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Workers Compensation Insurance: What Is Covered

In most cases, you and your family are entitled to compensation when you are injured and the accident takes place in the course of performing your job.  Workers compensation insurance covers your medical expenses for the treatment of your work related injury or illness.  This can include doctors, hospitals, physical therapy, prescription medication, and equipment needed to help you function.  Workers compensation will also pay for lost wages as a result of your injury or illness.  Your absence from the workplace must be related to your work injury.  It is important that your injury or illness have occurred during the course of your employment.  That is why it is so important to notify your employer of an accident as soon as possible so there will be fewer questions as to whether the accident occurred on the job or not.  As more time passes, more questions arise as to when and where the injury occurred.

man holding sore neck while using laptop computer seated at a table with sunlight shining through window

Injuries Outside of the Workplace

Sometimes an injury or illness occurs in the workplace but is not considered to have occurred during the course of your employment.  For example, the injury or illness could be the result of you performing personal tasks that are unrelated to your employment, especially if it is outside of your working hours.  If you are unsure whether the accident or exposure occurred during the course of your employment, you have to determine whether your duties either caused or contributed to the resulting injury or illness or significantly aggravated a pre-existing condition.  This is why it is so important to interview witnesses that were present during the workplace accident and record all details of the accident.

Pre-Existing Conditions

Sometimes your employer might argue that a pre-existing condition was the cause of your current injury or illness.  An injury or illness is a preexisting condition if it resulted solely from a non-work-related event or exposure that occurred outside the work environment.  However, an injury or illness can be work-related if the accident or exposure in the workplace significantly aggravated a pre-existing injury or illness.

For example, if you hurt your back while lifting a heavy box at work and become disabled as a result, you would qualify for workers compensation benefits due to that injury, especially if you have never previously had any back problems. However, even if you have suffered from back problems in the past, if the lifting of the heavy box aggravated those pre-existing problems, the injury would still be covered by workers compensation.

Likewise, if a construction worker suffered a heart attack while digging a ditch, you can have a valid workers’ compensation claim even if you would have at some point suffered a heart attack anyway due to you poor health.  When determining whether that pre-existing injury or illness would likely not have occurred but for the workplace accident or exposure.

Injuries While On Assignment Outside of the Workplace

There can also be question as to whether the accident or illness occurred in the workplace if you were on a business trip.   Injuries and illnesses that occur while you are on a business trip are work-related if, at the time of the injury or illness you are engaged in workplace activities in the interest of the employer.

Workers compensation systems are administered by the individual states.  In most states, employers are required to keep records of accidents.  Accidents must be reported to the workers compensation board within a specified number of days.  Workers compensation benefits depend on the status of the injury.  If you are unable to return to work right away, you are entitled to temporary disability benefits to help partially replace lost wages until the employee is able to return to work.  The money you are entitled to is based on several factors such as the rate of pay you received before you were injured at work.  If a workplace injury or illness results in permanent disability, you may become eligible for permanent disability benefits.  The amount you receive depends on the extent of the physical injury, the date of injury, your age when injured, and your occupation.

Mental Health

In recent years, mental health has been gaining more of a focus and workplaces can be a large contributor to mental health issues.  First responders have long been victims of PTSD, but they are far from the only people who suffer extreme stress and other mental health issues while on the job.  The additional stress placed on front-line and essential workers during the worldwide pandemic of 2020 only exacerbated the problem.  Worker’s compensation benefits for mental health related issues vary from state to state, and we encourage you to contact an attorney in your area to discuss whether you are covered for any mental conditions you have suffered.  In 2018, Florida introduced coverage for first responders who suffer from PTSD due to specific workplace incidents.

Fatal Injuries

If you are fatally injured on the job, reasonable burial expenses will be paid up to a maximum amount.  Also, your dependents may receive support payments for a certain period of time.  This will help your family stay on their feet in the event of your death.  The amount of money paid to your dependents depends on the number of dependents.  This is crucial, especially when you are the sole breadwinner in your family and they have no other means of money.

Employee Responsibilities

Man in blue hardhat checks a manometer at a natural gas factoryYou, as an employee, have some responsibilities when filing a workers compensation claim.  You must notify your supervisor of the injury or illness immediately.  You must also let your doctor know that you were injured on the job so he or she can treat you accordingly.  If you are unable to work as a result of your injury, notify your supervisor.  It is important to keep your supervisor informed of your health status and when or if you anticipate returning back to work.  Even though you might not be able to perform your usual duties, you might be able to return to work in some other capacity.  Every effort should be made by your employer to provide alternate work to you if it is possible.  The modified duties must be within the restrictions established by your doctor so you do not further injury yourself.

Remember that workers compensation insurance is the exclusive remedy when you are suffering from a workplace injury or illness.  You will not be able to sue your employer for damages.  This provision in workers compensation insurance is to protect the employer.  They need to know they their insurance will cover employees injured on the job and that they will not be personally responsible.

If you have questions about how your injury affects your employment status about how your claim is being treated by your employer or your state agency, it is important to contact an attorney who knows the workers compensation laws.  Unless you have a workers compensation attorney who knows the specific state’s law, you may fail to file by the specific deadline and you may delay or lose your right to bring a workers compensation claim altogether.

Read the first article in the series:  How to Stay Safe and Avoid Workplace Injury