Workers Compensation:

Injuries That Are Covered under Workers' Compensation

Injuries that are covered by workers compensation are only those that “arise out of and in the course of employment.” In order to claim workers compensation for a particular injury or illness, there needs to be a correlation between the accident that caused the grievance and the range of an individual’s employment duties. In most states, workers compensation programs do not include coverage for injuries that happen as a result of an accident or other occurrence outside the scope of an individual’s employment. For example, if a person were injured playing sports on his day off, he or she may not be entitled to workers compensation. However, if he or she sustained an injury from playing sports at a company sponsored picnic, he or she may be eligible for workers compensation benefits.

There are four types of injuries which workers compensation may cover:

1) Traumatic physical injuries

These are injuries caused by accidents such as slipping on a wet surface, or a plant explosion. Most workers compensation claims will be categorized under traumatic physical injuries.

2) Repeated trauma injury

This is the next most common group of injuries. These injuries occur over a period of time and are due to a repetitive action the worker is required to make such as heavy lifting or if a worker is required to repetitively perform some action as part of their work duties that can result in repetitive injury to the arms, shoulder, neck and back. In repeated trauma injuries, some employers will try to prove that the injury was a result of an activity outside of work. However, a doctor will most likely support the injured worker if he or she was subject to repetitive action as part of a job and he or she had no past problems and developed problems when he or she was working.

3) Occupational disease

This encompasses illnesses that resulted directly from an individual’s work duties or work environment; for example, asbestos related diseases such as mesothelioma. In some states, individuals can collect for specific occupational diseases. Some occupational diseases naturally flow from a particular occupation, such as coal mining for example. However, in order to collect workers compensation, it needs to be demonstrated that these diseases would not develop from ordinary life experiences.

4) Mental injuries

The law covering whether or not mental illness can be covered by workers compensation varies from state to state. In most states, mental illness that results from normal employment duties, such anxiety and depression, is not covered. However, a person who develops a mental illness as a direct result of an accident or incidence of trauma, is entitled to workers compensation in most states. For example, if a nurse develops depression as a result of working in the Emergency room, she or he is not eligible for coverage. However, if she or he develops anxiety as a result of being physically assaulted by a patient, she or he may be eligible to receive benefits for both the physical and mental injuries she or he sustained.

In certain cases, doctors may have a difficult time identifying whether the job caused the impairment. In most cases, workers compensation will cover injuries where it can be verified that work hastened the progression of an injury or aggravated a condition. You don't have to prove to 100% certainty that your injury was related to the job, only that it's more probable than not.