Getting injured on the job can be a major physical and financial setback for any employee. Fortunately, workers’ compensation insurance exists to help injured employees receive aid for their recovery. The workers’ compensation system can be complicated, however, and it can be difficult to understand whether your injury qualifies for these benefits. The type of injury and where it occurred can affect your eligibility, so keep reading to learn what qualifies for workers’ compensation and what does not.
What is Workers’ Compensation?
Workers’ compensation is a type of insurance that employers hold that provides benefits to employees who become injured or ill while on the job. When someone sustains a work-related injury, they file a workers’ compensation claim and receive benefits such as medical care coverage and lost wage replacement. If your company offers workers’ comp benefits, that generally means that employees are not allowed to sue them for an injury.
Most employers in the U.S. are required to carry workers’ compensation insurance, but not all. In some states, only companies with at least four employees need to have workers’ compensation. In other states, even companies with one employee must carry it. Texas is the only state where employers can opt out of having workers’ compensation, but they must notify employees if they do so. This also opens up Texas employers to potential lawsuits.
Types of Injuries That May Qualify for Workers’ Compensation
There are many types of injuries that may be eligible for workers’ compensation benefits. Some common work injuries include:
1. Repetitive Strain Injuries
Repetitive strain injuries, also called repetitive motion injuries, are caused by repetitive motions that occur over a long period of time. For example, carpal tunnel syndrome and tendinitis are common repetitive injuries. They occur when a person performs the same motion often over an extended period and often affect employees who use computers for work. Other industries where employees can sustain these types of injuries include assembly line and construction workers.
2. Slip and Fall Injuries
Slip and fall injuries can occur in any type of workplace, but they are particularly common in industries like construction and manufacturing. These accidents can be caused by wet floors, debris, or other hazards in the way. A slip-and-fall accident can lead to a number of serious injuries, including brain damage.
3. Overexertion Injuries
Overexertion injuries occur when an employee performs a task that goes beyond their physical limit, resulting in an injury. Common overexertion injuries include back strains and sprains, tendon tears, and joint dislocation. These injuries are common among construction workers or any type of job that involves manual labor. Movements such as pulling a heavy object, stepping in or out of a hole, or jumping up or down from a height can cause an injury.
4. Occupational Illnesses
Occupational illnesses are diseases that result from being exposed to hazardous substances or conditions in the workplace. These illnesses can include lung diseases like cancer or asthma, skin disorders such as dermatitis, and hearing loss. It is an employer’s responsibility to keep workers safe from dangerous conditions, and if they fail to do so, they must provide workers’ compensation benefits.
5. Motor Vehicle Accidents
Employees who are injured in a motor vehicle accident while performing their job duties may qualify for workers’ compensation benefits. This includes employees who drive for work, such as truck drivers or delivery drivers. Since driving is included in their job description, it qualifies as a work-related task and therefore qualifies.
Types of Injuries That Don’t Qualify for Workers’ Compensation
Since qualifying injuries must be sustained on the job, one type of injury that does not qualify as one that occurred outside of work hours, or during an activity that was not job-related.
If the injury was not serious enough to require medical care, it also won’t be eligible for benefits. Similarly, if there is not sufficient evidence of the injury, it won’t qualify. There need to be medical records documenting a serious injury that will require some form of medical attention.
Additionally, injuries that occurred at work while an employee was acting recklessly or illegally – for example, if they were drunk or stealing company property – may not qualify for benefits. However, being intoxicated doesn’t necessarily disqualify you. It may just reduce your benefits.
Next Steps After a Work Injury
If you sustain an injury on the job, it’s important that you report it right away. After making a report to your employer, your employer’s insurance company will determine if your injury qualifies for benefits. It’s always best to report your injury in writing, even as a follow-up to an in-person conversation, so that you have proof. Injuries must be reported within 30 days to qualify for workers’ compensation. Your employer will provide you with the necessary paperwork. You should also seek medical attention as soon as possible, not only to treat your injury but to get documentation of it. Your employer should be able to handle navigating the workers’ compensation process but if your claim is denied or you have any further questions, an attorney who specializes in work injuries like those at DiMarco | Araujo | Montevideo in Las Vegas can help.