What Kinds of Injuries or Illness Might be Compensated by Workers’ Comp?

Simply because an employee receives an injury while at work, the injury may or may not be covered under Workers’ Compensation. It is important to understand if you are even entitled to these benefits before going through the process of applying for, and potentially being denied of, benefits through your employer’s insurance company.

 

Below are some of the injuries that may or may not be covered under Workers’ Compensation.

 

Injuries “Arising Out Of” the Normal Scope of Employment

Injuries or illnesses are typically covered only when they “arise out of and in the course of employment.” There needs to be a nexus between the accident that caused the injury/illness and the scope of your employment duties.

Examples of compensable injuries are those caused by:

• lifting heavy equipment
• slipping on a wet or oily surface
• defective machinery
• fires or explosions

Illnesses that “arise out of and in the course of employment” can be covered under the workers’ compensation system where the working conditions present unusual or extraordinary risks of contracting an illness – such as computers where workers may experience carpal tunnel syndrome. Careful inquiry into the hazards arising out of the scope of your employment can determine whether the illness is one that is common to everyday life as opposed to risks of illness that are present in your particular employment situation.

 

An employee’s injury is said to have arisen in the normal course of employment if the injury is related to the employee’s work due to occurrence:

• Where the employee is normally located during his regular tour of duty;
• During the employee’s normal schedule of working hours; and
• While engaged in activities that are reasonably associated with the employee’s regular employment duties.

Keep in mind, however, that an employee may be injured while engaged in non-regular work duties, of which may still be compensable. For example, an employee may be entitled to medical care for an injury that occurs while the employee is tending to matters of personal comfort, such as in rest rooms.

 

Illnesses that “arise out of and in the course of employment” can be covered under the Workers’ Compensation system where the working conditions present unusual or extraordinary risks of contracting an illness – such as computers where workers may experience carpal tunnel syndrome. Careful inquiry into the hazards arising out of the scope of your employment can determine whether the illness is one that is common to everyday life as opposed to risks of illness that are present in your particular employment situation.

 

When an employee has both work-related injuries and non-work-related injuries, the employer is liable only for the expenses of treating the work-related injuries. If an employee is hospitalized for treatment of both work-related injuries and non-work-related injuries, the hospital bills are apportioned to the separate injuries, and the employer must pay only for that part of the hospital expenses related to the work-related injuries.

 

Nondisabiling Injuries

Often, an employee is injured on the job but does not miss enough work to be entitled to wage-loss compensation payments. In some jurisdictions, a worker who suffers a work-related injury which does not result in disability is not entitled to medical benefits. In most jurisdictions, however, an injured employee can receive medical benefits even though there is no compensable disability or reduction in earning power.

 

Injuries Caused by Third Persons

If an employee suffers on-the-job injuries as a result of the negligence or misconduct of a third person, the third person is ultimately liable for the employee’s medical expenses. This acts as a protection for the employer, guaranteeing that he or she does not need to redress the injuries cause by another. Thus, this is a type of injury not covered through the employer’s Workers’ Compensation insurance and must be dealt with through other means of compensation.