all—work-related injuries. Four factors typically determine which injuries insurance covers:  

• Whether your employer is required to carry workers’ compensation insurance
• Your job
• Your status as an employee
• What you were doing when you were injured 

Is Your Employer Required To Carry Workers’ Compensation Insurance?

Workers’ compensation systems use employers’ insurance premiums to pay injured workers. You can only receive benefits if your employer has workers’ compensation coverage. However, in most states, businesses don’t have to buy workers’ compensation insurance until they hire a minimum number of workers. So, smaller businesses may not be covered. A workers’ compensation attorney can help you determine if your employer meets the standards in your state. 

What’s Your Job? 

Workers’ compensation laws often exclude certain occupations. Most states exclude domestic workers, farm workers, and real estate agents. 

Are You an Employee?

Not all workers are employees. Some are independent contractors. Unlike employees, independent contractors aren’t eligible for workers’ comp benefits. The difference between employees and independent contractors is a complicated legal issue. A workers’ compensation lawyer can help you determine your status.  

What Were You Doing When You Were Injured?

Workers’ compensation insurers cover injuries that happen during the
“regular course of employment.” So, if the activity that you were doing at the time of the injury was part of your normal work duties, workers’ compensation will likely apply. As such, a warehouse worker hired to move packages who gets injured while stacking boxes will likely qualify for workers’ comp. 

However, injuries that occur outside of a person’s typical job duties or work environment may still qualify for workers’ compensation. The key question is whether the injury happened while the employee was doing something for the benefit of the employer. This standard might be met if, for example: 

• An employee gets injured in a car accident while driving to a local restaurant to pick up a catering order for a work event
• An employee sprains their ankle while playing for the company softball team
• An employee slips and falls at a hotel while attending a work-related conference

Common Workers Comp Injuries 

Workplace injuries can happen in many ways. Generally, the most common causes are: 

• Overexertion: Overexertion can lead to back injuries, neck injuries, heat exhaustion, sprains, and strains. 
• Slips, trips, and falls: These can cause traumatic brain injuries, concussions, contusions (bruises), and broken bones.
• Being caught between two objects: Caught-between incidents often cause amputations, lacerations, and internal organ damage. 
• Exposure to harmful substances: Interactions with toxic substances can lead to birth defects, chemical burns, cancer, brain damage, and lung diseases such as asthma. 
• Repetitive motion: Repeated movements can lead to medical conditions such as bursitis, carpal tunnel syndrome, and tendonitis. 

Does Workers’ Compensation Cover All On-The-Job Injuries?

No. Workers’ compensation is a no-fault system. Generally, workers are eligible for benefits even if they caused or contributed to their own injuries. However, intentional actions and workplace accidents caused by an employee’s unauthorized alcohol or drug use are usually excluded. States are also split on whether workers’ comp should cover injuries caused by workplace “horseplay.” 

Does Workers’ Compensation Cover Mental Health Conditions? 

In addition to physical injuries, many states allow workers’ compensation claims for mental or emotional injuries. This can be helpful for workers who develop a mental condition due to increased job duties or workplace harassment. 

Does Workers’ Compensation Cover Pre-Existing Conditions?

Yes. For example, an employee with a non-work back injury could be entitled to workers’ compensation benefits if they can prove that their work responsibilities made the back injury worse. 

When Should You Talk to a Lawyer? 

The workers’ compensation system was designed to be less formal than the personal injury litigation process. But you may still need to talk to a workers’ compensation lawyer. You should seek legal help if: 

• You suffered severe injuries that needed extensive medical treatment 
• Your claim is denied 
• Your benefits are too low
• The insurance company requests a hearing on your claim
• You’re offered a settlement
• You receive or are considering applying for disability benefits such as Social Security Disability Insurance

These are just a few of the situations where legal advice might be helpful. If you need legal help with your workers’ compensation claim, find an experienced workers’ compensation attorney near you.